Three retail pharmacy chains recklessly distributed vast amounts of pain pills in two Ohio counties, a federal jury said on Tuesday, in a verdict that could set the tone for US city and county governments that want to hold pharmacies accountable for their roles in the opioid crisis. Lake and Trumbull counties blamed pharmacies operated by CVS, Walgreens and Walmart for not stopping the flood of pills that caused hundreds of overdose deaths and cost each of the two counties about $1bn, their attorney said. It was the first time pharmacy companies had completed a trial to defend themselves in a drug crisis that has killed half a million Americans over the past two decades. The counties were able to convince the jury the pharmacies played an outsized role in creating a public nuisance in the way they dispensed pain medication into their communities. Attorneys for the chains maintained they had policies to stem the flow of pills when pharmacists had concerns and would notify authorities about suspicious orders from doctors. They also said it was the doctors who controlled how many pills were being prescribed for legitimate medical needs. Two other chains – Rite Aid and Giant Eagle – have settled lawsuits with the two Ohio counties. Attorney Mark Lanier, who represented the counties, said during the trial that the pharmacies were attempting to blame everyone but themselves. The opioid crisis has overwhelmed courts, social services agencies and law enforcement in Ohio’s blue-collar corner east of Cleveland, leaving behind heartbroken families and babies born to addicted mothers, Lanier told jurors. Roughly 80m prescription painkillers were dispensed in Trumbull county alone between 2012 and 2016 – equivalent to 400 for every resident. In Lake county, about 61m pills were distributed during the same period. The rise in physicians prescribing pain medications such as oxycodone and hydrocodone came at a time when medical groups began recognizing that patients have the right to be treated for pain, Kaspar Stoffelmayr, an attorney for Walgreens, said at the opening of the trial. The problem, he said, was that “pharmaceutical manufacturers tricked doctors into writing way too many pills”. The counties said pharmacies should be the last line of defense to prevent the pills from getting into the wrong hands. They didn’t hire enough pharmacists and technicians or train them to stop that from happening and failed to implement systems that could flag suspicious orders, Lanier said. The trial before US district judge Dan Polster in Cleveland was part of a broader constellation of federal opioid lawsuits – about 3,000 in total – that have been consolidated under the judge’s supervision. Other cases are moving ahead in state courts. It was one of five trials so far this year in the US to test claims brought by governments against parts of the drug industry over the toll of prescription painkillers. Trials against drugmakers in New York and distribution companies in Washington state are under way. A trial of claims against distribution companies in West Virginia has wrapped up, but the judge has not yet given a verdict. Earlier in November, a California judge ruled in favor of top drug manufacturers in a lawsuit with three counties and the city of Oakland. The judge said the governments hadn’t proven that the pharmaceutical companies used deceptive marketing to increase unnecessary opioid prescriptions and create a public nuisance. Also in November, Oklahoma’s supreme court overturned a 2019 judgment for $465m in a suit brought by the state against drugmaker Johnson & Johnson. Other lawsuits have resulted in big settlements or proposed settlements before trials were completed.