CVS, Walgreens and Walmart pharmacies were found liable in federal court Tuesday for helping fuel an opioid crisis in two Ohio counties.

The counties of Lake and Trumbell accused the three biggest pharmacy chains of selling and dispensing huge quantities of addictive prescription pain pills such as oxycodone and hydrocodone.

The jury deliberated for six days in the U.S. District Court in Cleveland. Judge Dan Polster will decide how much the companies should pay the counties, which were each seeking upwards of $1 billion.

The three companies are expected to appeal.

The verdict is expected to set the tone for other U.S. cities and counties in lawsuits against pharmacies. This is the first time pharmacies have had to defend themselves against opioid distribution.

“The law requires pharmacies to be diligent in dealing drugs. This case should be a wake-up call that failure will not be accepted,” said Mark Lanier, an attorney for the counties.

“The jury sounded a bell that should be heard through all pharmacies in America,” said Lanier.

A 2018 report by the National Institute on Drug Abuse listed Ohio fourth in opioid-related overdose deaths. Around 80 million prescriptions for pain pills were distributed in the two counties between 2012 and 2016, which comes to about 400 for every resident. There were 61 million pills distributed during the same period in Lake County.

Lanier blames the pharmacies for not hiring or training enough pharmacists and technicians to be able to catch suspicious prescriptions.

“For decades, pharmacy chains have watched as the pills flowing out of their doors cause harm and failed to take action as required by law,” the plaintiffs’ executive committee said in a statement.

“Instead, these companies responded by opening up more locations, flooding communities with pills, and facilitating the flow of opioids into an illegal, secondary market. The judgment today against Walmart, Walgreens and CVS represents the overdue reckoning for their complicity in creating a public nuisance.”

Kaspar Stoffelmayr, an attorney for Walgreens, blamed the pharmaceutical manufacturers and doctors for how many pills were prescribed.

“Pharmaceutical manufacturers tricked doctors into writing way too many pills," Soffelmayr said.

A spokesperson for CVS told NPR that, "We strongly disagree with the decision," the statement reads. "Pharmacists fill legal prescriptions written by DEA-licensed doctors who prescribe legal, FDA-approved substances to treat actual patients in need."