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On Tuesday, the Agency for Healthcare Research and Quality issued a report on opioid-related inpatient care and emergency room visits. Between 2005 and 2014, the rate of these visits increased by 99 percent.

Numbers for the last three years are not yet available, but the Washington Post reports that Maryland is at the very top of the national list for inpatient care related to opioid abuse. A state report showed that overdose deaths in Maryland have quadrupled since 2010, with 38 times more deaths related to fentanyl:

Baltimore City saw 694 deaths from drug and alcohol-related overdoses in 2016 — nearly two a day, and a stunning spike from 2015, when 393 people died from overdoses.

“We see overdoses in all ethnic groups, in all Zip codes,” said Leana Wen, the city’s health commissioner.

There are still regions where overdoses have remained relatively low; for example, Iowa recorded 73 admissions in hospitals per 100,000 residents related to opioid overdoses versus Maryland’s 404. In a long report by the New York Times about the surges in regional opioid abuse, authorities posited that certain places were protected by the flow of drug traffic, as some states tend to get their drug supply from places where fentanyl is more commonly mixed with heroin.

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Anne Elixhauser, a senior research scientist at AHRQ, told the Post that it was hard to know for sure where or when the epidemic will pop up in a new place.

“Our data tell us what is going on,” she said, “They tell us what the facts are. But they don’t give us the underlying reasons for what we’re seeing here.”