a fine of $270 million in March 2019, and Teva Pharmaceuticals, which makes generic drugs, agreed to pay $85 million in May. Ohio jury trial On October 4, 2021, a landmark trial began in a Cleveland court. The defendants are pharmacy chains and operators, including Walmart, Walgreens and CVS. These chains are accused of not having enough trained staff and sophisticated systems to responsibly dispense opioids. Lawyers allege that pharmacies have not fulfilled their legal responsibility to act as a "last line of defense,” and that the chains enable illegal street dealing of prescription opioids. Lake and Trumbull Counties in northeast Ohio were the plaintiffs and alleged the chains had “substantially contributed to the crisis of opioid overdose and deaths….” in the counties. In November 2021, a 12-person jury, after five and a half days of deliberation, held the retailers accountable for contributing to a “public nuisance.” This was the first jury verdict in the decades-long crisis. The retailers said they would appeal the jury's verdict. On August 17, 2022, CVS, Walgreens and Walmart were forced to pay out $650.5 million to Lake and Trumbull County. States reject distributors’ settlement In February 2020, 21 US states turned down an $18 billion (US), 18-year offer from McKesson, Cardinal Health Inc. and AmerisourceBergen Corp. that would have resolved litigation against the pharmaceutical companies over their distribution of the addictive painkillers. A letter from the attorneys general of Ohio, Florida and Connecticut (among others) said the settlement, as “currently structured,” was not acceptable to the states. This particular offer was part of the proposed $50 billion (US) agreement to find a resolution to over 2,000 lawsuits from both local and state governments attempting to recoup billions of dollars they have spent combatting the crisis. July 2021 settlement Four major drug manufacturers and distributors, J&J, McKesson, Cardinal Health, and AmerisourceBergen, have agreed to a settlement announced by a group of state attorneys general in July 2021. The settlement, $26 billion (US), will be used on the prevention of opioid addiction and treatment programs. J&J will pay $5 billion (US) over the next five years; the remaining $21 billion (US) will be paid by the other firms. The settlement, when approved by a "significant" group of states and local governments, will settle more than 4,000 individual legal actions. All four of the manufacturing firms disputed all allegations in the lawsuits. Cleveland Settlement The United States’