An Oklahoma judge has ordered Johnson & Johnson to pay $572.1 million (£468 million) to the state for its part in fuelling an opioid epidemic in the state.
The drugmaker was found to have been by deceptively marketing addictive painkillers, but the giant fine is something of a letoff - with investors fearing a much larger sum.
Oklahoma's attorney general filed the lawsuit, looking for $17 billion to address the impact of the drug crisis on Oklahoma.
"The expectation was this was going to be a $1.5 billion to $2 billion fine," said Jared Holz, healthcare strategist for Jefferies & Co. "$572 million is a much lower number than had been feared."
Johnson & Johnson said it would appeal the decision nonetheless.
Opioids were involved in almost 400,000 overdose deaths from 1999 to 2017, according to the US Centers for Disease Control and Prevention.
Since 2000, some 6,000 Oklahomans have died from opioid overdoses, according to the state's lawyers.
Roughly 2,500 lawsuits have been brought by states, counties and municipalities nationally seeking to hold drugmakers responsible for opioid abuse nationwide. Oklahoma's case was the first to go to trial. Some drugmakers have chosen to settle cases.
In holding Johnson & Johnson liable after a seven-week, non-jury trial, Judge Thad Balkman of Cleveland County District Court in Norman, Oklahoma, said the state proved that Johnson & Johnson's misleading marketing and promotion of its Duragesic and Nucynta painkillers created a public nuisance.
"The opioid crisis is an imminent danger and menace to Oklahomans," Balkman said.
Oklahoma wanted J&J to help it address the epidemic for the next 30 years by funding addiction treatment and prevention programs.
Balkman said in his written ruling that the award covered only one year of addressing the crisis because Oklahoma did not demonstrate the time and costs needed beyond that.
Lance Lang, a 36-year-old recovering user of opioids turned activist in Oklahoma City, said it was "short sighted" for the judge to have only ordered funding for a year.
"There's going to be people struggling with this for years," he said in an interview.
J&J said it will ask that the award be put on hold during an appeal process that could stretch into 2021. The company also said Oklahoma failed to show that its products and activities had created a public nuisance.
"You can't sue your way out of the opioid abuse crisis," Sabrina Strong, a lawyer for Johnson & Johnson, said at a news conference after the verdict.
"Everyone must come together to address this. But Johnson & Johnson did not cause the opioid crisis."
"Accountable for deaths and addiction"
The case was brought by Oklahoma Attorney General Mike Hunter, who alleged that Johnson & Johnson's marketing practices helped fuel the opioid epidemic by flooding the market with painkillers.
"Johnson & Johnson will finally be held accountable for thousands of deaths and addictions caused by their actions," Hunter said.
The trial came after Oklahoma had resolved claims against OxyContin maker Purdue Pharma LP in March for $270 million and Teva in May for $85 million, leaving Johnson & Johnson as the only defendant.
During the Oklahoma trial, lawyers for the state argued that Johnson & Johnson carried out a years-long marketing campaign that minimised the painkillers' addiction risks and promoted their benefits.
The lawyers called Johnson & Johnson an opioid "kingpin" and argued that its marketing created a public nuisance as doctors over-prescribed the drugs, leading to a surge in overdose deaths.
Johnson & Johnson countered that its marketing claims had scientific support and its painkillers accounted for a tiny fraction of opioids prescribed in Oklahoma.
The company said in a statement that since 2008, its painkillers accounted for less than 1% of the US market, including generics.
Teva said the ruling supported its reasons for settling the case before trial.
