The U.S. opioid crisis has cost more than $1 trillion since 2001, according to a report Tuesday from nonprofit health research and consulting firm Altarum. The costs have accelerated over the past few years and if they maintain their current rate could cost an additional $500 billion by 2020.

The analysis found that in 2001, the opioid epidemic cost $29.1 billion per year and has ballooned to $115 billion per year by 2017. The majority of the costs went to healthcare, lost wages and productivity.

Altarum’s analysis found that the average age of an opioid overdose death is 41, costing the individual $800,000 in lost earnings and productivity.

The healthcare industry absorbed roughly a quarter of the costs ($215.7 billion), with overdose care and emergency-room visits representing the majority of the costs.

Not quantified in the study was the emotional toll the epidemic has on families and others. According to the Centers for Disease Control and Prevention, an estimated 63,600 people died from drug overdoses in 2016, the latest year for which data was available. In small towns in states like New Hampshire, opioid addiction and overdose deaths can rattle an entire school district.

President Donald Trump often spoke about the opioid epidemic during the 2016 campaign. In his latest budget proposal, he outlined adding $13 billion to the budget over the next two years to combat the crisis.

The Department of Health and Human Services outlined their five-point plan to fight the epidemic in their  budget proposal. The department wants to improve prevention, treatment and recovery services, increase the availability of overdose-reversing drugs like naloxone, strengthen reporting and data collection on the crisis, support research on pain and addiction and advance better pain management practices.

Proposed Medicaid cuts and attempts to undermine the Affordable Health Care Act, also known as Obamacare, could have an adverse effect on the opioid epidemic, possibly undercutting efforts to curb the problem.