THE PROGNOSIS

During the worst years of the opioid crisis that has ravaged the United States, five pharmacy chains ordered 33 billion oxycodone and hydrocodone pills, making up nearly half of the prescription painkillers distributed nationwide.

Chain pharmacy Walgreens played a unique role at the height of the crisis, during which it handled nearly 1 in 5 of the most addictive opioids.

While most pharmacies worked with wholesalers supplying their prescriptions, Walgreens obtained nearly all of its painkillers directly from drug manufacturers, which allowed it more control over the number of pills sent to pharmacies, according to my Washington Post colleagues Jenn Abelson, Aaron Williams, Andrew Ba Tran, Meryl Kornfield. In this latest investigative piece in The Post’s ongoing series examining the opioid epidemic, my colleagues went deep on how Walgreens dominated the retail opioid market in the United States from 2006 to 2012.

These are some of their most notable findings:

  • During those years, Walgreens purchased about 13 billion pills. That’s 3 billion more than the 9.9 billion pills CVS ordered from 2006 through 2012.
  • The chain ordered 73 percent more of these pills than other U.S. pharmacies during that time. 
  • Walgreens obtained 97 percent of its pain pills directly from drug manufacturers, according to a Post analysis of a Drug Enforcement Administration database of opioid shipments.
  • Here’s why that's notable, as my colleagues point out: “By acting as its own distributor, Walgreens took on the responsibility of alerting the DEA to suspicious orders by its own pharmacies and stopping those shipments. Instead, about 2,400 cities and counties nationwide allege that Walgreens failed to report signs of diversion and incentivized pharmacists with bonuses to fill more prescriptions of highly addictive opioids.”
  • By the end of 2012, the chain's orders of pills containing oxycodone and hydrocodone dropped to 2.2 billion from a peak of 2.4 billion in 2011, according to a Post analysis of the DEA database, known as the Automation of Reports and Consolidated Orders System. 

Eventually, the company stopped internally distributing oxycodone and hydrocodone. The Post team writes: “The chain also removed sales of opioids from its bonus calculations for pharmacists, according to court records.

The company declined to explain the change, but said dispensing volume was ‘one of many factors’ used to determine bonuses. ‘The nominal compensation factor in question in no way incentivized pharmacists to inappropriately fill prescriptions for any medication,’ Walgreens said.”

Now, the company is awaiting a trial. Walgreens did not take part in the settlement reached with two Ohio counties last month in a federal suit in Cleveland against major distributors and drug companies. The trial for the company has been postponed until next year.

Plaintiffs in the case argue the company's unique system of operating as its own distributor may make it more blameworthy. “Because Walgreens had full visibility into all dispensing related information necessary to reveal red flags and criteria of suspicion, Walgreens might even be viewed as more culpable due to the wealth [of] data at its complete disposal,” the plaintiffs allege. 

The five pharmacy chains that ordered the most opioids from 2006 to 2012 provided statements to The Post. They were Walgreens, CVS, Walmart, Rite Aid and Kroger.

Here’s part of what Walgreens said: “Walgreens did not manufacture prescription opioid medications. Walgreens never marketed or promoted opioid medications. Walgreens also has not distributed prescription controlled substances since 2014. Before 2014, we only distributed such medications to our own chain of pharmacies, staffed by our own pharmacy professionals. In this way, Walgreens is unlike any of the other distributors involved in the national opioid litigation. Specifically, Walgreens never distributed opioids to pain clinics, internet pharmacies or the ‘pill mills’ that fueled the national crisis.”

— Read the full report from Jenn, Aaron, Andrew and Meryl here. And follow The Post's entire investigation of the opioid epidemic here

Federal lawsuit alleges that Walgreens failed to stop opioid diversion as the epidemic spread.
Jenn Abelson, Aaron Williams, Andrew Ba Tran and Meryl Kornfield
National
The Post has reported extensively on the opioid crisis' key figures: manufacturers, distributors, pharmacies, doctors and the DEA itself.
Washington Post Staff

AHH, OOF and OUCH

AHH: The Trump administration is suing the pharmaceutical giant Gilead Sciences — the company that sells the HIV-prevention medication Truvada — alleging that it reaped billions of dollars on the therapy while ignoring government patents.

The lawsuit, filed on behalf of the Health and Human Services Department, alleges that “beginning in 2015, Gilead repeatedly refused to recognize CDC patents for an HIV prevention called Truvada for PrEP,” our Post colleague Christopher Rowland reportsThe lawsuit claims that “Gilead has profited from research funded by hundreds of millions of taxpayer dollars. Indeed, Gilead has reaped billions from PrEP . . . but has not paid any royalties to CDC.’’

“HHS recognizes Gilead’s role in selling Truvada® and Descovy® to patients for prevention of HIV. Communities have put these drugs to use in saving lives and reducing the spread of HIV,” HHS Secretary Alex Azar said in a statement. “However, Gilead must respect the U.S. patent system, the groundbreaking work by CDC researchers, and the substantial taxpayer contributions to the development of these drugs. The complaint filed today seeks to ensure that they do.”

The suit comes as the administration has pledged to end the HIV epidemic in this country by 2030 — an effort for which expanded distribution of Truvada for PrEP is key.

“Gilead has pledged to provide free Truvada to help meet Trump’s ambitious HIV eradication goals,” Christopher writes. “HHS and Gilead said Wednesday the dispute over the patent would not effect the pledge. The San Francisco-based company has said it will donate 2.4 million bottles per year of Truvada for PrEP to the effort. The CDC will decide where the drugs should be distributed.”

OOF: Juul Labs announced it would suspend sales of its most popular product, mint-flavored e-cigarettes, as it awaits a much-anticipated move from the Trump administration to ban nearly all flavored e-cigarettes.

It’s not yet known when the administration’s new ban will be announced.

“In a statement Thursday, Juul said it made the decision to halt mint sales ‘in light of’ new data released this week showing mint’s popularity among underage vapers. The studies indicated that teens prefer Juul products and that mint is their favorite flavor,” our Post colleague Laurie McGinley reports.

The company will stop taking orders from retailers for its mint pods immediately, and will stop online sales. 

About 70 percent of Juul's sales in the United States are mint-flavored products, compared with 20 percent for tobacco-flavored products and 10 percent for menthol. Juul had already halted sales of its popular mango, fruit, crème and cucumber liquid-nicotine pods last year in stores and online in September.

Juul CEO K.C. Crosthwaite said the company plans to “support the upcoming FDA flavor policy” and has no plans to rebrand the mint products under another name unless cleared by the FDA, Laurie writes.

OUCH: Federal health officials announced there are now 2,051 confirmed and probable cases of mysterious vaping-linked illnesses in every state but Alaska, as well as in the District of Columbia. There have also at least 39 deaths confirmed as of Nov. 5.

The latest data from the Centers from Disease Control and Prevention represents an uptick from the 1,888 cases and 37 deaths from the illnesses reported last week.

“Most of the patients who have fallen sick and for whom officials have demographic information are male and young: Almost 80 percent of the patients are under 35, and their median age is 24, according to the CDC,” our Post colleagues Lena H. Sun and Hannah Knowles write in this updating page on what you should know about the illnesses.

TRUMP TEMPERATURE

— A second judge struck down the Trump administration’s “conscience rule” that would have allowed health providers to refuse to provide abortions or other types of care if they disagree on religious or moral grounds.

The decision from a federal judge in Washington state comes one day after a federal judge in New York declared the rule unconstitutional in a 147-page decision.

 “Washington was one of a number of states, cities and advocacy groups — including New York, California, San Francisco, the American Civil Liberties Union and Planned Parenthood — that had sued over the rule, which was scheduled to go into effect Nov. 22,” the Hill’s Nathaniel Weixel reports.

“The court agreed that all Washingtonians deserve to receive the full range of health care services,” Washington Attorney General Bob Ferguson said in a statement. “This rule would have disproportionately harmed rural and working poor Washington families, who have no alternatives to their local health care providers, as well as LGBTQ individuals, who already face discrimination when they seek medical care.”

In a news release, Ferguson said the ruling from U.S. District Judge Stanley Bastian in Spokane “provides an extra layer of protection against appeal by the Trump Administration.”

— And here are a few more good reads:

HEALTH ON THE HILL

A pair of bipartisan measures to lower drug prices were thrown off track Thursday by objections as senators battle over the issue. 
The Hill

OPIOID OPTICS

With the opioid crisis ravaging America, the president had accused the Chinese government of not doing enough to prevent the substance from reaching the United States.
Gerry Shih
Teva Pharmaceutical Industries Ltd on Thursday expressed confidence in its abili...
Reuters

AGENCY ALERT

The story of how American lives may be threatened over the use and production of this chemical is an example of what happens when two bureaucracies — the FDA and the Environmental Protection Agency — fail to work together.
Politico

INDUSTRY RX

In October, providers, health plans and their business associates reported 47 data breaches affecting 311,430 patients to HHS' Office for Civil Rights, the agency that maintains the government's database of healthcare breaches. The 36 data breaches reported in September, by contrast, compromised data from nearly 2 million people.
Modern Healthcare

MEDICAL MISSIVES

Arts and Entertainment
The podcast hosts have since removed the episode and apologized for their reaction to his comments.
Michael Brice-Saddler

DAYBOOK

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the response to lung illnesses and youth e-cigarette use on Nov. 13.
  • The House Veterans' Affairs Subcommittee on Technology Modernization holds a hearing on cybersecurity challenges and cyber risk management at the VA Department on Nov. 14.