(AP) — A hearing has begun in federal court in Cleveland for a judge to determine how much CVS, Walgreens and Walmart pharmacies should pay two Ohio counties to help them ease the ongoing costs and problems caused by the opioid crisis.

A jury in November found the pharmacy chains responsible for recklessly distributing massive amounts of pain pills in Lake and Trumbull counties. It was the first time pharmacies in the U.S. have been held responsible for the opioid crisis.

Plaintiff’s attorneys said before trial that each county needs about $1 billion to repair the damage caused by the flood of pills, which caused hundreds of overdose deaths.

Around 80 million prescription painkillers were dispensed in Trumbull County between 2012 and 2016 — 400 for every county resident — while 61 million pills were dispensed in Lake County during that five-year period — 265 pills for every resident.

Dr. Katherine Keyes, an epidemiologist from Columbia University, testified Tuesday that her estimates show nearly 6,000 people were addicted to opioids in 2019 in Lake County and nearly 7,600 suffered from opioid use disorder in Trumbull County that year. Thousands of children in the two counties suffer from mental illness, learning problems and other issues like PTSD because their parents use illicit opioids, Keyes testified.

Drug overdose deaths increased since 2015 because of synthetic opioids like fentanyl in the two counties, Keyes said, and some of those users’ drug problems began after initially becoming addicted to prescription opioids. Children of parents who illegally use opioids are at a higher risk for addiction as well, she testified.

Attorneys for the pharmacy chains questioned Keyes at length about the methodology she used to arrive at her estimates.

Back in November, a jury in U.S. District Judge Dan Polster’s courtroom sided with the counties and agreed that the way the pharmacies dispensed pain medication played an outsized role in creating a public nuisance.

Now, the counties are expected to present testimony from doctors to discuss the harm suffered by those communities, the opioid crisis’ impact on child welfare and other county agencies, and an abatement plan created for the counties.

“The jury sounded a bell that should be heard through all pharmacies in America,” Mark Lanier, the lead attorney for the counties, said after November’s verdict.

Across the U.S., many lawsuits filed by governments over the toll of the drugs have been resolved in recent years — most with settlements, and some with judgments or verdicts in trials. So far, drug makers, distributors and pharmacies have agreed to settlements totaling well over $40 billion, according to an Associated Press tally.

Trials are underway in courts in West Virginia, Florida and California. A decision has not yet been issued after another trial last year in West Virginia.

According to an April 25 court filing, the abatement plan created for Lake and Trumbull counties by Dr. Caleb Alexander of John Hopkins Bloomberg School of Public Health, “are reasonable and necessary to abate the public nuisance found by the jury.”

The plan focuses on prevention, treatment, recovery and “measures intended to specifically address the needs of special populations who have been uniquely affected by the opioid epidemic,” the court filing said.

Attorneys for Walgreens and Walmart argued in a court filing that the counties’ $878 million abatement plan should be limited to one year and not the minimum of five years the counties argue they need. One of the pharmacy chains’ experts has estimated the actual cost at $346 million while another expert said it’s less than $35 million, the filing said.

Defense attorneys also argued that damage caused by other entities who contributed to the public nuisance of opioid addiction should be excluded from any amounts awarded by Polster and that those costs should be limited to the pharmacies’ “appropriate share of contribution to the nuisance.”

Pharmacy chain Rite-Aid settled with the counties in early October before the start of trial. Pittsburgh-based Giant Eagle reached a settlement with the counties in late October after the trial started.

There were nearly 500,000 deaths caused by legal and illegal opioids between 2000 and 2019, according to the U.S. Centers for Disease Control.