Retail chain pharmacy opioid dispensing practices from 1997 to 2020: A content analysis of internal industry documents

Abstract

Context

Lawsuits have determined that community pharmacy chains played a crucial role in the opioid epidemic. However, little research has assessed community pharmacy practices. This study sought to understand the contribution of pharmacies to the opioid epidemic through improper opioid prescription dispensing.

Methods

We conducted an observational, retrospective content analysis that assessed the opioid dispensing practices of a retail community pharmacy chain, Walgreens, using pharmaceutical industry documents released in litigation between 1997 and 2020. The documents were retrieved from the Opioids Industry Document Archive (OIDA) at the University of California, San Francisco and reviewed to identify themes and identify organizational practices.

Findings

We identified four primary factors that may have contributed to improper opioid dispensing practices: store-level procedures, management pressure, distribution center activities, and pharmaceutical company sponsorship. Stores dispensed opioid prescriptions without resolving red flags, management pressured pharmacists to fill more opioid prescriptions, distribution centers failed to investigate high volume orders, and pharmaceutical companies sponsored pharmacist continuing education advocating for opioid pain management.

Conclusions

Our findings suggest that Walgreens may have contributed to the early prescription opioid epidemic through improper opioid dispensing and also identify key practices that could be reformed to reduce the risk of future inappropriate dispensing of addictive and potentially harmful medications.