Why is SF’s drug crisis so out of control? Stop blaming Chesa and look at Walgreens

Last year, Walgreens stores in San Francisco made national headlines after a tweet documenting a brazen act of theft went viral. In the now-famous video, security guards stood by as a man hastily filled a garbage bag with items from the shelves, before riding out of the front doors on a Lyft rental bike. The tweet’s author, a TV reporter from KGO, used the hashtag #NoConsequences and tagged then-District Attorney Chesa Boudin.

Fox News covered the incident multiple times, lambasting the city’s shoplifting crisis. Then the Daily Mail chimed in. Breitbart News picked it up. Things died down, until Walgreens announced it was shuttering several of its San Francisco stores due to theft — and the stories started again.

All of this added color to the portrait of San Francisco as a crime-ridden hellhole, due to chronic homelessness and unchecked drug use — all enabled by the kind of liberal permissiveness district exemplified by our lax attorney, Boudin.

This narrative has stuck — buttressed by legitimate concerns about a wave of drug overdose deaths on our streets. And it is still influencing our politics and policymaking. Boudin was ousted in a recall, and his replacement, Brooke Jenkins, has made it clear she intends to make street-level enforcement of drug crimes a top priority.

The current rhetoric of accountability and personal responsibility surrounding drugs and addiction — and the crimes like petty theft that support them — is seductive. It has a kind of common-sense appeal that’s easy to rally behind. San Francisco got in this mess because we were too lenient. Getting tough, therefore, is the natural solution.

But this explanation isn’t just facile, it’s untrue. And the past few weeks have offered newfound clarity on why. Walgreens, once again, is in the middle of the story, but this time as an alleged perpetrator of crime.

According to a lawsuit filed by the City Attorney’s Office, for more than a decade, Walgreens was the largest distributor of opioids in San Francisco — and was a key player in setting off the current iteration of our crisis. The suit claims Walgreens irresponsibly distributed prescription opioids to San Franciscans, contributing to a rise in fatal overdoses, addiction and public drug use.

Walgreens has already paid hundreds of millions of dollars in settlements across the country for its irresponsible dispensing of opioids. But its role in the crisis in San Francisco is often overlooked, and we’re subsequently missing the full picture. Because for a little while, the city had its overdose crisis under control.

During a deadly heroin wave in the 1990s, the city managed to drastically reduce fatal overdoses. Drug users rallied to care for one another. Underground groups handed out clean syringes and learned how to administer naloxone, the overdose reversal drug. By 1999, doctors, drug users, researchers and outreach workers had developed a series of recommendations aimed at reducing harm for people who injected drugs. Overdose rates plummeted.

But that began to change a few years later when hundreds of millions of opioid pills were shipped to San Francisco. A major dispenser, according to the lawsuit: Walgreens.

The overdose landscape shifted dramatically. In 2010, there were just 10 reported heroin overdoses citywide. But that year, 110 people died from prescription opioids.

During closing arguments this month, lawyers lambasted Walgreens’ “fill, fill, fill corporate culture.” For years, they claimed, the pharmacies operated under extreme staffing shortages. There was no real oversight in monitoring or reporting suspicious prescriptions and little time for under-resourced pharmacists to investigate them.

Fraud was rampant, according to the lawsuit. From 2006 through 2020, nearly 6.4 million doses of opioids were filled through San Francisco Walgreens from dozens of doctors who were under active investigation or had suspended licenses. One Mission District Walgreens dispensed more than 86,000 prescriptions written by a single doctor, even after pharmacists raised concerns about the frequency and size of the scripts.

Witness testimony in the case was mind-boggling. One Bayview pharmacist said that he dispensed opioids to a patient, only to see that patient sell them in the parking lot outside moments later.

When the federal government cracked down on opioid prescribing practices, Walgreens was forced to institute better oversight, and the drugs became harder to obtain.

But addiction didn’t go away.

dr Phillip Coffin, director of substance use research at the city’s Department of Public Health, tested that he’d been tracking overdose rates since the 1990s. After the reduction in access to prescription drugs he saw people return to the streets to address their pain. Heroin use rose again. When fentanyl hit the scene, deaths skyrocketed. Last year, 641 people died of overdoses in San Francisco.

But today, pills still play a role. A quarter of all overdoses that arrive at Zuckerberg San Francisco General Hospital are due to prescription pills, according to testimony from Dr. Christopher Cowell, head of the emergency department.

Which brings us back to the viral video. In painting San Francisco as a rogue hellhole, and itself as a victim, Walgreens successfully distracted from any responsibility in perpetuating what is arguably the city’s biggest and most pernicious drug crime.

And yet the narrative of corporate victimhood is hard to shake. This week, District Attorney Jenkins revived it, with a tweet of a news article claiming the same man pictured in the Walgreens theft video, after serving time in prison, had hit a CVS — another pharmacy chain that’s had to pay millions for its role in the overdose crisis.

“There are no victimless crimes and we have to send a strong message that repeat offenders will face consequences for their actions if they continue to choose a life of crime,” she tweeted.

If anything, the man’s alleged re-offense is evidence that incarceration does not stop recidivism. But Jenkins’ tweet still managed to rack up 900 likes in just four hours.

News of Walgreens’ culpability in our overdose crisis, meanwhile, was difficult to find in San Francisco’s increasingly contentious online criminal justice conversation.

Drug use and crimes are complex. Their solutions can’t be reduced to a tweet. And we won’t have any hope of moving forward if we don’t understand how we got here. That, however, requires zooming out and taking a hard look at the broader picture and the story it tells, which is: There are no shortage of players seeking to profit from the suffering of our most vulnerable.

Until that is addressed, we’re not going to solve anything.

Nuala Bishari is a San Francisco Chronicle columnist and editorial writer. Email: nuala.bishari@sfchronicle.com

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