Pharmacy chain Walgreens will have to pay San Francisco $230 million — the largest sum it will pay to any city — for its role in overprescribing opioids and helping create the fentanyl crisis.

What is often missing in discourse about San Francisco Walgreens closures, supposedly due to shoplifting or drug-fueled crime, is the degree to which Walgreens created the drug use problem by overprescribing opioids to generate massive profits. A Chronicle report last July  noted that “One Mission District Walgreens dispensed more than 86,000 prescriptions written by a single doctor, even after pharmacists raised concerns about the frequency and size of the scripts,” and that another “Bayview pharmacist said that he dispensed opioids to a patient, only to see that patient sell them in the parking lot outside moments later,”

In November, Walgreens and CVS settled national suit for overprescribing opioids for $10 billion, but City Attorney David Chiu was pursuing his own case against Walgreens. And Walgreens settled that suit today for $230 million according to the Chronicle, in what Chiu describes as the “largest award to a local jurisdiction against an opioid defendant in the country.”

“For so many of us it has been frustrating to witness the tragedies on our streets every day. It’s easy to blame those we see right in front of us struggling,” Chiu said at a Wednesday press conference announcing the massive settlement. “We must remember that some of the most profitable companies in the world engineered this public health crisis.”

Chiu added that “From the trial it was noted that a shocking 70-80% of heroin users today started with prescription opioids.”

U.S. District Judge Charles Breyer said in his ruling forcing the settlement that “Walgreens San Francisco pharmacies received over 1,200,000 red-flag opioid prescriptions, yet they performed due diligence for less than 5% of these prescriptions before dispensing them.”  

Breyer added that “There is persuasive evidence showing how abuse of prescription opioids often leads to use of illicit opioids, including heroin and fentanyl. As addiction becomes more severe, opioid users tend to seek out stronger, cheaper, and more potent opioids.”

According to the Chronicle, Walgreens said in their own statement that “We never manufactured or marketed opioids, nor did we distribute them to ‘pill mills’ and internet pharmacies,” and “The settlement allows us to focus on our mission of reimagining healthcare and wellbeing for our patients, customers, and communities. Our thoughts are with those impacted by this tragic crisis.”

Consider that the entire state of West Virginia only got $83 million in their Walgreens settlement, so this was some excellent lawyering by David Chiu. There will likely be major City Hall battles looming over how to spend that money, which legally must be spent specifically on combating the opioid crisis. But for now, it’s quite a victory that the city will have an extra quarter-billion dollars to take on the worsening crisis.

Related: Judge Rules Walgreens Can Be Held Liable For Overprescribing Opioids in SF, In Landmark Decision [SFist]

Image: Stephanie Rhee via Unsplash