Approximately 72,000 Americans died of drug overdoses — the largest number ever — in 2017, according to Centers for Disease Control (CDC) preliminary estimates.

The record number, which represents an increase of almost 7 percent from 2016, can be traced back to the growing amount of drugs that are laced with dangerous substances like the synthetic opioid fentanyl, reported The New York Times’ blog The Upshot.

The states with the “biggest spike in fatalities” were Nebraska, North Carolina, New Jersey and Indiana. Those states experienced drug overdose death rate increases from 15 to 33 percent, reported Fortune. The nationwide increase was not seen in all states — states including Wyoming, Utah and Oklahoma saw decreases of 9 to 33 percent.

Fentanyl is much more powerful than the drugs like heroin and cocaine it can be mixed with, causing even experienced drug users to overdose. Fentanyl-laced drugs are more common on the East Coast, where fentanyl is hard to detect when mixed with other white, powdery substances. Now drug distributors in the western United States, where black tar heroin is more common, are beginning to figure out ways to mix fentanyl and black tar heroin, with deadly results.

Synthetic opioids like fentanyl were by far the largest category of drugs to lead to overdose deaths. Overdose deaths from other drugs like heroin and prescription opioid pills decreased.

Drug overdoses were declared the leading cause of death for Americans under 50 in 2017 and killed more people than than AIDS, car accidents or gun violence, reported The Upshot.

The monthly overdose death numbers seemed to be “leveling off” as 2017 drew to an end, suggesting a possible downward trend, reported The Upshot. States have taken advantage of a nearly $1 billion grant program from the Department of Health and Human Services (HHS) to fight their opioid crises from 2017 to 2019.

For example, Massachusetts is seeing a drop in overdose deaths after an intense public health campaign, reported The Upshot.

Some experts are hopeful that a decline is in the near future although an increasing number of Americans — approximately 2 million — had opioid use disorders, according to HHS statistics.

“Because of the forces of stigma, the population is reluctant to seek care,” said Daniel Ciccarone, a University of California, San Francisco, professor who studies the heroin epidemic according to The Upshot. “I wouldn’t expect a rapid downturn; I would expect a slow, smooth downturn.”

The 72,000 figure is a preliminary estimate and could grow as the CDC continues to gather information about 2017 deaths that are still under investigation. The CDC’s 2016 approximate count grew from 59,000 to 64,000 as it finalized its numbers.

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