Walgreens helped fuel the opioid epidemic in San Francisco by dispensing hundreds of thousands of prescriptions without performing adequate due diligence, a federal judge ruled Wednesday.

U.S. District Judge Charles Breyer found that over the course of a 15-year period, Walgreens pharmacists did not stop or flag suspicious orders, including tens of thousands from doctors with suspect prescribing patterns.

“It is more likely than not that Walgreens pharmacies dispensed large volumes of medically illegitimate opioid prescriptions that were diverted for illicit use and that substantially contributed to the opioid epidemic in San Francisco” and contributing to a public nuisance, Breyer wrote in a 112-page opinion.

The city sued dozens of defendants related to the opioid epidemic in San Francisco, including pharmacies, drug companies and distributors. Walgreens was the only one that did not settle by the time the trial closed in July. 

Breyer found that Walgreens did not provide its pharmacists with sufficient time, staffing or resources to perform due diligence on opioid prescriptions. Pharmacists experienced constant pressure to fill prescriptions as quickly as possible, and a shortage of resources to review them before dispensing.

Walgreens is the largest retail pharmacy chain in San Francisco. During the period from 2006 to 2020, Walgreens pharmacies distributed and dispensed more than 100 million prescription opioid pills in the city.

“In exchange for the privilege of distributing and dispensing prescription opioids, Walgreens has regulatory obligations to take reasonable steps to prevent the drugs from being diverted and harming the public. The evidence at trial established that Walgreens breached these obligations,” Breyer wrote.

A subsequent trial will determine how much Walgreens must pay. The decision comes after the company reached a $683 million settlement with the state of Florida in May.

Walgreens spokesman Fraser Engerman said the company was “disappointed” and would appeal what he said was a “misguided and unsustainable” expansion of public nuisance law.

“The facts and the law do not support the court’s decision. As we have said throughout this process, we never manufactured or marketed opioids, nor did we distribute them to the ‘pill mills’ and internet pharmacies that fueled this crisis,” Engerman said in a statement to The Hill.

“We stand behind the professionalism and integrity of our pharmacists, dedicated healthcare professionals who live in the communities they serve,” he added.

In 2012, the Drug Enforcement Administration shut down one of Walgreens’ three controlled substance distribution centers because its failure to monitor for suspicious opioid orders posed an imminent threat of harm to public health and safety.

Walgreens stopped distributing controlled substances to its pharmacies entirely in 2014.

During a press conference Wednesday, City Attorney David Chiu said the verdict gives a voice to the overdose victims of the opioid epidemic. 

“This crisis did not manifest out of thin air,” Chiu said. “Walgreens significantly contributed. Walgreens did not red flag suspicious orders and pharmacists were pressured to fill, fill, fill. Walgreens flooded our city with opioids.”