CVS Agrees To Pay $315 Million Over Unlawful Controlled Substance Prescriptions – Here's What Patients Should Know

CVS has agreed to pay $315 million to settle federal claims over how its pharmacies filled opioid prescriptions. The CVS opioid settlement, announced by the U.S. Department of Justice on Oct. 13, covers more than 12 years of controlled substance prescriptions. Prosecutors said some of those prescriptions paired opioids with other sedating drugs in dangerous combinations. However, CVS disputes the claims and did not admit wrongdoing, the Associated Press reports.

Still, the case raises a key question for patients: How do you know a controlled substance is safe for you? Below, medical experts explain what the settlement means, why some drug combinations are risky and how to protect yourself.

Why was CVS sued?

The Justice Department filed its complaint in December 2024 in federal court in Rhode Island, where CVS is based. The case began as a whistleblower lawsuit filed by Hillary Estright, a former CVS employee.

The government alleged that from October 2013 through December 2025, CVS pharmacies filled prescriptions that:

• Contained dangerous and excessive quantities of opioids.
• Were filled too early.
• Combined an opioid, a benzodiazepine and a muscle relaxant, a mix known as the “trinity.”
• Came from so-called pill mill prescribers who wrote prescriptions without a legitimate medical purpose.

The government also alleged that CVS billed Medicare and other federal health programs for many of those prescriptions. In addition, the complaint claimed that performance metrics, incentive pay and short staffing put profits ahead of patient safety. CVS policies also allegedly kept pharmacists from warning one another about problem prescribers.

CVS strongly disagrees with the claims, and the settlement includes no finding of liability. Notably, the CVS opioid settlement is separate from the roughly $5 billion deal CVS announced with state and local governments in 2022, as reported by CBS News.

What CVS agreed to change in the opioid settlement

In addition to the payment, CVS signed an agreement with the Drug Enforcement Administration (DEA). Under that agreement, CVS must:

• Create a hotline so employees and the public can report suspected illegal dispensing.
• Proactively monitor dispensing patterns at its pharmacies.
• Set up a process to evaluate prescribers suspected of illegal prescribing.

“Today’s settlement requires CVS to implement additional safeguards to ensure that prescriptions for opioids and other controlled substances are dispensed only when medically appropriate,” Brett A. Shumate, assistant attorney general for the Justice Department’s Civil Division, said in a statement.

Why opioid safety is a concern

The CVS opioid settlement puts a spotlight on risky drug combinations. Opioids, benzodiazepines and many muscle relaxants all slow down the central nervous system. On their own, each one can cause drowsiness. Together, however, their effects can stack up.

Mohit Chhatpar, DO, DABOM, a board-certified family medicine physician with fellowship training in addiction medicine, explained the risk. “An opioid, a benzodiazepine and a sedating muscle relaxant can compound effects on alertness and breathing. A medication being prescribed does not remove the interaction risk. Alcohol can add to it,” he told Blavity Health.

The data back up that concern. According to the National Institute on Drug Abuse, nearly 14% of overdose deaths involving opioids in 2021 also involved benzodiazepines. For that reason, the Food and Drug Administration (FDA) requires boxed warnings on both drug types. These labels, its strongest warnings, flag the dangers of using the drugs together.

The stakes are especially high for Black Americans. In fact, CDC researchers found that overdose death rates among Black people rose 44% from 2019 to 2020. Yet only about 1 in 12 Black people who died of an overdose had evidence of substance use treatment. That gap is one reason students and community groups have stepped up overdose prevention outreach.

Risks and side effects

The biggest danger of mixing these drugs is respiratory depression. In other words, breathing becomes too slow or shallow to keep the body supplied with oxygen.

Opioids directly slow the brain’s drive to breathe. Benzodiazepines and sedating muscle relaxants then add more sedation on top. As a result, the combination can lead to an overdose more quickly than any single drug, according to the National Institute on Drug Abuse.

Overdose warning signs

The Centers for Disease Control and Prevention (CDC) lists these signs of an opioid overdose:

• Unconsciousness or being unable to wake up.
• Slow, shallow or difficult breathing.
• Discolored skin, especially on the lips or nails.
• Small, pinpoint pupils that don’t react to light.

Dr. Brian Spears, MD, an emergency physician and chief medical officer of OrderlyWellness, said not to hold out for a full checklist. “Pinpoint pupils can occur with opioid overdose, but you shouldn’t wait for every sign. If someone is unresponsive or breathing abnormally, call 911 immediately and give naloxone if it’s available,” he told Blavity Health.

“Stay with the person. Even if naloxone helps, emergency care is still needed; naloxone does not reverse every drug in a mixed overdose,” Chhatpar added.

That last point matters with the trinity. After all, the National Institute of Drug Abuse notes that naloxone only reverses opioids, so other sedatives in the mix can keep slowing a person’s breathing.

Long-term use of opioids or benzodiazepines can also lead to physical dependence. As a result, stopping suddenly can be risky. The FDA warns that stopping a benzodiazepine abruptly, or lowering the dose too fast, can trigger life-threatening withdrawal reactions.

“If you already take these medicines regularly, do not abruptly stop them on your own; benzodiazepine withdrawal can be dangerous, and medication changes need an individualized plan,” Chhatpar said.

Who is most at risk?

Some people face higher risks from opioids and benzodiazepines, even at prescribed doses. “Older adults, anyone with sleep apnea or chronic lung disease, and anyone taking other medicines or substances that cause sedation all have less reserve if their breathing becomes suppressed,” Spears said.

Age changes how the body processes medications. Plus, many older adults take several medications at once, which raises the odds of a harmful interaction. For this reason, the CDC’s opioid prescribing guideline calls for extra caution and closer monitoring for adults 65 and older.

Alcohol is another central nervous system depressant, so it adds to the sedation. Meanwhile, getting sedating prescriptions from more than one clinician raises the chance that no one sees the full picture. “Every prescriber and pharmacist should know the complete medication list, including medications supplied by another practice,” Chhatpar said.

Best practices

You have more control than you might think, both at the pharmacy counter and in your pain care.

Speak up at the pharmacy

The CVS opioid settlement also shows why you shouldn’t assume the pharmacy will catch every problem. “A high dose or early refill warrants clarification with the prescriber and pharmacist, rather than an assumption that more medication is needed,” Chhatpar said.

Spears also encourages patients to ask whether they need every medication in the mix. “I always support using the least number of medications and the lowest doses possible to achieve the desired result when treating illnesses. This applies here as well since your symptoms may be controlled with only one of these three drugs, helping you avoid any potentially dangerous situations where all three are interacting with each other,” he said.

If something seems off, you can also ask the pharmacist to call your prescriber before you leave.

Store and dispose of leftover pills

Keep controlled medications locked away from children, visitors and pets. When you no longer need them, the FDA says a take-back program is the best disposal option.

The DEA’s next National Prescription Drug Take Back Day is Saturday, Oct. 24, from 10 a.m. to 2 p.m. You can find a drop-off site at DEATakeBack.com. Also, more than 15,300 pharmacies, hospitals and businesses offer disposal year-round.

If no take-back option is available, the FDA recommends mixing pills with used coffee grounds, dirt or cat litter. Next, seal the mixture in a bag or container and throw it in the trash.

Ask about non-opioid pain treatments

For chronic pain, opioids are no longer the default. In fact, the CDC guideline states that “nonopioid therapies are preferred for subacute and chronic pain.”

Rob Letizia, PT, DPT, owner of Spectrum Therapeutics in Wayne, New Jersey, agrees. “Physical therapy should be a first-line option for most chronic musculoskeletal pain, not a fallback after opioids fail,” he told Blavity Health. “Opioids dull the signal, but they do nothing for why the joint or tissue is still struggling.”

His advice: “If you’re offered opioids for a muscle, joint or back problem, ask whether physical therapy has been tried first, and for how long.”

Treat the mind and body together

Eve Mugar, LICSW, is a psychotherapist in Cambridge, Massachusetts, who specializes in chronic pain. She said psychological care deserves a bigger role. She also lived with chronic pain through much of her 20s. As she put it, “Pain doesn’t always resolve when the original injury or trigger does.”

“CBT for pain and pain reprocessing therapy can help people change how they respond to pain and reduce the fear and avoidance that can keep them stuck,” Mugar told Blavity Health. Still, she stressed, “Psychological treatment isn’t about suggesting that pain is imaginary or that it’s all in someone’s head.”

Stress can also feed the pain cycle, and chronic stress already takes a heavy toll on Black women. If cost is a barrier to physical therapy or counseling, review your coverage options before you skip care.

Advocate for yourself

Black patients have long had their pain dismissed. For example, a 2016 study surveyed white medical students and residents. About half endorsed false beliefs about biological differences between Black and white people. Those who held those beliefs rated Black patients’ pain lower and made less accurate treatment recommendations.

Many Black women say doctors aren’t listening, and some now push for extra testing to be taken seriously. So, specific language helps. First, describe how pain limits your daily life, not just where it falls on a 1 to 10 scale. Next, keep a simple log of your symptoms, sleep and activities you had to skip. You can also bring a trusted person to appointments. Finally, if your pain still feels undertreated, ask for a referral to a pain specialist or get a second opinion.

Bottom line

Under the CVS opioid settlement, the company will pay $315 million and add new safeguards, though it denies wrongdoing. Still, the case shows that a valid prescription does not guarantee a safe combination. Ask questions at the pharmacy and keep naloxone nearby if you take opioids. Also, ask your doctor about non-opioid options for chronic pain.

Frequently Asked Questions

What are the changes to CVS’ controlled substance policy in 2026?

CVS must run a reporting hotline, monitor its pharmacies’ dispensing patterns and review prescribers suspected of illegal prescribing.

Who owns CVS now?

CVS Pharmacy is part of CVS Health Corporation, a publicly traded company that also owns Aetna and CVS Caremark.

Citations

U.S. Department of Justice. CVS agrees to pay $315M for illegally filling unlawful opioid prescriptions and for submitting false claims to the federal government. Published October 13, 2026. Updated October 14, 2026. https://www.justice.gov/opa/pr/cvs-agrees-pay-315m-illegally-filling-unlawful-opioid-prescriptions-and-submitting-false

Associated Press. CVS agrees to pay $315 million to settle Justice Department allegations over opioid prescriptions. ABC News. Published October 13, 2026. https://abcnews.com/Business/wireStory/cvs-agrees-pay-315-million-settle-justice-department-137231624

CBS News. CVS Health agrees to $5 billion settlement in opioid lawsuits. CBS News Detroit. Published November 2, 2022. https://www.cbsnews.com/amp/detroit/news/cvs-health-5-billion-settlement-opioid-lawsuits

National Institute on Drug Abuse. Benzodiazepines and Opioids. NIDA. Published November 7, 2022. https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids

National Institute on Drug Abuse. Naloxone DrugFacts. NIDA. Published January 11, 2022. https://nida.nih.gov/publications/drugfacts/naloxone

U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines. FDA. Published August 31, 2016. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or

U.S. Food and Drug Administration. Benzodiazepine Drug Class: Drug Safety Communication – Boxed Warning Updated to Improve Safe Use. FDA. Published September 23, 2020. https://www.fda.gov/safety/medical-product-safety-information/benzodiazepine-drug-class-drug-safety-communication-boxed-warning-updated-improve-safe-use

U.S. Food and Drug Administration. FDA Approves First Over-the-Counter Naloxone Nasal Spray. FDA. Published March 29, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray

U.S. Food and Drug Administration. Where and How to Dispose of Unused Medicines. FDA. Published April 16, 2025. https://www.fda.gov/consumers/consumer-updates/where-and-how-dispose-unused-medicines

Centers for Disease Control and Prevention. Overdose Rates in Urban vs. Rural Areas. CDC. Published July 19, 2022. https://www.cdc.gov/media/releases/2022/s0719-overdose-rates-vs.html

Centers for Disease Control and Prevention. What to Do If You Think Someone Is Overdosing. CDC. Published May 15, 2024. Updated April 2, 2024. https://www.cdc.gov/stop-overdose/response/

Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95. doi:10.15585/mmwr.rr7103a1. https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm

U.S. Drug Enforcement Administration. DEA to Host 31st National Prescription Drug Take Back Day on Saturday, October 24th. DEA. Published October 7, 2026. https://www.dea.gov/press-releases/2026/10/07/dea-host-31st-national-prescription-drug-take-back-day-saturday-october

Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296-4301. doi:10.1073/pnas.1516047113. https://pubmed.ncbi.nlm.nih.gov/27044069/