Addiction to prescription pain medication has taken a staggering toll on America: According to one accounting, overdoses killed more people in one year than guns and car accidents combined.

Tens of thousands of Americans are dying each year from overdoses. It’s a grim trend that has touched just about every aspect of life—even, as the latest figures from the Bureau of Labor Statistics indicate, work. While traffic accidents, homicides, and suicides are still the top culprits of on-the-job fatalities, deaths related to addiction are increasing at a rapid clip. Last year alone, the number of workers who died at work because of drug- or alcohol-abuse-related incidents increased by more than 30 percent, to more than 200. While that number may seem small, it’s evidence of how rapidly the problem is growing—less than five years ago, fewer than 70 people died from overdoses at work. Since 2012, the number of people dying from drug or alcohol related causes while on the job has been growing by at least 25 percent each year, according to the Bureau of Labor Statistics.

These deaths represent unspeakable individual tragedies. They also, in the larger picture, serve as a striking illustration of how America’s addiction epidemic is changing the landscape of work.

Over the past few years, economists have struggled to explain why so many people appear to be dropping out of the workforce. The most telling measure of that is the labor-force participation rate—which measures the percentage of the population that is employed or actively looking for work—which now sits around 62.7 percent. That’s low by historical standards. For example, between 1986 and 2001, labor-force participation grew fairly steadily, to between 65 and 67 percent. There are many theories about why this figure has been declining in the past decade or so: Automation, a lack of quality jobs, and an aging workforce are all thought to play a role. Still, the shortage of 25-to-54-year old workers—a group economists call “prime age” workers—particularly male ones, remains a big problem for the future of the labor market.