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Four drugmakers helped cause the deadly U.S. opioid epidemic and a “mountain” of pills to flood the country by deceptively marketing their drugs and downplaying their addictive risks, a lawyer for several California counties argued on Monday at the start of closely-watched trial.

Fidelma Fitzpatrick, the lawyer, told a California judge that Johnson & Johnson , Teva Pharmaceutical Industries Ltd , Endo International PLC and AbbVie’s Allergan unit needed to be held responsible for a drug crisis that only got worse during the COVID-19 pandemic.

Teva’s lawyer, Collie James, countered that the two drugs linked to his client had only ever made up a “minuscule” part of the market, and that doctors and patients were fully warned of the risks. Teva had acquired the drugs approved for breakthrough pain in cancer patients already on opioids with its purchase of Cephalon.

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The other drug companies are expected to make their opening statements later in the day.

The plaintiffs - the populous Santa Clara, Los Angeles and Orange counties and the city of Oakland - say the drugmakers should have to pay more than $50 billion to cover the costs of abating the public nuisance they created, plus penalties.

Fitzpatrick told Orange County Superior Court Judge Peter Wilson that the case was about the companies’ “deadly legacy” of trying to boost their profits by promoting opioid painkillers to treat chronic pain, resulting in a “mountain” of addictive pills flooding the state and country.

“The evidence will show each of these companies, all of them, knew what would happen: that their opioids would cause the crushing burden of addiction, overdose and death that California and its people have experienced,” she said.

James said the counties’ case was based on “suggestion and speculation.”

“You won’t hear from a single doctor who was ever misled,” he said.

Opioids have resulted in the overdose deaths of nearly 500,000 people from 1999 to 2019 in the United States, according to U.S. Centers for Disease Control and Prevention.

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More than 3,300 similar lawsuits are pending nationally over the opioid crisis. The only other case to go to trial in the opioid litigation resulted in the state of Oklahoma in 2019 winning a $465 million judgment against J&J, which is appealing.

Other cases are slated to go to trial in the coming months, creating new pressure for the companies to reach settlements.

The nation’s three largest drug distributors - McKesson Corp , AmerisourceBergen Corp and Cardinal Health Inc - and J&J have proposed paying a combined $26 billion to resolve the cases against them. The proposed deal has not been finalized.

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