Big pharma executive John Kapoor is on trial for his role in creating the opioid epidemic and if convicted faces up to 25 years in prison.

For the first time, big pharma is being challenged for its role in creating the opioid crisis that has swept the country and taken hundreds of thousands of lives since the epidemic began in 1999. The trial for Insys Therapeutics Inc. founder John Kapoor, who also served as chairman and CEO of Insys, began before a Boston jury on Monday.

Kapoor plus four other executives are facing racketeering and conspiracy charges on allegations they used speaker fees to ramp up Subsys sales and lied to insurers about which patients were getting the drug, as Bloomberg reported.

Essentially, the government alleges Kapoor and his fellow defendants were involved in a massive bribery scheme that paid doctors to overprescribe Subsys, which is a synthetic opioid.

Kapoor’s lawyers revealed during Monday’s opening session that the defense would argue Kapoor had no knowledge or control over the scheme and that the Insys sales executive running the bribery scheme actively worked to block Kapoor’s knowledge of the project.

“All the criminal activities lead back to one person only — Alec Burlakoff,” Kapoor’s lawyer Beth Wilkinson said.

Burlakoff and former Insys CEO Michael Babich are expected to be the government’s key witnesses against Kapoor. Both already pleaded guilty to charges related to the scheme.

Subsys was approved by the FDA in 2012 but only for use by cancer patients. However, the government alleges Insys pressured and bribed doctors to over-prescribe the drug to patients without cancer.

According to the government, Kapoor oversaw Insys’ practice of paying doctors for poorly attended “sham conferences” meant to educate others about Subsys, but actually served as fronts to pay doctors for over-prescribing the drug.

Assistant U.S. Attorney David Lazarus also told jurors on Monday that Insys defrauded insurers. Michael Gurry, one of Kapoor’s co-defendants and former Insys vice president, was in charge of Insys department tasked with working with insurers. Gurry allegedly instructed employees to lie to insurance companies about which patients were receiving Subsys.

Gurry’s lawyer passes the responsibility onto Elizabeth Gurrieri, Gurry’s subordinate, claiming that she ran the program and gave the instructions to bend the rules, not Gurry. Gurrieri pleaded guilty in 2017 to deceiving insurers and will testify in the Kapoor case.

One of the key pieces of evidence at the trial are tapes recorded by an Insys’ whistleblower and former sales rep. The former rep recorded dozens of conversations between Insys executives and will likely be plaid by prosecutors during the trial.

Watching the trial closely will be lawyers for thousands of civil lawsuits filed against big pharma by state and local governments, including tribal governments, around the country.

According to NPR, the lawsuits allege opioid manufacturers, suppliers and pharmacies made billions of dollars while knowingly overprescribing prescription pain pills. Big name retailers CVS, Walmart and Walgreens are also targeted in the lawsuits.

By filing the lawsuits, state and local municipalities are hoping for results akin to big tobacco’s payouts to compensate for health consequences tied to smoking. In the last 20 years, tobacco makers have paid out $20 billion to compensate for the public health costs tied to smoking. The possibility of financial compensation could help municipalities dig their way out of the public health crisis created by the opioid epidemic and pay for treatment programs and education.