Reuters – A West Virginia city and county launched their case against the three largest U.S. drug distributors at a widely anticipated trial on Monday, accusing them of fueling the opioid crisis that has resulted in nearly 500,000 overdose deaths in the United States over two decades.

“We intend to prove the simple truth that the distributor defendants sold a mountain of opioid pills into our community, fueling the opioid epidemic,” Paul Farrell, a lawyer for Cabell County, said in his opening statement in Charleston, West Virginia.

The distributors—AmerisourceBergen Corp, McKesson Corp and Cardinal Health Inc—have denied the allegations, saying they are not responsible for drugs that reached the black market after they were sold.

Robert Nicholas, a lawyer for AmerisourceBergen, said on Monday that the “true roots” of the opioid crisis was the increasing number of prescriptions written by doctors.

AmerisourceBergen “always reported suspicious orders,” but state authorities did not act on those reports, Mr. Nicholas said.

A verdict in the trial could help lay the groundwork for settlements in the sprawling nationwide litigation over the opioid crisis, which encompasses more than 3,300 lawsuits by local governments around the country against opioid manufacturers, distributors and pharmacies.

The town of Huntington and Cabell County, the plaintiffs in the case, opted out of a proposed $26 billion nationwide settlement with the three distributors and drugmaker Johnson & Johnson.

Mr. Farrell said Huntington and Cabell County would use detailed records of opioid sales to show the enormous volume of the addictive pain medicines sold in the region, citing a 2016 report from the West Virginia Gazette-Mail that the wholesalers had sold 780 million hydrocodone and oxycodone pills in the state.

He said there were numerous “black flags” showing the distributors were aware that their drugs were being diverted into illegal channels, but nonetheless continued to escalate opioid sales.

Opioids resulted in the overdose deaths of nearly 500,000 people in the United States from 1999 to 2019, according to the U.S. Centers for Disease Control and Prevention. West Virginia is among the hardest hit states, recording more opioid prescriptions and overdose deaths per capita than any other in 2018, according to data from the National Institutes of Health.

Another opioid trial is underway in a case brought by California counties against J&J and other drugmakers, and a trial in a case brought by New York counties is scheduled to begin next month.