An Oklahoma judge has ordered Johnson & Johnson to pay $572.1 million to the state for its part in fueling an opioid epidemic by deceptively marketing addictive painkillers.
J&J said it would appeal the decision.
The state's attorney general had filed the lawsuit, seeking $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."
Shares of J&J were up 2% in extended trading following the decision.
Other pharmaceutical companies that sell opioid painkillers also rose after-hours, including Teva Pharmaceutical Industries Ltd up 2.6% and Endo International Plc, which was 1.4% higher.
Oklahoma's case was the first to go to trial out of more than 2,000 brought by municipalities seeking to hold drug makers responsible for opioid abuse in the US.
In holding J&J liable after a seven-week, non-jury trial, Judge Thad Balkman of the Cleveland County District Court in Norman, Oklahoma, said the state proved that J&J'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," Judge Balkman said.
But in his written decision, Judge Balkman said his award covered only one year, because Oklahoma did not demonstrate the time and costs needed to address the opioid crisis beyond that.
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 created a public nuisance.
Sabrina Strong, a lawyer for J&J, said at a news conference after the verdict: "You can't sue your way out of the opioid abuse crisis.
"Everyone must come together to address this. But J&J did not cause the opioid crisis."
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, around 6,000 Oklahomans have died from opioid overdoses, according to the state's lawyers.
The case was brought by Oklahoma Attorney General Mike Hunter, who alleged that J&J'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," Mr Hunter said.
Oklahoma had sought to have J&J help it address the epidemic for the next 30 years through funding addiction treatment and prevention programs.
The trial came after Oklahoma had resolved claims against OxyContin maker Purdue Pharma LP in March for $270m and Teva in May for $85m, leaving J&J as the lone defendant.
Lawyers for the plaintiffs representing other municipalities called the Oklahoma case "another milestone" in opioid-related litigation against the drug industry.
The verdict came as two counties prepare for a scheduled October trial before an Ohio federal judge, who has been pushing for a settlement.
"While this was one trial against one defendant, important facts were presented that further demonstrate the strength of our clients' claims," the municipalities' lawyers said in a statement.
Some plaintiffs' lawyers have compared the opioid cases to litigation by states against the tobacco industry that led to a $246 billion settlement in 1998.
J&J said it remains "open to viable options" to resolve the Ohio case, including through settlement.
During the Oklahoma trial, lawyers for the state argued that J&J carried out a years-long marketing campaign that minimised the painkillers' addiction risks and promoted their benefits.
The lawyers also called J&J 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.
J&J countered that its marketing claims had scientific support and that its painkillers accounted for a tiny fraction of opioids prescribed in Oklahoma.
The company also said in a statement that since 2008, its painkillers accounted for less than 1% of the US market, including generics.