Baltimore needs billions of dollars to carry out a comprehensive treatment and prevention plan that would ease the city’s deadly opioid crisis.

A pair of drug companies, defeated in court by the city last month, say that they shouldn’t have to pay for it.

Now, after five days of testimony, a judge is set to decide what will happen. The decision could take months.

The city and the drug companies spent the last week tussling in court over Baltimore’s far-reaching — and expensive — opioid abatement plan, which would cost $11 billion to fully implement over 15 years.

The city is seeking $5 billion from the drug distributors, McKesson and AmerisourceBergen, after winning a $266 million jury verdict at the close of a seven-week trial. Jurors found the companies partially responsible for a public nuisance stemming from the misuse of prescription opioids, which pharmaceutical companies distributed by the millions during the height of painkiller prescribing.

This phase of the case, known as “abatement,” is separate from the jury trial. A judge, not jurors, will decide how much money the city wins for abatement, which is designed to relieve Baltimore’s opioid crisis going forward, rather than covering past costs. The city and the drug companies finished presenting evidence Tuesday.

Baltimore City Circuit Judge Lawrence Fletcher-Hill is responsible for determining how much money the city can receive for abatement, if any. Last week, the Ohio Supreme Court tossed a $650 million abatement award against national pharmacy chains, casting a shadow over the proceedings in Baltimore

But the law in Maryland is distinct from Ohio’s, and Fletcher-Hill, while appearing dubious of the city’s claims at times, heard days of testimony from experts about how much it would cost to abate Baltimore’s opioid crisis. He is expected to issue a written decision next year.

The abatement plan is something of a wish list for the city: Assuming the resources are available, what would be the best way to remediate the harms opioids have caused in Baltimore? Susan Sherman, a professor at the Johns Hopkins Bloomberg School of Public Health, developed the plan at the city’s request.

“There have never been the resources to test the entirety of this plan,” Sherman testified last week.

The city is experiencing the highest rate of overdose deaths of any major city in America, according to a series of articles on the scope of the issue in The Baltimore Banner and The New York Times.

The proposal is wide-ranging and covers broad categories, including harm reduction, opioid use disorder treatment, and prevention. If fully implemented, city experts estimate, the plan could avert more than 6,000 fatal overdoses over the next 15 years and more than triple the rate at which city residents receive medical treatment for opioid use disorder, among other benefits.

The plan also includes wraparound services that would make abatement more successful by ensuring that people in treatment have adequate transportation, nutrition, housing and other essential needs, Sherman testified.

“It’s important for people to have stability — food, housing, mental health treatment — to help them be successful in their treatment,” she said.

The drug companies argued that they should not be responsible for the cost of social programs that might alleviate the downstream effects of the opioid crisis. They also did not propose their own abatement plan and have asked Fletcher-Hill to reject the city’s request.

“The city seeks to use this phase of trial to enact a sweeping, 15-year social policy plan related to opioid addiction and many other social issues—e.g., homelessness, re-entry after incarceration, foster care, job training, food support, and bolstering the healthcare workforce,” the companies wrote in an abatement filing. “That type of public policy-making is for the General Assembly, not a court.”

The companies also pointed to evidence that many of the programs outlined in the city’s plan already exist and are funded by outside sources. Medical interventions for opioid use disorder are already available in Baltimore, they argued, and are largely covered by private insurance and Medicaid.

The city countered that it cannot assume that those funding sources will continue covering necessary programs in Baltimore, and that the existing treatment capacity is far below what the city needs.

“If you think of it as a puzzle, there’s some pieces that are there and some very important pieces that are missing,” said Dr. Joshua Sharfstein, a professor at the Johns Hopkins Bloomberg School of Public Health who is advising Baltimore Mayor Brandon Scott’s administration while it seeks a new health commissioner.

Sharfstein, who testified on behalf of the city, also served as Baltimore’s health commissioner in the 2000s, then led the Maryland Department of Health and Mental Hygiene before working in the U.S. Food and Drug Administration.

He said that the need for opioid use disorder treatment, harm reduction and wraparound services in Baltimore is profound, but that the city previously succeeded in reducing heroin overdose deaths before the onslaught of prescription opioids reversed that progress.

The 15-year period covered by the abatement plan, he said, is “kind of the minimum” amount of time necessary to take meaningful steps toward ending Baltimore’s opioid crisis.

If the city wins abatement money, it would go through the same process as the other $668 million Baltimore won through settlements with drug companies or at the trial against McKesson and AmerisourceBergen.

Opioid money will be held in a trust to be spent slowly over 15 years. Distribution of the funds will be overseen by a Restitution Advisory Board, which will make spending recommendations, and an “Overdose Cabinet,” which will review the recommendations before the mayor makes a final decision.

Madeleine O’Neill is a Baltimore-based freelance journalist.