A new report on the opioid epidemic in Vermont reveals deaths linked to fentanyl continue to rise rapidly despite a decrease in heroin fatalities.

The Vermont Department of Health’s annual report on drug use to state lawmakers shows fentanyl, a synthetic opioid roughly 50 to 100 times more powerful than morphine, is now the primary fuel behind overdose deaths in the state. While heroin deaths experienced a nearly 20 percent decline in 2017, killing 41 people, fentanyl deaths jumped by one-third, claiming 68 lives in 2017, reports U.S. News and World Report.

Overdoses across all drugs claimed 104 lives in Vermont in 2017, more than double the lives lost to overdoses in 2012. Authorities warn they are increasingly finding fentanyl in non-opioid drugs like cocaine, which is contributing to the increase in fatalities.

“We fully expect that when there are deaths, they will include fentanyl,” said Mark Levine, health commissioner of Vermont, according to U.S. News and World Report. “That’s the crisis in the country … Fentanyl is such a high proportion of the products that people with substance use disorder are purchasing.”

Officials with the Barre Police Department issued a warning last week due to rising fentanyl deaths, particularly linked to cocaine.

Health officials in Vermont are only the latest to sound the alarm on the threat posed by the infiltration of fentanyl across drug supplies. The Ohio Department of Health recently asked medical professionals and first responders to start using the opioid overdose reversal drug Narcan for any situation where a person has overdosed on drugs in case fentanyl is involved.

Authorities fear that because cocaine is more widely used as a social drug than a substance like heroin, many users are unaware of the fatal risks even a small amount of the drug now carries.

Fentanyl overtook heroin as the U.S.’s deadliest substance in 2016, claiming 19,413 lives, according to the Centers for Disease Control and Prevention.

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Nationally, drug overdoses are now the leading cause of accidental death for Americans under age 50, killing more than 64,000 people in 2016.

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