Former Wal-Mart pharmacist says the company ignored the danger signal due to the surge in opioid sales

When Ashwani Sheoran appeared in an early morning shift wearing a white Wal-Mart smock at a rural pharmacy in Michigan, he often found customers longing for a bottle of painkillers.

“We see patients aged 15 to 20 already in line to prescribe morphine sulfate, oxycodone, and other narcotics,” he said.

This was in 2012, when the prescription opioid epidemic exploded, killing tens of thousands of Americans each year.

Sheoran, now 41, told NPR that he continues to see what the Drug Enforcement Administration considers to be a “danger signal.” The patient was driving a long distance to buy medicine from Wal-Mart. They could not explain why such a strong opioid dose was needed.

He began issuing alerts and sent emails to his Michigan boss and Wal-Mart headquarters in Arkansas. He warned that their pharmacies are supplying opioid black markets like Oxycontin.

What happened next made him angry. “They just keep quiet and start putting more pressure on me to say nothing more,” Sheoran said.

“They told me,’Don’t call the Drug Enforcement Administration, don’t call the police, and your employment will end soon,'” Chelan warned his boss. Said.

Walmart faces public calculations About its role in the country’s deadly opioid epidemic Killed about 450,000 Americans From 1999 to 2018, according to the Centers for Disease Control and Prevention.

The Department of Justice, along with state and local governments Sue a retail giantWal-Mart claims to have shipped and sold billions of highly addictive pills without proper protective measures.

Wal-Mart says the company acted responsibly.

But Sheoran wasn’t the only one raising concerns. Wal-Mart pharmacists have been warning for years about the sale of potentially dangerous or illegal opioids, according to an NPR investigation based on interviews and submissions to government courts.

The red flag kept popping up

Wal-Mart operates more than 5,000 pharmacies nationwide, many of which are located in regions that have been hit hard by the opioid epidemic.

Sheoran worked as a “floater” pharmacist for about a year at the company’s stores in small towns such as Bad Ax and Caro north of Detroit.

He said the red flag kept popping up. Sometimes the prescription wasn’t filled out properly and the doctor’s signature appeared to be printed by the computer. He often couldn’t get them over the phone when he tried to contact the doctor to find out what was happening.

“This directly shows that these prescriptions are not for true medical purposes, but instead are abused by patients and distributed on the streets,” Sheoran said.

Under the Controlled Substances Act, doctors prepare prescriptions for patients, but pharmacists like Sheoran need to act as a kind of second gatekeeper.

It is their job to ensure that powerful and highly addictive drugs such as opioids are dispensed and sold only for legitimate medical purposes.

Sheoran said she often rejected suspicious prescriptions. Police records and emails reviewed by NPR indicate that he has also notified local police and the Drug Enforcement Administration.

He was later suspended and fired by Wal-Mart in early 2013. He sued the company under federal whistleblower law, alleging that the warning was ignored. The proceeding is still pending.

Another Wal-Mart pharmacist issued a warning

An internal document released last month as part of a lawsuit against Wal-Mart warned Wal-Mart executives about the sale of opioids that pharmacists across the country would find unsafe.

The pharmacist complained that a dangerous “Pillmill” doctor was sending the patient to Wal-Mart after another chain stopped filling the opioid prescription. The pharmacist emailed Wal-Mart executives that he was afraid to lose his license and job for the sale of opioids.

According to DOJ complaints, patients often paid in cash and were considered a danger signal by the DEA. A pharmacist at the Wal-Mart store in Texas said filling out an opioid prescription “is a risk of staying up late.”

As part of a complaint against Wal-Mart, the Justice Department pointed out a case in North Carolina where doctors were finally sentenced to 20 years in prison for illegal opioid prescriptions.

“Wal-Mart’s own pharmacists have reported concerns about doctors upstream of the corporate chain, but for years, Wal-Mart has dispensed thousands of opioid pills,” said Robert Higdon, federal prosecutor in eastern North Carolina. I didn’t do anything other than keep doing it. ” In the statement..

Wal-Mart says federal regulators are trying to shift blame

Wal-Mart rejected NPR’s repeated requests for interviews, and the spokesman did not answer the list of detailed questions.

In an October complaint filed by Wal-Mart against the DOJ and DEA, company lawyers accused the opioid epidemic of problematic doctors and government regulators.

As part of its submission, the company acknowledged that it had been warned by the DEA of a “danger signal” that could indicate that the prescription was unsafe or could be illegal.

However, according to Wal-Mart, these warnings are not legally binding and correspond to what the company describes as “mere guidance.”

Wal-Mart also argued that it was the job of government regulators, not Wal-Mart, to crack down on dangerous mill doctors.

“By asking pharmacists and pharmacies for a second guess doctor, the Justice Department puts pharmacists and pharmacies between rocks and difficult places.” Wal-Mart said in a statement..

Can a Walmart pharmacist say no?

Wal-Mart also emphasized in an official statement the fact that the pharmacist had the authority to reject suspicious prescriptions. According to the company, it happened frequently in stores.

“Wal-Mart has always empowered pharmacists to refuse to fill out problematic opioid prescriptions, and refused to fill out hundreds of thousands of such prescriptions,” the company said in a statement.

It sounds like a lot. However, according to federal data, Wal-Mart stores dispense hundreds of millions of opioid pills annually.

Between 2006 and 2012, the company shipped approximately 5.2 billion opioid pills to a chain of 5,000 pharmacies. These are the years when the records collected by the DEA are published.

Former Wal-Mart pharmacists and other industry experts told NPR that there was strong pressure to sell opioids and prescribe them quickly without asking many questions.

“Did they do that when they said they gave pharmacists the ability to use their professional judgment?” Nicholas Bald, a pharmacist and professor studying opioid dispensing at East Tennessee State University. Meyer said.

According to Hagemeier, Wal-Mart pharmacists, like other chain pharmacy employees, often lacked the time, training, information, and corporate support to properly review opioid prescriptions.

Hagemeier surveyed pharmacists across the country and found that pharmacists working at chain pharmacies, including Wal-Mart, were more likely to be afraid of disciplinary action if they questioned too many opioid prescriptions. Bonuses were often related to sales and efficiency, not safety.

“There is no financial incentive to say no,” he said.

Opioid pills dispensed, no questions asked

Critics say the impact of these decisions on Americans shopping at Wal-Mart pharmacies was often devastating. Christina Dine was later unlicensed in her twenties when she was prescribed a high dose of oxycodone by an Ohio doctor.

When she fell addicted in 2012, Dine said no one in the local Wal-Mart she frequently purchased pills intervened or warned of danger.

“They took it and filled it out like any other prescription. They never asked, asked, or asked pharmacists or other pharmacy staff.”

33-year-old Dine is now a recovery nurse helping other people suffering from addiction. However, she lost years of life with the use of prescription opioids and heroin.

“I was calm for the first time in 2015 after my daughter’s father overdose and died. I went in and out. I had a little trouble, but I’ve been calm since 2017,” she told NPR. It was.

As early as 2009, federal regulators told the company that systems managing high-risk medicines were not robust enough to keep patients safe, according to court documents submitted by the Justice Department. I have notified you. Under pressure from the DEA, Wal-Mart signed a promising reform agreement in 2011.

DEA raided Wal-Mart pharmacy in 2016

Critics say dangerous practices continue. In 2016, federal agents attacked Wal-Mart Pharmacy in Texas as part of an investigation into two doctors, Pilmil, who are currently in prison. One has a 20-year term and the other has a 10-year term.

Court filings and official statements by former Justice Department officials indicate that the government has considered filing criminal charges against Wal-Mart as part of the case.

However, in December of this year, the Justice Department filed a civil suit alleging that Wal-Mart “illegally met prescriptions for thousands of invalid controlled drugs.” According to the DOJ, penalties can reach billions of dollars.

“Wal-Mart had the responsibility and the means to prevent the diversion of prescription opioids,” said Jeffrey Bossart Clark, Deputy Attorney for the Department of Justice’s Citizens Department.

“Instead, for years it did the opposite — meeting thousands of invalid prescriptions at pharmacies and not reporting suspicious orders for opioids or other drugs placed by those pharmacies. “

These arguments, and Wal-Mart’s counterclaim that federal regulators should be held responsible for the opioid crisis, will be tested in court as proceedings against companies filed by the Department of Justice and local and state governments.

Last year, the company asked federal judge Dan Polster to dismiss major opioid proceedings filed by two counties in Ohio, which are widely expected to serve as a test of Wal-Mart’s liability.

Polestar rejected the move, noting that he described it as an “apparent flaw” in Wal-Mart’s opioid safety practices. The case will be brought to trial later this year.

Faced with similar legal pressure and fierce public opposition to its role in the opioid crisis, oxycontin maker Purdue Pharma agreed to settle with the federal government last year. For $ 8.3 billion..

Wal-Mart promises to uphold opioid practices in court, claiming that federal agents acted unethically as part of a plan to “embarrass” the company to take advantage of large-scale cash payments. did.

The government suing Wal-Mart says the settlements and fines paid by the company will go to help communities suffering from the opioid crisis.

Other National pharmacy chain Rite Aid and Walgreens, including CVS, are facing similar proceedings related to their role in opioid trading.

Ashwani Sheoran said that many companies that acted as gatekeepers at the start of the epidemic could have avoided much of the damage.

“It’s very painful. It not only affects the patient, but also the people around the patient and the society as a whole around the patient. We pharmacists were responsible for saving lives,” Sheoran said. Said.

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