NORMAN, Okla. — Who is to blame?

That’s the question in the state of Oklahoma’s civil lawsuit against Johnson & Johnson and its subsidiary, Janssen. The two sides made opening statements Tuesday in a trial held in Cleveland County, Oklahoma, District Judge Thad Balkman’s courtroom.

This trial is being heard before the judge and not a jury. This is the first to go to trial of some 2,000 lawsuits filed by states, local governments and Native American tribes alleging the pharmaceutical industry helped fuel the opioid crisis.

Oklahoma Attorney General Mike Hunter’s team asserts Johnson & Johnson contributed to a public nuisance in his state and the company should pay to fix it. That could cost up to $17.5 billion over the next 30 years and, under Oklahoma statutes, Hunter believes J&J should pay the whole tab. Two others named in the lawsuit, Purdue Pharma (the maker of OxyContin) and Teva Pharmaceuticals, have settled with the state for a combined $355 million.

J&J attorneys said the company only made two products — both designed to reduce the likelihood of abuse or diversion — comprising a tiny market share of opioids sold in Oklahoma over the past several decades, and that the drugs were regulated and approved at the state and federal level.

In the state’s opening statement, Hunter said more than 4,500 Oklahomans died of opioids from 2007-2017 and thousands more are battling addiction, calling the epidemic the “largest manmade health crisis” in the state.

“How did this happen? Greed,” he said.

Attorney Brad Beckworth said the opioid crisis began in the mid-90s as opioid manufacturers began developing and marketing their products as drugs to solve chronic pain: drugs to start treatment with, and for patients to stay on long-term. These companies then used “deceptive marketing” and “aggressive sales techniques” to influence people to flood the market with opioids.

“When you oversupply, people die,” Beckworth said. 

In the defense’s opening statement, attorney Larry Ottaway said J&J produced necessary medications approved and regulated by the federal government that were lawfully marketed and dispersed and, in cases of opioids prescribed to individuals on the state’s Medicare program, were reimbursed by the state.

“The state will present zero documented cases of addiction or death due to doctors prescribing Janssen products,” Ottaway said.

Ottaway also disagreed with the state’s use of Oklahoma public nuisance law as the basis for its claim, noting a hundred years of precedent demonstrate public nuisance claims almost always involve property.

“Nuisance just doesn’t apply here,” he said.

The state’s first witness was Julio Rojas, a psychologist at the University of Oklahoma’s Health Sciences Center in Oklahoma City. Rojas testified that opioids are highly addictive, and walked the court through the impact of opioid use on individuals at a higher risk for addiction.

Rojas said that due to the social stigma surrounding opioid abuse, addicts rarely seek treatment. He said opioid addiction is a chronic illness that requires at least 90 days in a residential treatment facility and a lifestyle change.

On Wednesday, the state is expected to call Enid, Oklahoma, attorney Craig Box as a witness. Box’s son, Austin, was a former University of Oklahoma student and football player. When he died in 2011, he had five opioids present in his system. 

The trial is expected to take six-to-eight weeks, although the last-second Teva Pharmaceuticals settlement, announced Sunday, may reduce that timeline, Hunter said.