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In an exhaustively researched project, the New York Times collected data from across the U.S. to present an estimate for the number of opioid related deaths in 2016, though the official numbers from the Centers for Disease Control and Prevention won’t be available until later this year. Their numbers are extremely disturbing.

In 2015, the number of drug overdose deaths recorded was 52,404. The New York Times has estimated that 2016 will come in at about 62,500, a 19% increase and the biggest annual jump ever recorded in the United States. Drug overdoses are now the leading cause of death among people under 50, and are largely linked to abuse of opioids like heroin and fentanyl.

The increase in deaths also appear to be largely regional, with level or declining deaths in the West where Mexican black tar heroin is more likely to be used. East of the Mississippi the use of powdered heroin is more prevalent and more deadly, particularly if laced with—or replaced entirely by—fentanyl. But one of the most deadly varietals found in opioids, writes the Times, is the newer carfentanil, an elephant tranquilizer that is supposedly 5,000x stronger than heroin:

“July 5th, 2016 — that’s the day carfentanil hit the streets of Akron,” said Capt. Michael Shearer, the commander of the Narcotics Unit for the Akron Police Department. On that day, 17 people overdosed and one person died in a span of nine hours. Over the next six months, the county medical examiner recorded 140 overdose deaths of people testing positive for carfentanil. Just three years earlier, there were fewer than a hundred drug overdose deaths of any kind for the entire year.

The CDC’s official drug overdose death count for 2016 will be released in December. On May 31, the State of Ohio filed a lawsuit against pharmaceutical companies for leading marketing campaigns that “misled doctors and patients about the danger of addiction and overdose.” The suit is similar to cases pending in Chicago, some New York counties, Mississippi, California and West Virginia, and is asking for restitution for money spent on Medicaid programs and treatment centers. The NYT shared a statement from Purdue, the maker of OxyContin, saying, “We share the attorney general’s concerns about the opioid crisis and we are committed to working collaboratively to find solutions.”