A federal judge ordered CVS, Walgreens and Walmart to pay a collective $650.5 million to two counties in Ohio for their part fueling the opioid crisis in the state, a landmark ruling that lays partial blame for the epidemic on pharmacies that supplied the drugs.

U.S. District Judge Dan Aaron Polster said the penalty must be paid over the next 15 years, the first ruling that hands down a massive monetary figure against pharmacy chains. The ruling came after a federal jury found last November that the three chains had substantially contributed to the opioid crisis, turning a blind eye to the burgeoning epidemic of abuse and dispensing pain medication without considering red flags.

The money will be used to address the ongoing opioid epidemic in Ohios Lake and Trumbull counties, near Cleveland. Lake County will receive about $306 million and Trumbull $344 million. The companies will also be required to increase their monitoring and reporting rules for opioid prescriptions.

Mark Lanier, a lawyer for the plaintiffs in the case, presented expert testimony that the two counties would need more than $3 billion to address the opioid crisis. The judge, however, said the pharmacies were just one of three major components that needed to be held accountable, the others being the drug manufacturers and drug distributors.

The $650.5 million figure represents about a third of that $3 billion, the judge said.

These companies are rending the fabric of society apart, Lanier told The New York Times on Wednesday. They should not only show remorse, they should show they need to rectify what theyve done. And they wont do it. So the judge is doing it.

About 80 million prescription painkillers were dispensed by pharmacies in Trumbull County from 2012 to 2016, The Associated Press added , about 400 for every resident.

Polster said in his ruling Wednesday that the pharmacies had largely ignored orders that they submit proposals to address what damages they thought they might owe. The companies, the judge added, squandered the opportunity to present a meaningful plan to abate the nuisance.

The three pharmacy giants said they planned to appeal the ruling.

Instead of addressing the real causes of the opioid crisis, like pill mill doctors, illegal drugs and regulators asleep at the switch, plaintiffs lawyers wrongly claimed that pharmacists must second-guess doctors in a way the law never intended and many federal and state health regulators say interferes with the doctor-patient relationship, Walmart said in a statement .

The decision is the latest court ruling against companies at the top of the opioid crisis and reflects the growing legal challenges for those who were linked to the epidemic.

Purdue Pharmas Sackler family agreed to pay as much as $6 billion in March as part of a sweeping settlement with almost all U.S. states and thousands of local governments for its role in selling and marketing OxyContin. Teva Pharmaceuticals, one of the countrys biggest manufacturers of generic opioids, also reached a $4.25 billion settlement last month with thousands of local governments, states and tribal regions for its role in the crisis.

More than half a million American s have died from opioid-related causes since 1999, and nearly 75% of all drug overdose deaths in 2020 involved an opioid, according to the Centers for Disease Control and Prevention. Overdose deaths rose to record levels in 2021, linked heavily to the worsening fentanyl crisis .