People walk by a CVS pharmacy store in Manhattan, New York City, New York, U.S., November 17, 2021.
People walk by a CVS pharmacy store in Manhattan, New York City, New York, U.S., November 17, 2021. Reuters / ANDREW KELLY

CVS Health Corp, Walgreens Boots Alliance Inc and Walmart Inc on Tuesday begin a first-of-its-kind trial to determine what the pharmacy chains owe for their role in the opioid epidemic in two Ohio counties, which are seeking $878 million.

A federal jury decided in November that the companies helped create a public nuisance with an alleged flood of addictive pain pills that wound up on the black market, in the first trial the companies faced over the crisis.

The jury did not decide how much the companies should pay to help alleviate the health crisis, which will now be determined by U.S. District Judge Dan Polster, marking the first trial to separately determine what the pharmacy chains owe after having been found liable.

Ohio's Lake and Trumbull Counties want the pharmacy chains to fund a $878 million five-year plan that includes treatment for addiction and overdoses, resources for law enforcement and healthcare providers, and employment training for addicts. Walgreens, CVS and Walmart countered with an offer of a one-year program to buy back unused prescription opioid drugs in the two counties. They argue that Ohio's public nuisance law only requires them to stop the nuisance identified by the jury - an oversupply of prescription drugs - and not to address all of its negative effects.

CVS, Walgreens and Walmart have denied the counties' allegations and said they would appeal the November verdict.

The companies argued that if they must do more than buy drugs back, they should not be forced to cover costs related to illegal drug use. They also said the counties have overstated the costs of their five-year plan.

The U.S. opioid epidemic has caused more than 500,000 overdose deaths over two decades, according to government data. More than 3,300 opioid lawsuits have been filed nationally against drugmakers, distributors and pharmacy chains, leading to a wave of proposed settlements.

CVS and Walgreens recently agreed to pay more than $1.1 billion to settle an opioid lawsuit by the state of Florida, the first time that pharmacy chains have reached a statewide settlement of opioid claims.

The Ohio counties' public nuisance theory has rarely been tested at trial, and it has had mixed results in other courts.

Oklahoma's top court on Nov. 9 overturned a $465 million judgment against Johnson & Johnson, and a California judge in November ruled in favor of four drugmakers in a case brought by several large counties.

A New York jury in December found drugmakers Teva Pharmaceutical Industries Ltd and AbbVie Inc responsible for causing a public nuisance in the state, although the amount they must pay will be determined in a trial later in 2022.