How much should CVS, Walgreens, and Walmart pharmacies pay in damages to two Ohio counties to help them deal with the opioid crisis?

That is the question before a federal judge in Cleveland, who will begin hearing testimony on Tuesday after a jury found the three major pharmacy chains responsible for recklessly distributing massive amounts of pain pills in Lake and Trumbull counties last fall. It was the first time that pharmacies in the United States were held accountable for the opioid crisis.

Before the trial, plaintiff’s attorneys stated that each county would require approximately $1 billion to repair the damage caused by the flood of pills, which resulted in hundreds of overdose deaths.

Between 2012 and 2016, Trumbull County dispensed approximately 80 million prescription painkillers — 400 pills for every county resident — while Lake County dispensed 61 million pills — 265 pills for every county resident.

Back in November, a jury in U.S. District Judge Dan Polster’s courtroom agreed with the counties that the manner in which the pharmacies dispensed pain medication played a significant role in creating a public nuisance.

The counties are now expected to present doctor testimony to discuss the harm done to those communities, the impact of the opioid crisis on child welfare and other county agencies, and an abatement plan developed for the counties.

“The jury rang a bell that should be heard throughout all pharmacies in America,” Mark Lanier, the counties’ lead attorney, said after the verdict in November.

Many lawsuits filed by governments in recent years over the toll of drugs have been resolved in the United States, most with settlements and some with judgments or verdicts in trials. According to an Associated Press tally, drug manufacturers, distributors, and pharmacies have agreed to settlements totaling well over $40 billion.

Trials are currently underway in West Virginia, Florida, and California. After another trial in West Virginia last year, no decision was issued.

According to an April 25 court filing, Dr. Caleb Alexander of John Hopkins Bloomberg School of Public Health’s abatement plan for Lake and Trumbull counties “are reasonable and necessary to abate the public nuisance found by the jury.”

According to the court filing, the plan focuses on prevention, treatment, and recovery, as well as “measures intended to specifically address the needs of special populations who have been uniquely affected by the opioid epidemic.”

In a court filing, Walgreens and Walmart attorneys argued that the counties’ $878 million abatement plan should be limited to one year rather than the minimum of five years that the counties claim they require. According to the filing, one of the pharmacy chains’ experts estimated the actual cost at $346 million, while another expert estimated it at less than $35 million.

Defense attorneys also argued that any amounts awarded by Polster should exclude damage caused by other entities that contributed to the public nuisance of opioid addiction, and that those costs should be limited to the pharmacies’ “appropriate share of contribution to the nuisance.”

Rite-Aid, the pharmacy chain, reached an agreement with the counties in early October, prior to the start of the trial. After the trial began in late October, Pittsburgh-based Giant Eagle reached an agreement with the counties.

According to the Centers for Disease Control, there were nearly 500,000 deaths caused by legal and illegal opioids between 2000 and 2019.