Maryland’s top lawyer announced Wednesday afternoon that the state had reached settlements with Walgreens, Walmart and two opioid manufacturers that are expected to add $238 million to its efforts to fight the opioid crisis over the course of 15 years.

The settlements follow multi-year investigations of the roles of the opioid manufacturers and chain pharmacies in fueling Maryland’s opioid crisis, the Office of Maryland Attorney General Anthony G. Brown said in a news release.

Along with forcing the companies to pay out, the settlements also mandate that they “stop engaging in practices that gave rise to the opioid crisis and take steps to prevent further illegal conduct,” the news release said.

There were 2,600 fatal overdoses in Maryland from November 2022 to October 2023, according to state data. Fentanyl – a highly potent form of opioid – was involved in 80% of these deaths.

“The opioid epidemic has claimed thousands of innocent lives through addiction and overdoses, has torn families apart, and has devastated communities across this country,” Brown said in the release. “This settlement money will help support recovery efforts in Maryland and prevent future loss where we need it most.”

All revenue from the settlements will be placed in the Maryland Opioid Restitution Fund and be spent on efforts to ease the crisis, the news release said.

Two years ago, pharmaceutical manufacturer Johnson & Johnson and the country’s three largest pharmaceutical distributors agreed to pay the state and most of its localities about $395 million over the course of 18 years. In exchange, the state absolved the companies of liability for illegally marketing and distributing opioids before the settlements.

One of the opioid manufacturers involved in the latest settlements — Teva, which is based in Israel — marketed and sold extremely dangerous and addictive rapid-onset fentanyl products, according to the news release, which cites documents filed Wednesday morning in Frederick County Circuit Court.

The products — Actiq, a fentanyl lozenge resembling a lollipop, and Fentora, a fentanyl tablet — were approved by the U.S. Food and Drug Administration only to treat extreme pain in patients with advanced cancers that are unlikely to be cured. However, the release said, the company falsely claimed the drugs were safe for non-cancer conditions and funneled hundreds of thousands of dollars to at least 16 Maryland prescribers through a “bogus” speaker bureau.

This money, which the complaint describes as “kickbacks,” encouraged prescribers to write prescriptions for Actiq and Fentora for people who did not have cancer and should not have taken the drugs.

A former sales representative who provided sworn testimony to the Attorney General’s Opioids Unit claimed that Teva paid thousands of dollars in speaker fees, meals and drinks to three prescribers from the same Annapolis practice. These prescribers generally treated chronic non-cancer pain.

Under the settlement agreement, Teva will be required to pay restitution to the state for 13 years. The news release estimated that the state will bring in about $70.3 million from that agreement.

The complaint against the second opioid manufacturer, Allergan — now a part of AbbVie, headquartered in Chicago — alleges the company misled prescribers and patients about the relative safety of its extended-release morphine product, Kadian. The attorney general’s office said the company sold the product by deceptively marketing it as an option that was safer than other opioids.

The company also misled prescribers about the nature of addiction, the news release said, claiming that patients who were exhibiting the signs of addiction were not really addicted, but simply required more medicine to relieve their pain.

“These false messages led Maryland prescribers to increase opioids doses to those already suffering from addiction, contributing to the vast overprescription of opioids that fueled the opioids epidemic of addiction and death,” the attorney general’s office said.

Over the course of seven years, Allergan is expected to pay about $38.2 million to the state.

The biggest pay-out announced Wednesday comes from Walgreens, which is expected to pay $74.8 million over the course of 15 years for failing to protect their customers from inappropriate or unsafe prescription drugs.

Pharmacies are required by state and federal law to investigate opioid prescriptions that seem “problematic” before filling them, the attorney general’s office said. However, Walgreens and Walmart — which will pay the state about $55.5 million over the next six years — put inappropriate pressures on pharmacists and other pharmacy employees to fill prescriptions despite warning signs that showed the prescriptions might be unsafe.

This led both retailers to fill opioid prescriptions that were inappropriate and unsafe, “creating or contributing to the addiction and ultimate death of many Marylanders,” the news release said.

According to the news release, Walmart pharmacies filled prescriptions from health care providers at a now-shuttered pain management clinic in Baltimore County for 39 patients who later died from overdoses caused by opioid abuse and addiction. Walgreens pharmacies filled prescriptions for 116 patients from the same clinic who later died from overdoses.

“Walmart and Walgreens, the complaint charges, were aware of issues with the providers, but filled these and other prescriptions anyway, while deceiving the public that they were keeping consumers safe,” the news release said.