According to researchers from the University of Pennsylvania and Georgetown University, the numbers we use to quantify the epidemic’s human toll downplay the severity of drug usage. The study, published in PLOS ONE on Wednesday, found that the number of drug-associated deaths in 2016 was 2.2 times bigger than previously recorded, adding more than 60,000 deaths onto the currently accepted figure.

Researchers analyzed data collected by the Center for Disease Control; in 2016, there were 63,000 “drug-coded” deaths (fatalities linked to poisoning, overdoses, and drug-related mental and behavioral issues). But when the researchers expanded the definition to include infectious diseases transmitted via drug usage; the decreased life expectancy of people who use drugs; and other factors like “impaired judgement, suicide, [and] circulatory disease,” they found the number of deaths associated with drug usage that year was actually around 142,000.

Accounting for regional disparities also helped establish a more accurate figure, according to the researchers. The study found particularly high drug-associated mortality rates in West Virginia, Massachusetts, Maryland, Pennsylvania, and Ohio, while states like Nebraska, Iowa, Montana, North Dakota, and South Dakota had lower ones.

The study’s authors were careful to emphasize that their conclusions were not meant to point fingers. "The drug epidemic is probably killing a lot more Americans than we think," Dana Glei, one of the demographers who conducted the study, said in a statement. "That's the main point we're trying to make." When it comes to finding solutions that work for the people who need them most, a better understanding of who is suffering and who is dying is critical.

Update: A previous version of this story attributed the deaths to opioids specifically; the study refers to drugs in general.

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