Long anticipated bundled proceedings against opioid manufacturers and US opioid distributors began on Oct. 16 in a US court in Cleveland, Ohio, where cases against Israeli generics giant Teva and five distributors were to be heard.

Pharma industry watchers are hedging their bets as to whether the multidistrict litigation will lead to a global settlement of thousands of pending cases or end in a landmark trial against many drugmakers and distributors.

Teva and at least three of the distributors named as defendants are currently in negotiations to settle lawsuits brought by two Ohio counties, Summit and Cuyahoga. Cases against defendants including distributors McKesson, Cardinal Health and AmerisourceBergen also are pending in other US states and local political units.

According to news agency Bloomberg’s sources, the three named distributors have proposed to pay $18 billion to end the litigation against them, with the money being doled out in annual increments of $1 billion. The latest proposal reportedly is $8 million higher than its first offer.

Johnson & Johnson (J&J) has already settled with the two Ohio counties to the tune of $20.4 billion, and Bloomberg said the healthcare giant has now offered to pay $4 billion to settle all remaining cases as part of a potentially large deal involving both opioid manufacturers and distributors that could generate a settlement worth more than $20 billion.

J&J already has “credit” with the state of Oklahoma, where it was recently ordered to pay $572 million for allegedly fueling the opioid crisis. After the verdict, district judge Thad Balkman acknowledged that he had mistakenly set aside $107,683,000 in the healthcare group’s penalty to help combat neonatal abstinence syndrome, or NAS. The figure should have been $107,683. J&J planned to appeal the verdict.

With pockets less deep than those of its US rivals and struggling with a heavy debt load, Teva is opting to take the drugs-for-dismissal route open under US law to avoid declaring bankruptcy. The company, which has already agreed to pay $85 billion to the state of Oklahoma to settle opioid cases, has proposed to offer free doses of Narcan, the generic version of its nasal spray overdose remedy Naxalone, over a 10-year period, together with other generic drugs worth altogether $15 billion

Additionally, two other US-based opioid makers, Mallinckrodt and Endo, are seen as ready to settle.

Several contenders for the 2020 Democratic presidential nomination, including senators Bernie Sanders and Elizabeth Warren, have said CEOs of opioid manufacturers should face prison time. California senator Kamala Harris, a former prosecutor, called companies like Purdue and Teva “nothing more than some high-level dope dealers”