The first federal case against the opioid industry goes to trial Monday. Some companies have settled to avoid trial, others will get their day in court.

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Local governments across the country want the drug industry to pay for the damage from the opioid crisis. Thousands of counties, cities, Native American tribes and other parties have sued manufacturers, distributors and pharmacies. Opening arguments are scheduled to begin next Monday in the first set of claims to go to trial. Two Ohio counties will serve as plaintiffs. And all the while, attorneys continue to negotiate possible settlements. From member station WCPN, Nick Castele reports.

NICK CASTELE, BYLINE: Eric Stimac’s path to addiction began with a work injury. Several years ago, he says, he was working a side job on a day off.

ERIC STIMAC: It was some stage flooring. We were unloading off of the back of a box truck. And it fell off of the lift gate and then landed on my foot and crushed my foot.

CASTELE: Stimac was prescribed opioid painkillers, he says, and grew addicted. After a close friend died of a heroin overdose, Stimac describes reacting in a way that may seem surprising.

STIMAC: My first thought was, well, if, you know, if this was something that they were willing to give their life over, what’s the deal with it, you know? So that’s when I tried heroin for the first time.

CASTELE: After an arrest, Stimac sought treatment at IBH Addiction Recovery Center, where we talked on a porch overlooking the campus. It’s a residential facility in Summit County, Ohio, one of the two plaintiffs in the upcoming trial. Stimac is now part of a post-treatment volunteer program that he says has given meaning to his life.

Many people have gone down the same road, beginning with prescription pills before moving to street drugs, such as heroin or fentanyl. That’s why counties say drug companies are responsible for lighting the fuse of an addiction crisis that exploded and strained local services.

JONATHAN WYLLY: An average episode here is going to cost between $15-20,000.

CASTELE: Jonathan Wylly is the executive director of IBH. Treatment centers like this one often bill Medicaid for those costs, he says, and also receive funding from county addiction and mental health boards. Wylly says no amount of money can truly match the damage that people have suffered here.

WYLLY: There’s no number they can come up with that’s going to meet at the societal cost of what the opiate epidemic has meant to this state.

CASTELE: There’s the cost to medical examiners for toxicology reports after overdose deaths, to the foster system to care for children who have lost parents, to local jails and courts that handle drug cases. An expert witness for the plaintiffs says damages in these two Ohio counties could run higher than $200 million. The counties have accused drug companies of marketing painkillers aggressively while underplaying the risk of addiction and of failing to control suspicious orders of pills.

ANDREW POLLIS: This case, the facts of the case are just incredibly strong. They’re devastating.

CASTELE: Andrew Pollis is a law professor at Case Western Reserve University.

POLLIS: They demonstrate, really, a profit-driven desire to exploit the fact that opioids are inherently physically addictive.

CASTELE: Companies didn’t make representatives available for interviews. But in court filings, they’ve said counties can’t pin the crisis on the industry. They say they plan to argue that they complied with a changing set of federal rules and that they can’t be blamed for the damage of illegal drugs. Abbe Gluck is faculty director of the Solomon Center for Health Law and Policy at Yale Law School.

ABBE GLUCK: I would predict that we’re going to see a lot of attention to this question of causation. Can we really say that all of these different defendants caused the harm that they’re being sued for causing?

CASTELE: She says defendants may point out there are many decision-makers in the drug supply chain, including the FDA, doctors and patients.

GLUCK: And what the defendants have been saying all along is that it’s impossible to trace any one of their actions to any one overdose or any one addiction problem.

CASTELE: Manufacturers have largely settled with the two Ohio counties, allowing them to avoid trial. And settlement negotiations have gone down to the wire with opioid distributors. Those possible nationwide agreements could be worth billions of dollars.

For NPR News, I’m Nick Castele in Cleveland.

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