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An NPR investigation has found that pharmacists working for Walmart tried for years to raise the alarm about the company's sale of highly addictive opioids. Walmart says it broke no laws and acted responsibly. The company faces lawsuits, including a complaint by the Justice Department. Walmart has been an NPR underwriter, which we cover like any other company, and NPR addiction correspondent Brian Mann has this story.
BRIAN MANN, BYLINE: To understand the role pharmacists and pharmacy chains like Walmart played in the opioid crisis, it helps to look at one Walmart customer, a woman named Christina Dine. She was in her 20s when a doctor in Ohio prescribed her large doses of powerful opioids.
CHRISTINA DINE: At the highest, I was prescribed three 30-milligram oxycodone a day with two 15-milligram oxycodone kind of thrown in there for a quote-unquote, "breakthrough pain."
MANN: Dine had been diagnosed with bursitis - painful, but not the sort of ailment where a highly addictive narcotic is generally recommended. Under federal law, after a doctor writes a prescription, especially one like Dine's that poses a serious risk of addiction, the pharmacist is also required to play an important gatekeeper role - it's a big part of their job - to make sure powerful drugs are only dispensed when there's a legitimate medical purpose. Dine says she had her opioid prescriptions filled repeatedly for two years at a number of pharmacies, including her local Walmart. No one warned her about the danger.
DINE: And I never once had a pharmacist or any other pharmacy staff question it, question me, ask me any questions whatsoever.
MANN: Dine became addicted to pain pills and, later, heroin. This was in 2012. And at first, she didn't realize she was part of an opioid epidemic already killing tens of thousands of people a year. By the time Dine fell into addiction, Walmart was doing huge business, shipping hundreds of millions of opioid pills every year to its chain of pharmacies across the country. Ashwani Sheoran is a pharmacist who saw this happening in Walmart stores where he worked in rural Michigan. He says there were often lines of people when the store opened waiting to buy opioids.
ASHWANI SHEORAN: I see that patients, 15 to 20, are already lined up to get their prescriptions filled.
MANN: Sheoran told NPR he saw things that scared him. People who looked healthy were getting a lot of pain pills. They were traveling hundreds of miles to fill their prescriptions at his Walmart store. When he tried to call doctors to find out what was happening, he often couldn't get them on the phone. He was so troubled he sent warnings to Walmart's corporate headquarters in Arkansas.
SHEORAN: So I send the email to Walmart executive levels. And I explained them that there are a large number of controlled substance and the narcotics were dispensed not for genuine purpose, which are for distribution on the street.
MANN: Sheoran says nothing happened to fix the problem, and that made him angry. So he kept trying, warning his managers that Walmart pharmacies seemed to be feeding a black market for opioid pills.
SHEORAN: They told me, do not reach out to the DEA or do not call the police. If you're going to do so, your employment going to be terminated immediately.
MANN: Records show Sheoran did contact local police and the Drug Enforcement Administration. He was suspended by Walmart and later fired. He sued the company under a federal whistleblower statute, a case that's still pending. NPR tried to ask Walmart about this. The company declined repeated interview requests and didn't respond to a list of detailed questions. It turns out, Sheoran wasn't the only pharmacist raising alarms. Internal company documents made public in lawsuits against Walmart show pharmacists all over the country kept warning company executives about opioids and about pill mill doctors sending patients to Walmart.
UNIDENTIFIED PHARMACIST: There was no oversight from up top about the overdispensing of controlled substances.
MANN: This is a pharmacist who worked for Walmart in the South, who says he left a couple of years ago voluntarily to take another job. NPR agreed not to use his name because he fears a family member still employed by Walmart could face retribution. He says Walmart pharmacies kept doing business with doctors even when there were clear signs things weren't right.
UNIDENTIFIED PHARMACIST: They were primary care doctors. They weren't, like, pain management doctors. They weren't oncologists. And they were prescribing large amounts of opiates.
MANN: Now, again, as part of their gatekeeper role, all pharmacists have the authority to reject suspicious prescriptions. And Walmart points out in public statements, this does happen at its pharmacies. But as Walmart shipped and sold hundreds of millions of pills a year, industry experts and the pharmacists NPR interviewed said there was enormous pressure at Walmart to say yes, to dispense opioid pills quickly.
UNIDENTIFIED PHARMACIST: You know, they - Walmart didn't make it so that it was easy for you to say no or to do the right thing.
MANN: Another thing we've learned from court documents filed in lawsuits against Walmart is that pharmacists weren't the only ones raising alarms. Federal regulators also kept telling Walmart its system for managing opioids and keeping patients safe wasn't good enough. Under pressure from the DEA, Walmart signed an agreement way back in 2011 promising national reforms. The pharmacists we talked to said things never improved. Again, Walmart declined NPR's interview request. But the company has created a public campaign to explain its opioid practices, including this video posted last year on Walmart's website.
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UNIDENTIFIED PERSON: We all have a responsibility to dispense opioids appropriately. And so when somebody comes to our pharmacy and we're going to dispense them a medication, we're going to do it responsibly. We want to make sure that they're safe.
MANN: In legal filings, Walmart attorneys acknowledged the DEA warned the company about red flags and patterns of prescribing behavior that could mean opioid prescriptions were unsafe or illegal. Walmart says those advisories weren't legally binding and says government guidance on opioids was often vague, confusing and contradictory. The company also argues it was the government's job, not Walmart's, to crack down on dangerous pill mill doctors.
These arguments will be tested in courts around the country as lawsuits against Walmart and other pharmacy chains move forward. People like Christina Dine will be watching. After filling her first prescription for oxycodone pills back in 2012, Dine says it took years to put her life back together.
DINE: I first got sober in 2015 after my daughter's father overdosed and died. I kind of went in and out. I struggled for a bit. But I've been sober since 2017.
MANN: Dine is doing better now, working as a recovery nurse, helping others with addiction. But more than 230,000 Americans have died from overdoses linked directly to prescription opioids.
Brian Mann, NPR News.
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