SAN FRANCISCO (AP) — A federal judge ruled Wednesday that Walgreens can be held responsible for contributing to San Francisco's opioid crisis for over-dispensing opioids for years without proper oversight and failing to identify and report suspicious orders as required by law.

San Francisco City Attorney David Chiu said the pharmacy chain "continually violated what they were required to do under the federal Controlled Substances Act," failing to track opioid prescriptions, preventing pharmacists from vetting prescriptions and "nor did they see the many red flags of physicians and others who were dramatically over-prescribing."

"Pharmacists were pressured to fill, fill, fill," he said, "and as a result, Walgreens filled our streets with opioids."

U.S. District Judge Charles Breyer ruled that for 15 years, Walgreens dispensed hundreds of thousands of pills, eventually contributing to the city's hospitals being overwhelmed with opioid patients, libraries being forced to close because of syringe-clogged toilets, and syringes littering children's playgrounds in San Francisco.

A Walgreens spokesman said the chain is disappointed in the outcome, which he said is not supported by the facts and the law.

"As we have said throughout this process, we never manufactured or marketed opioids, nor did we distribute them to the 'pill mills' and internet pharmacies that fueled this crisis," spokesman Fraser Engerman said in a statement. "The plaintiff's attempt to resolve the opioid crisis with an unprecedented expansion of public nuisance law is misguided and unsustainable. We look forward to the opportunity to address these issues on appeal."

Several drug manufacturers and pharmacies opted to settle with the city previously as part of the case, including opioid makers Allergan and Teva, which agreed to pay $54 million on the eve of closing arguments in the trial, leaving Walgreens as the sole defendant.

Wednesday's ruling did not include a ruling on monetary damages, which will be determined in a future trial.

Drug overdose deaths have surged in the country, including in San Francisco. Mayor London Breed declared a state of emergency last year in the Tenderloin neighborhood, saying something had to be done about the high concentration of drug dealers and people consuming drugs in public.

The city attorney's office says San Francisco saw a nearly 500% increase in opioid-related overdose deaths between 2015 and 2020 and that on a typical day, roughly a quarter of visits at the Zuckerberg San Francisco General Hospital Emergency Department are opioid-related.

Deerfield, Illinois-based Walgreens Boots Alliance Inc. runs a network of around 9,000 drugstores in the United States. Walgreens and other prescription drug distributors have faced a slew of lawsuits over the opioid crisis.

In May, Walgreens reached a $683 million settlement with the state of Florida in a lawsuit accusing the company of improperly dispensing millions of painkillers that contributed to the opioid crisis.

The company also faces litigation in Alabama, Michigan and New Mexico, among other states.

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Associated Press writer Tom Murphy in Indianapolis contributed to this story