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In the United States, the opioid crisis is catching up with businesses



New York (United States)

From our correspondent

Walmart would have done well without such a Christmas present. On December 22, 2020, the US Department of Justice initiated legal proceedings against the giant retailer for its role in the opioid crisis. He accuses the company, which has a vast network of pharmacies within its supermarkets, of having dispensed these highly addictive substances used for the treatment of pain to its customers, despite questionable prescriptions. In total, the authorities believe that the distributor, the largest private employer in the United States, is responsible for “Hundreds of thousands of violations” of the United States Controlled Substance Act, which regulates the dispensing of potentially addictive drugs.

Walmart is far from being the first manager of pharmacies questioned for its role in this epidemic which killed nearly 500,000 people between 1999 and 2018 and which is experiencing a new surge in the context of the uncertainty of Covid-19. In 2020, two counties in northeastern Ohio (Lake and Trumbull) sued several large American pharmacy chains (Walgreens, CVS, Rite Aid, etc.) for flooding them between 2000 and 2014 with 130 million pills of oxycodone and hydrocodone, the most commonly implicated pain relievers.

Another complaint filed in 2019 notes that Walgreens, which operates nearly 10,000 pharmacies in the country and several drug distribution centers, ordered 13 billion oxycodone and hydrocodone pills between 2006 and 2012. Far more than its competitors. The volume was so large that several of its pharmacies were targeted by break-ins. “So far, the lawsuits against the companies involved in the opioid epidemic have not achieved the same level of compensation as those which targeted tobacco manufacturers in 1998. These, considered to be a benchmark, raised $ 250 billion. After targeting opioid manufacturers, lawyers are therefore turning to other sources, such as pharmacies, to make those responsible for this crisis pay ”, analyzes Alexandra Lahav, professor of law at the University of Connecticut.

Lawsuits against large pharmacies were inevitable as the place of these companies in the sale of drugs continued to grow in the 20th century.e century, driven by the boom in medical advertising, including television, which has increased demand. They have gradually eclipsed independent pharmacies, especially in suburbs and rural areas, less well equipped to offer low-cost drugs or retain their workforce with high salaries.

Unlike the other large companies, for which the pharmacy was originally the core business, Walmart started in this activity in 1978, at the same time as it was investing in the jewelry and automotive sectors. At the time, the group wanted to respond to growing concern around obesity and chronic disease. It now has 5,000 pharmacies located within its supermarkets, a common model in the United States, where pharmacy brands also sell everyday consumer products (including alcohol!).

“For department stores like Walmart, pharmacies are not a source of profit. But they are used to attract the customer to spend money in the supermarket ”, explains Liz Chiarello, sociologist at the University of Saint-Louis who studies the world of pharmacy.

The lawsuit against Walmart, which could cost the company billions of dollars, highlights the pressures on pharmacists employed in such chains. “In large pharmacies, pharmacists don’t have a lot of time to fill prescriptions. They have to run 300 to 600 a day. They only have a few minutes to judge whether they are suspicious or not, make the necessary checks, etc. Sometimes it is easier for them to dispense the drugs, even when a prescription is questionable. “

In the case of Walmart, its own pharmacists have alerted management on several occasions to prescriptions deemed suspicious (doctors prescribing a large number of opioids, dangerous cocktails of drugs, patients with strange behavior, etc.), but these “red flags” would have been largely ignored, according to the complaint of the Ministry of Justice. Walmart executives, made up of non-pharmacists, have also asked to speed up drug dispensing and made the job of controlling prescriptions more difficult by limiting the sharing of information between pharmacists.

The giant Walmart denies all these accusations and recalls that it has put in place programs to fight against the opioid epidemic. The big pharmacies have tried to clear their customs by putting the blame on the doctors who prescribe the drugs and the public authorities, responsible for granting them professional licenses. “This argument is not unfounded. Although the law gives pharmacists the power to control prescriptions, they also have an obligation to dispense drugs if the prescription is valid. They cannot refuse it without having a very good reason ”, Judge Alexandra Lahav. An arduous mission: “In the United States, pharmacists are not seen as part of the healthcare team. They must make the decision to give drugs while being under pressure from their hierarchy and without knowing the patient’s treatment, diagnosis or medical history, continues Liz Chiarello. They have to rely on their instincts. They are working blind. “

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