The opioid crisis has cost more than a trillion dollars since 2001, a new analysis finds, and may incur an additional 500 million dollars in costs over the next three years.

The new report from healthcare nonprofit Altarum analyzed CDC mortality data through June of 2017, NPR reports. The report analyzed the economic impact of lost productivity, earnings, and tax revenue in addition to the direct health costs associated with drug overdose.

The greatest individual cost associated with the opioid epidemic, Altarum concluded, was lost productivity due to opioid fatalities—there were more than 42,000 such deaths in 2016. Although the bulk of the costs accrue to the private sector, early deaths and substance abuse also negatively impact federal, state, and local tax receipts.

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