What Role Do Pharmacies Play in Addiction?

In 2020, court filings, according to The New York Times, “asserted that pharmacies including CVS, Rite Aid, Walgreens, and Giant Eagle as well as those operated by Walmart were as complicit in perpetuating the [opioid] crisis as the manufacturers and distributors of the addictive drugs.”

These filings also held that in preceding years of lawsuits against large opioid manufacturers, pharmacies had mostly “eluded scrutiny.” American and global chain pharmacies “earned enormous profits by flooding the country with prescription opioids.” While “they were keenly aware of the oversupply of prescription opioids through the extensive data and information they developed and maintained as both distributors and retail sellers of opioids... instead of taking any meaningful action to stem the flow of opioids into communities, they continued to participate in the oversupply and profit from it.”

It was not a pretty picture. Although not completely unfamiliar (just think of The Pharmacist on Netflix or the film Drugstore Cowboy), it certainly contrasts with typical images of the drugstore on Main Street, which has served as a bedrock in American civic life and the economy.

But beyond opioids, and in a broader sense, Americans are struggling with what David Courtwright calls the Age of Addiction. Recently, we have become more attuned to the commodification of drug treatment and rehabilitation industries, or the exploitation described in American Rehab. Obesity and hyper-palatable foods, including sugary drinks and candy, remain a concern. Authors have shed light on our use of "happy pills" and how marketing has remade the American patient.

So what's the role of pharmacy? As a professor of history as well as the historical director at the American Institute of the History of Pharmacy, I have the job of asking such questions. Pharmacists and pharmacies are key drivers in the marketplace. They serve as the endpoint of the American pharmaceutical supply chain. They dispense opioids, as described above.

But they are also the dispensers of a wide-ranging set of consumer goods. Some of these are nonthreatening. Others are potentially harmful to public health. Many of them act on the brain.

To better organize and conceptualize how pharmacies fit within the so-called Age of Addiction, I have created the term “Big Pharmacy." Of course, everyone immediately recognizes the term "Big Pharma." Or "Big Tobacco." And, to a lesser extent, many people now understand and use the term "Big Cannabis."

Equally important in my view, though, is Big Pharmacy. It refers to, in a larger sense, the ways that the field of pharmacy has interacted with other business entities, government, and health professions to sell psychoactive substances on a mass scale. In adding pharmacies to the roster of consumerist locales in the post-war United States and in thinking about how psychoactivity is sold, we can draw even deeper connections about the transformation of health, corporate medicine, and addiction in America. Alcohol, tobacco, hyper-palatable foods, sugar: these were (and are) vital elements of what one might call Big Pharmacy.

To think about the present and go back to the beginning of this article, the opioid crisis demonstrates the links between capitalism and addiction. In the pages of Pharmacy Times and Drug Topics, authors are asking about the pharmacists' role and whether blame can be assigned. Were pharmacists co-conspirators in rising levels of addiction? Were pharmacists providing enough counseling? Or offering reasonable information to patients?

New research and historical questions about psychoactivity and pharmacy will help to add to the conversation in the months and years ahead.