The US government has sued Rite Aid, one of the nation’s largest pharmacy chains, for allegedly missing “red flags” when it knowingly filled unlawful drug prescriptions – including opioids and fentanyl – and ignored internal controls on its practices.
In a complaint filed on Monday, the federal justice department asserted that Rite Aid “filled at least hundreds of thousands of unlawful prescriptions for controlled substances that were medically unnecessary, lacked a medically accepted indication, or were not issued in the usual course of professional practice” between 2014 and 2019.
Rite Aid pharmacists are accused of ignoring obvious signs of misuse, including filling prescriptions for “trinities” – a combination of opioids, benzodiazepine and muscle relaxants.
So-called drug trinities are considered particularly euphoric for substance abusers – but also especially dangerous. Opioids such as oxycodone slow breathing, benzodiazepines like Xanax slow the heart, and muscle relaxants compound both effects, leading to fatal overdoses.
The justice department’s complaint said that Rite Aid had “early fills” of fentanyl and oxycodone prescriptions before a prior prescription for the same drug had run out, which is “a clear sign of over-utilization”.
In a statement, the US attorney general, Merrick Garland, said: “The justice department is using every tool at our disposal to confront the opioid epidemic that is killing Americans and shattering communities across the country.”
Associate attorney general Vanita Gupta said that the pharmacy chain’s prescribing practices had “opened the floodgates for millions of opioid pills and other controlled substances to flow illegally out of Rite Aid’s stores”.
The justice department also accused Rite Aid of intentionally deleting some pharmacists’ internal notes about suspicious prescribers, such as “cash only pill mill???”, “writing excessive dose[s] for oxycodone” and bluntly “DO NOT FILL CONTROLS”.
A statement from Orville Greene of the Drug Enforcement Agency said Monday’s action “should serve as a warning to those in the pharmacy industry who choose to put profit over customer safety”.
Rite Aid has declined to comment on the allegations, saying the litigation is pending.
The complaint comes after three former employees of Rite Aid – Andrew White, Mark Rosenberg and Ann Wegelin – brought a lawsuit against the chain in October 2019 accusing the company of pressuring pharmacists to rush and fill prescriptions without conducting “red flag” research, which could include looking into a doctor who is writing large amounts of opioid prescriptions or customers who showed signs of doctor-shopping.
The whistleblower lawsuit said that federal and state laws require pharmacies to review prescriptions to ensure they are being prescribed legally and for the right reasons.
“Rite Aid violated these duties by dispensing extremely large amounts of opioids from its retail pharmacy stores throughout the United States,” the lawsuit says. “… Pharmacies serve as the last line of defense between dangerous opioids and the public.”
Federal prosecutors later took over the whistleblower lawsuit. In a press release, the justice department said its intervention in the civil case “illustrates the government’s emphasis on combating health care fraud”.
The lawsuit comes days after the justice department announced the creation of the opioid epidemic civil litigation taskforce, a group charged with coordinating the government’s response to the prescription opioid crisis of the late 90s and early 2000s.
Over-prescription of opioids is estimated to have been responsible for 500,000 deaths since 2000, according to the US Centers for Disease Control and Prevention. It is now widely blamed for setting the stage for the current fentanyl crisis, which is estimated to be a factor in two-thirds of a record 107,000 fatal drug overdoses last year.
The taskforce hopes to “steer the [government’s] civil litigation efforts involving actors alleged to have contributed to the opioid epidemic, including by diverting prescription opioids”, the justice department said in a statement.
More recently, bipartisan political support has been growing to list fentanyl-smuggling Mexican drug cartels as foreign terrorist organizations. That came after the Gulf cartel reportedly mistook four US travelers in the Mexican border city of Matamoros for drug smugglers, shot at them, and kidnapped them.
Two of the Americans were killed, and the other two were later rescued. The group had gone to Mexico for one of them to undergo a cosmetic surgery known as a tummy tuck.