A federal jury said in a ruling on Tuesday that CVS, Walgreens and Walmart Pharmacy unscrupulously distributed large amounts of painkillers in two Ohio counties. The responsible U.S. city and county government set the tone.

Their lawyers said Lake County and Trumbull County accused the three drugstore chains of failing to prevent the flood of pills that caused hundreds of overdose deaths. The two counties spent approximately $1 billion each.

How much compensation the pharmacy must pay will be determined by a federal judge in the spring.

This is the first time a pharmacy company has completed a trial to defend itself in the drug crisis that killed half a million Americans in the past two decades.

The counties were able to convince the jury that pharmacies played a huge role in distributing painkillers to the community and causing public nuisance.

“The law requires pharmacies to be diligent when dealing with drugs. This case should sound the alarm and show that it will not accept failure,” said Mark Lanier, a lawyer in each county.

“The jury rang the bell that all pharmacies in the United States should hear,” Lanier said.

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Lawyers at the three pharmacy chains insist that when their pharmacists have any concerns, they have a policy to block the circulation of pills and will notify the authorities of suspicious orders from doctors. They also said that doctors control how many pills are prescribed for legal medical needs.

Spokespersons for CVSHealth and Walgreen Co. said the two companies disagree with the verdict and will appeal.

“As the plaintiff’s own experts testified, many factors contribute to the problem of opioid abuse, and solving this problem requires the participation of all stakeholders in our healthcare system and all members of our community,” CVS spokesperson Mike DeAngelis said. Said in a statement.

Walgreens spokesperson Fraser Engerman said the company believes that the court erroneously “allowed the case to be submitted to a jury on the grounds of flawed legal theory that is inconsistent with Ohio law.”

“As we said throughout the process, we never made or sold opioids, nor did we distribute them to the’pill factories’ and Internet pharmacies that contributed to this crisis,” Engelman said in a statement Say. “The plaintiff tried to solve the opioid crisis by expanding the pollution law unprecedentedly. This is a misleading and unsustainable practice.”

Two other chains—Rite Aid and Giant Eagle—have reached settlements with two counties in Ohio.

Lanier said during the trial that the pharmacy tried to blame everyone but themselves.

Lanier told jurors that the opioid crisis has overwhelmed courts, social service agencies, and law enforcement in Ohio’s blue-collar corner east of Cleveland, leaving behind heartbroken families and babies born to drug-addicted mothers.

Between 2012 and 2016, Trumbull County alone distributed approximately 80 million prescription painkillers—the equivalent of 400 prescription painkillers per resident.

In Lake County, approximately 61 million pills were distributed during this period.

At the beginning of the trial, Walgreens lawyer Kaspar Stoffelmayr said that as the number of doctors prescribing painkillers such as oxycodone and hydrocodone has increased, the medical community has begun to realize that patients have the right to receive pain treatment.

He said the problem is that “the drug maker tricked the doctor into writing too many pills.”

The counties stated that pharmacies should be the last line of defense to prevent pills from falling into the hands of criminals.

Lanier said they did not hire enough pharmacists and technicians, nor did they train them to prevent this from happening, nor did they implement a system to flag suspicious orders.

The trial of U.S. District Judge Dan Polster in Cleveland is part of a broader federal opioid lawsuit — some 3,000 in total — and these lawsuits have been combined under the supervision of the judge. Other cases are being heard in state courts.

Kevin Roy, chief public policy officer of Shatterproof, an advocacy group for addressing addiction, said the verdict may lead pharmacies to follow the example of major distribution companies and some drugmakers, which have already settled nationwide A multi-billion dollar opioid case.

So far, no pharmacy has reached a settlement nationwide.

Roy said: “This is a signal, at least in some places, the public believes that it has been exposed and needs remediation.”

The council of local government lawyers suing the pharmaceutical industry in federal court called Tuesday’s decision a “milestone victory.”

The plaintiff’s executive committee said in a statement: “For decades, pharmacy chains have watched pills flow out of their doors and cause harm, but failed to act as required by law.” “On the contrary, these companies responded by opening more. The location, the use of pills to flood the community and promote the flow of opioids into the illegal secondary market. Today’s verdicts against Wal-Mart, Walgreens and CVS represent their long overdue liquidation of their complicity in causing public nuisance.”

The government’s claims against drug manufacturers, distributors, and pharmacies depend on state and local pollution laws.

Roy pointed out that the courts are not consistent in whether these laws apply to such cases. “There have been various decisions recently that should give us reason to be cautious about what this really means in the grand plan,” he said.

Two recent rulings run counter to this theory. More and more cases are moving towards adjudication.

Trials are currently being conducted against drugmakers in New York and distribution companies in Washington State. The trial for claims against the West Virginia distribution company has ended, but the judge has not yet issued a verdict.

In early November, a judge in California ruled in a lawsuit against the three counties and the city of Oakland in favor of the top drugmaker. The judge said the government has not proven that pharmaceutical companies use deceptive marketing to increase unnecessary opioid prescriptions and cause public nuisance.

Also in November, the Oklahoma Supreme Court overturned the state’s decision in a $465 million lawsuit filed against the drugmaker Johnson & Johnson in 2019.

Other litigation resulted in a major settlement or proposed settlement before the trial was completed.

The jury’s decision in Cleveland has little effect on the stocks of CVS, Walgreens and Walmart. On Tuesday, the shares of all three companies rose. This year, the shares of CVS and Walgreens have risen 36% and 19%, respectively.