A U.S. federal judge in Ohio ordered three major retailers to pay $650.6 million for their involvement in the nation’s opioid crisis. The ruling directed CVS, Walgreens, and Walmart to pay combined damages to two counties in the state over their role in oversupplying addictive pain pills, especially since a significant portion of those pills ended up on the black market. (In Re: National Prescription Opiate Litigation, U.S. District Court for Northern District of Ohio, No. 1:17-md-2804, 2022)

The judge, Dan Polster, ordered that $86.7 million from the total must be paid into a fund immediately, with the remainder to be paid out to the counties over the next 15 years in installments. He also ordered that the companies create and institute procedures to tackle illegal diversion of opioids, as part of a “nuisance-abatement plan.”

While Lake County will receive a total of $306 million and Trumbull County will receive $44 million over the next 15 years, the order is a significant decrease from the $3 billion that the counties’ attorneys claimed was equivalent to the damage to area residents.

The court’s order follows a unanimous jury decision from November 2021 that found the three pharmacy chains liable for the crisis’s impact on Lake and Trumbull counties in Ohio, finding that the companies’ actions contributed to a huge and fatal “public nuisance.” The counties “blamed the three chain pharmacies for not stopping the flood of pills that caused hundreds of overdose deaths and cost each of the two counties about $1 billion,” according to the Associated Press.

“…Roughly 80 million prescription painkillers were dispensed in Trumbull County alone between 2012 and 2016—equivalent to 400 for every resident,” the AP said. “In Lake County, some 61 million pills were distributed during that period.”

Polster ruled that because of “the enormous complexity of this case, the court will retain jurisdiction over the nuisance-abatement plan, conduct periodic hearings to carefully monitor the plan’s progress, and make adjustments to this order as necessary.”

As part of the plan, the funding from the companies will be directed to programs that work to reduce opioid use disorder (OUD) and addiction among residents of either county.

The counties were instructed to present annual reports to an administrator selected by the court on how the received funds were spent. Any funds not spent will either be credited or refunded to the companies.

“The retailers will also be required to train personnel on the dispensing of controlled substances, create a hotline through which patients and employees can report inappropriate sales of painkillers, and appoint a controlled-substance compliance officer to review prescription-validation processes,” the Washington Post reported. 

Representatives from the companies said they would file an appeal against the jury’s decision and judge’s determination over the monetary damages, according to The Guardian.

“We strongly disagree with the court’s decision regarding the counties’ abatement plan, as well as last fall’s underlying verdict,” Mike DeAngelis, executive director of corporate communications for CVS Health, told CNN Business.

While other companies in sectors tied to the opioid industry have reached nationwide settlements—including manufacturers like Johnson & Johnson and distributors like Teva Pharmaceutical Industries—pharmacies have not reached such agreements yet.

“The ruling is the first by a federal judge that assigns a firm money figure against the pharmacy chains for their roles in the opioid crisis,” according to The New York Times.

Two other pharmacy chains—Giant Eagle and Rite Aid—reached a settlement with Lake and Trumbull counties before the trail, according to MarketWatch. 

Walgreens is facing similar orders elsewhere in the United States. Earlier in August, a federal judge in California ordered that the company can be held responsible for its role in the opioid crisis in San Francisco.