After weeks of testimony, Baltimore’s landmark case against drug distributors accused of contributing to the opioid epidemic is in the hands of six city residents.

Jurors in the civil trial will begin deliberating Friday morning after a full day of closing arguments from the city’s lawyers and from the distributors, McKesson and AmerisourceBergen.

“This is the biggest and most important case in the city’s history,” Baltimore’s lead attorney, Bill Carmody, told jurors. “Do justice.”

The lawsuit claims that the drug distributors — which are among the largest companies in the nation — shipped millions upon millions of opioid pills to Baltimore pharmacies without concern for the impact a huge influx of addictive painkillers might have on the community.

Baltimore has argued throughout the trial that it was making progress in reducing heroin overdoses until opioids like oxycodone flooded the city and county, enabled by drug companies more concerned about profits than public health and safety.

When the supply of painkillers began to dry up amid a federal crackdown in 2012, the city claims, people who had become addicted to prescription opioids turned to dangerous street drugs like heroin and fentanyl, fueling one of the deadliest overdose epidemics in the nation.

“See something, say nothing” was the distributors’ playbook, Carmody told jurors. Though federal regulations required drug manufacturers and distributors to report suspicious orders of controlled substances, the city claims that McKesson and AmerisourceBergen ignored that responsibility and went years without reporting a single suspicious order in Baltimore.

Carmody asked jurors to award Baltimore $260,243,587 in damages to cover the costs of responding to the opioid crisis, including policing, emergency response and public health measures.

“It doesn’t have to be inevitable that there’s going to be an opioid epidemic in Baltimore,” Carmody said. With resources — like money from the drug distributors — the city can fight back, he said.

Baltimore has already won more than $400 million in settlements from other opioid companies named in the lawsuit, including Walgreens, CVS, Cardinal Health and Johnson & Johnson. The city declined to participate in a statewide settlement with Johnson & Johnson and the “big three” opioid distributors and has already won more than the entire state of Maryland will receive through that deal.

But the drug companies argue that they did not cause the “public nuisance” that is at the heart of the city’s lawsuit. The distributors say they simply sold legal painkillers to licensed pharmacies that were filling prescriptions doctors wrote for their patients.

The vast majority of doctors were prescribing opioids in good faith, said McKesson attorney Andrew Stanner, and prescribed more of the drugs in response to changing medical standards that called for using opioid painkillers to manage chronic pain. (In retrospect, most experts agree those standards went too far and ignored the risks associated with the addictive drugs.)

Stanner said it is ridiculous to blame two drug distributors for the city’s opioid crisis when there were thousands of doctors and hundreds of pharmacies operating in Baltimore, in addition to an established illegal drug trade.

“We’re certainly not trying to blame the city of Baltimore,” Stanner said, but “any honest assessment” of the opioid crisis has to start with crime.

Both companies argued that they tried to follow the Drug Enforcement Administration’s regulations but received little guidance from the federal agency, which also hiked opioid manufacturing thresholds during the same period.

The city filed its lawsuit with the benefit of hindsight, the distributors’ lawyers said, but didn’t fairly represent what the companies knew at the time, when the opioid crisis was still developing and unscrupulous doctors hadn’t yet been charged with crimes.

“Could we or should we reasonably have known, when nobody else did?” Stanner asked. “When McKesson saw something, it did something.”

The attorneys also told jurors that the city failed to support its claims with evidence.

“Time and again, the city and its paid experts made broad, general assertions that they did not back up,” said Robert Nicholas, one of the lawyers for AmerisourceBergen.

The lawsuit centers on a small number of pharmacies where, the city’s lawyers contend, drug distributors should have noticed red flags for opioid diversion. The most prominent is Drug City, a pharmacy in Dundalk that received nearly 20 million opioid pills between 2006 and 2019 and was McKesson’s top buyer of oxycodone among independent pharmacies nationwide.

McKesson increased Drug City’s threshold for opioids over and over again, at one point selling 3 million pills there in a single year. The company continued shipping opioids there even after the DEA reached out to inquire about the pharmacy in 2011.

“They just keep selling more and more and more oxys to Drug City,” Carmody said.

Drug City and its former owner reached a $900,000 settlement with the DEA in 2016 for dispensing controlled substances to people that the company “should have known were diverting the drugs.”

Carmody also said AmerisourceBergen similarly failed to meet its regulatory requirements by informing pharmacy customers of their opioid thresholds so they could avoid triggering suspicious order monitoring systems. In 2013, for example, AmerisourceBergen took over distribution at some Walgreens stores and acknowledged in emails that the pharmacies were considered “high risk.”

“It was kind of a race to the bottom,” Carmody said. If one opioid distributor told its customers their thresholds, others followed suit in order to stay competitive.

The distributors, Carmody argued, “didn’t bring a single witness into this case who defended their conduct.”

“Because their conduct was indefensible,” he said. The companies largely relied on expert witnesses rather than calling their own employees to testify.

Jurors have been asked to decide whether a public nuisance exists in the city of Baltimore (in this case, a population of people whose opioid use disorder began with the misuse of prescription opioids), whether the drug companies acted “unreasonably,” and whether their conduct was a “substantial factor” in causing the public nuisance.

If jurors find the companies liable, they will also have to decide how much money to award the city and how to split up the cost among the distributors. The distributors have also argued that other parties are responsible for the public nuisance, and the jury could decide that the companies played only a small role in the crisis and award damages accordingly.