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A global megacorporation best known for Band-Aids and baby powder may have to pay billions for its alleged role in the opioid crisis.听 was the sole defendant in a closely watched trial that wrapped up in Oklahoma state court this week, with a decision expected later this summer. The ruling in the civil case could be the first that would hold a pharmaceutical company responsible for one of the in American history.

Oklahoma Attorney General听听lawsuit alleges Johnson & Johnson and its subsidiary 听helped ignite the opioid crisis with overly aggressive marketing, leading to thousands of overdose deaths over the past decade in Oklahoma alone.

The trial took place over seven weeks in the college town of Norman. Instead of a jury, a state judge heard the case.

During closing arguments Monday, Hunter called the company the 鈥渒ingpin鈥� of the opioid crisis.

鈥淲hat is truly unprecedented here is the conduct of these defendants on embarking on a cunning, cynical and deceitful scheme to create the need for opioids,鈥� Hunter said.

The state urged Judge Thad Balkman, who presided over the civil trial, to find Johnson & Johnson liable for creating a 鈥減ublic nuisance鈥� and force the company to pay more than $17 billion over 30 years to abate the public health crisis in the state.

Driving the opioid crisis home has been a cornerstone of Oklahoma鈥檚 lawsuit. In closing arguments Monday, one of the state鈥檚 attorneys, Brad Beckworth, cited staggering prescribing statistics in the county where the trial took place.

鈥淲hat we do have in Cleveland County is 135 prescription opioids for every adult,鈥� Beckworth said. 鈥淭hose didn鈥檛 get here from drug cartels. They got here from one cartel: the pharmaceutical industry cartel. And the kingpin of it all is Johnson & Johnson.鈥�

Johnson & Johnson鈥檚 attorney Larry Ottaway, rejected that idea in his closing argument, saying the company鈥檚 products, which had included the fentanyl patch Duragesic and the opioid-based pill Nucynta, were minimally used in Oklahoma.

He scoffed at the idea that physicians in the state were convinced to unnecessarily prescribe opioids due to the company鈥檚 marketing tactics.

鈥淭he FDA label clearly set forth the risk of addiction, abuse and misuse that could lead to overdose and death. Don鈥檛 tell me that doctors weren鈥檛 aware of the risks,鈥� Ottaway said.

Ottaway played video testimony from earlier in the trial, showing Oklahoma doctors who said they were not misled about the drugs鈥� risks before prescribing them.

鈥淥nly a company that believes its innocence would come in and defend itself against a state, but we take the challenge on because we believe we are right,鈥� Ottaway argued.

Johnson & Johnson Fought On After Settlements

Initially, Hunter鈥檚 lawsuit included Purdue Pharma, the maker of OxyContin. In March,听听with the state for $270 million. Soon after, , including fraud, against the two remaining defendants.

Just two days before the trial began, another defendant, Teva Pharmaceuticals of Jerusalem, announced an听听with the state. The money will be used for litigation costs and an undisclosed amount will be allocated 鈥渢o abate the opioid crisis in Oklahoma,鈥� according to a press release from Hunter鈥檚 office.

Both companies deny any wrongdoing.

The Legal Liability Of 鈥楶ublic Nuisance鈥�

Most states and more than 1,600 local and tribal governments are suing drugmakers who manufactured various kinds of opioid medications, and drug distributors. They are trying to recoup billions of dollars spent addressing the human costs of opioid addiction.

鈥淓veryone is looking to see what鈥檚 going to happen with this case, whether it is going to be tobacco all over again, or whether it鈥檚 going to go the way the litigation against the gun-makers went,鈥� says University of Georgia law professor听.

But the legal strategy is complicated. Unlike the tobacco industry, from which听, the makers of听prescription opioids manufacture a product that serves a legitimate medical purpose and is prescribed by highly trained physicians 鈥� a point that Johnson & Johnson鈥檚 lawyers made numerous times during the trial.

Oklahoma鈥檚 legal team based its entire case on a claim of public nuisance, which refers to actions that harm members of the public, including injury to public health. Burch says each state has its own public nuisance statute, and Oklahoma鈥檚 is very broad.

鈥淛ohnson & Johnson, in some ways, is right to raise the question: If we鈥檙e going to apply public nuisance to us, under these circumstances, what are the limits?鈥� Burch said. 鈥淚f the judge or an appellate court sides with the state, they are going to have to write a very specific ruling on why public nuisance applies to this case.鈥�

Burch said the challenge for Oklahoma has been to tie one opioid manufacturer to all of the harms caused by the ongoing public health crisis, which includes people struggling with addiction to prescription drugs, but also those harmed by illegal street opioids, such as heroin.

University of Kentucky law professor听 agreed that it鈥檚 difficult to pin all the problems on just one company.

鈥淐ompanies do unethical or immoral things all the time, but that doesn鈥檛 make it illegal,鈥� Ausness said.

If the judge rules against Johnson & Johnson, Ausness said, it could compel other drug companies facing litigation to settle out of court. Conversely, a victory for the drug giant could embolden the industry in the other cases.

Earlier in the trial, the state鈥檚 expert witness, Dr. Andrew Kolodny, testified that Johnson & Johnson did more than push its own pills 鈥� until 2016, it also profited by manufacturing raw ingredients for opioids and then selling them to other companies, including Purdue, which makes Oxycontin.

鈥淧urdue Pharma and the Sacklers have been stealing the spotlight, but Johnson & Johnson in some ways, has been even worse,鈥� Kolodny testified.

Kolodny said that鈥檚 why the company downplayed to doctors the risks of opioids as a general class of drugs, knowing that almost any opioid prescription would benefit its bottom line.

The state鈥檚 case also focused on the role of drug sales representatives. Drue Diesselhorst was one of Johnson & Johnson鈥檚 busiest drug reps in Oklahoma. Records discussed during the trial showed she continued to call on Oklahoma doctors who had been disciplined by the state for overprescribing opioids. She even continued to meet with doctors who had patients who died from overdoses.

But Diesselhorst testified she didn鈥檛 know about the deaths, and no one ever instructed her to stop targeting those high-prescribing physicians.

鈥淢y job was to be a sales rep. My job was not to figure out the red flags,鈥� she said on the witness stand.

The Role And Responsibility Of Doctors

Throughout the trial, Johnson & Johnson鈥檚 defense team avoided many of the broader accusations made by the state, instead focusing on the question of whether the specific opioids manufactured by the company could have caused Oklahoma鈥檚 high rates of addiction and deaths from overdose.

Johnson & Johnson鈥檚 lawyer, Larry Ottaway, argued the company鈥檚 opioid products had a smaller market share in the state compared to other pharmaceutical companies, and he stressed that the company made every effort when the drugs were tested to prevent abuse. He also pointed out that the sale of both the raw ingredients and prescription opioids themselves are heavily regulated.

鈥淭his is not a free market,鈥� he said. 鈥淭he supply is regulated by the government.鈥�

Ottaway maintained the company was addressing the desperate medical need of people suffering from debilitating, chronic pain 鈥� using medicines regulated by the Food and Drug Administration and the Drug Enforcement Administration. Even Oklahoma purchases these drugs, for use in state health care services.

Next Steps

Judge Thad Balkman is expected to announce a verdict in August.

If the state鈥檚 claim prevails, Johnson & Johnson could, ultimately, have to spend billions of dollars in Oklahoma helping to ease the epidemic. State attorneys are asking that the company pay $17.5 billion over 30 years, to help abate the crisis in the state.

Balkman could choose to award the full amount, or just some portion of it, if he agrees with the state鈥檚 claim.

鈥淵ou know, in some ways, I think it鈥檚 the right strategy to go for the $17 billion,鈥� Burch, the law professor, said. 鈥淸The state is saying] look, the statute doesn鈥檛 limit it for us, so we鈥檙e going to ask for everything we possibly can.鈥�

In the case of a loss, Johnson & Johnson is widely expected to appeal the verdict. If Oklahoma loses, the state will appeal, Attorney General Mike Hunter said Monday.

This story is part of a partnership that includes , and Kaiser Health News.