When every pharmacy in Warren County refused to fill prescriptions from a McMinnville doctor under probe by federal authorities for peddling opioids to street dealers and addicts, Walgreens barred its pharmacists from rejecting them, records contained in a lawsuit allege.
When Walgreens learned a Dayton prescriber was shelling out opioids and other dangerous drugs in a clinic filled with dogs to cash-paying patients, the drug company told its Tennessee pharmacists to keep filling the prescriptions and keep quiet about it, the records suggest.
Walgreens knew a Chattanooga pill-mill prescriber was offering opioid patients a free prescription for referring 10 more people to his practice but filled his prescriptions anyway, and the retailer refused to stop filling prescriptions from a Jackson prescriber whose practice had been raided, according to the documents.
"These are far from isolated examples," attorneys with the Tennessee Attorney General's office wrote in a 148-page lawsuit against the national drug store chain earlier this year in Knox County Circuit Court. "While Walgreens conducted itself in Tennessee as both retailer and (opioid) distributor, it complied with the obligations of neither ... Walgreens did not flood the state of Tennessee with opioids by accident."
(READ MORE: Advocates seek more say in how opioid settlements are spent)
In 14 years, Walgreens pharmacies in Tennessee sold more than one billion opiate painkillers -- enough to supply every child and adult in the state with 175 pills of the deadly and addictive narcotic, the drug company's records show.
And, Walgreens pharmacies are still selling them, filling opioid prescriptions daily in more than 200 pharmacies in Tennessee. The retailer has already shelled out billions of dollars in damages to settle claims in other states over opioid profiteering.
The attorney general's office is demanding in the lawsuit that Walgreens forfeit opioid profits collected in Tennessee, too.
Walgreens did not immediately respond to a request for comment on the Tennessee litigation.
"UTTERLY SATURATED"
The lawsuit includes Walgreens internal records, including emails from its Tennessee pharmacists to corporate bosses, from its Tennessee pharmacies from 2006 to 2020, as well as prescription-filling data.
The numbers cited in the litigation -- drafted by attorney general consumer protection attorneys Margaret Rowland, Olha Rybakoff, Kristine Knowles and Hamilton Millwee -- are staggering.
Walgreens pharmacies in Sullivan County, an epicenter in the opioid epidemic, doled out enough prescription painkillers to supply every resident in Sullivan County with 226 pills each.
Walgreens stores in Tullahoma sold enough opiates to supply every citizen there 269 pills each.
The chain's Dunlap pharmacies dispensed enough of the pills to supply that city's residents 309 each.
A single Walgreens pharmacy in Jamestown sold enough of the drug to supply residents there with 2,104 pills each.
"Walgreens utterly saturated the state of Tennessee with narcotics," the lawsuit stated.
(READ MORE: Whitfield County Commission approves opioid settlement resolution)
Among pharmacies, Walgreens had an advantage in the opioid trade, the litigation alleges. In addition to ordering opioids from distributors, Walgreens also supplied itself, buying directly from drug makers, lawsuit records show. The move meant Walgreens was able to sell far more opiates than competitors while raising less suspicion of over-dispensing.
"Notably, Walgreens had the highest market share in the state from 2008 to 2012, and often by a significant margin, during what was arguably the peak of prescription opioid dispensing," the lawsuit states.
When one Walgreens pharmacy maxed out its opioid-dispensing limit, the chain ordered pharmacists to send pill-seekers to another Walgreens still under the limit, the lawsuit says.
"When orders placed by (one Tennessee) store ... began to raise flags with Walgreens (compliance officers) or its distributors, Walgreens steered customers to (another Walgreens in the same area) so that Walgreens could continue to supply opioids into the local community without having its suspicious orders being reported to the (U.S. Drug Enforcement Administration,)" the lawsuit states.
"Between two stores (in Middle Tennessee), over 20 million opioid pills entered the Crossville and Cookeville communities, enough for each of the combined 50,000 residents to receive approximately 500 (doses) each," according to the lawsuit. "Walgreens actually told (supervisors at its Jackson, Tenn.) store how to manipulate Walgreens' systems to artificially increase its ordering limits."
As proof Walgreens executives knew they were fueling the opioid epidemic, the lawsuit cites the demographics of its opiate-seeking customer base in Tennessee. Customers of Walgreens pharmacies in Tennessee hailed from dozens of states across the nation as far flung as Alaska and California.
"Three stores in Hamilton County dispensed 35 million doses for patients from 4,500 zip codes, including ones as far away as Seattle," the state's attorneys wrote.
DEA VISIT
According to the records in the lawsuit, an unidentified pharmacist wrote to his bosses about McMinnville prescriber Charles Edward Morgan.
"He was paid a visit by the DEA a few months ago," the pharmacist wrote. "Currently no pharmacy in the county ... will accept new patients from his office ... McMinnville Drug Center and Rite Aid have given their patients a month to find new pharmacies and then will no longer fill any prescriptions for him.
"He has started including diagnosis codes on his scripts, but they are often odd," the email continued. "While his practice is listed with the DEA as family practice obstetrics, he has started putting 'cancer' as the diagnosis for many of his patients, but they are being given high dose (opiates) with no additional therapy from himself or anyone else ... Other pharmacies have noted he is prescribing (prescription narcotics) for patients currently serving jail time.
"We have not been able to speak to him on the phone," the pharmacist continued. "Many of the patients that are presenting (Morgan's prescriptions) at this time are asking for their insurance to be bypassed and are willing to pay high cash prices."
Walgreens supervisors rebuffed the pharmacist's request to ban Morgan's prescriptions "and did not warn other pharmacies about his prescribing practices," the lawsuit states. "Walgreens' calculated total revenue potential for Dr. Morgan in 2016 was $1.7 million."
Morgan's state medical license was suspended for over-prescribing opiate pills and other dangerous narcotics in 2004. His license was permanently suspended in 2017, a review of state records by the Tennessee Lookout shows.
Another pharmacist at a Tennessee Walgreens wanted to stop filling prescriptions written by Sequatchie County nurse practitioner Geoffrey Peterson, who "had worked at several pain clinics that had been shut down by the DEA ... and was operating a primary care clinic, where he also hoarded dogs including in patient exam rooms," records state. The chain refused.
"Even after Peterson was arrested in December 2014 for felony possession of drugs (including morphine-filled syringes), Walgreens continued filling prescriptions written by him," the litigation states.
Peterson was stripped of his medical license and convicted in a criminal case filed against him in 2015.
Walgreens executives also turned aside warnings about Chattanooga prescriber Charles Larmore, continuing to fill his prescriptions even after he was indicted federally in a pill-mill ring, the lawsuit states.
Larmore has since been convicted and his medical license revoked, records show.
"The DEA told Walgreens as far back as 1988 that its (opioid tracking) practices were insufficient," the lawsuit stated.
The litigation says the chain shelled out money to lobby state legislators and "killed a bill in Tennessee that would have required" pharmacies to lock up opioids. The legislation was filed after a spate of robberies at Walgreens pharmacies across the state by armed pill-seekers who sometimes opened fire inside the stores.
"Walgreens set speed and volume goals for pharmacists," the lawsuit states. "It also had a tool that tracked the time it took a pharmacist to fill a prescription ... These financial drivers loomed large for pharmacists, and the company's revenue from selling opioids was never far out of mind."
Walgreens has not yet filed a response to the litigation.
Read more at TennesseeLookout.com.