U.S. death rates from suicides, drug overdoses, and alcohol have reached an all-time high, with some states having been hit far harder than others, according to a report released last Wednesday by the Commonwealth Fund.

The report examined data from all 50 states and Washington, D.C., taking an in-depth look at the 47 factors that have an impact on health incomes, including access to doctors, insurance coverage, smoking, obesity and even tooth loss and ultimately assigning each state with a score. The data used is from 2017.

Although the rates of deaths due to suicide, drug overdoses, and alcohol are up nationally, the investigators of the report were particularly shocked by the regional difference in the rates.

“When we look at what’s going on in mid-Atlantic states—West Virginia, Pennsylvania, Ohio—those are the states that have the highest rates of drug overdose deaths in the country,” a senior scientist for the Commonwealth Fund, David Radley, stated. The rates in those states are at least double the national average of rates for fatal drug overdoses.

West Virginia had the highest drug overdose death rates, mainly due to the opioid epidemic. The rates rose by over 450 percent from 2005 to 2017, according to the Commonwealth Fund report.

“The rate of growth in drug overdose deaths in West Virginia is absolutely mind-boggling,” Radley told NBC News.

And it’s not just heroin and prescription painkillers that are driving these death rates. The authors of the study also point to fentanyl and other potent synthetic opioids that manage to make their way into illicit drugs such as cocaine. Fentanyl is similar to morphine, except its about 50 to 100 times more potent, according to the National Institute on Drug Abuse.

Following West Virginia, New Hampshire, Delaware, Kentucky, and the District of Columbia had the next highest rates for drug overdose deaths in the country.

Death rates from suicide and alcohol also showed vast regional disparities. People died at higher rates from alcohol or by suicide than from drug overdoses in Montana, the Dakotas, Oregon, Nebraska, and Wyoming.

Specific state-by-state information can be found using the Commonwealth Fund’s interactive tool.

Following this report, it is important to raise awareness for these kinds of deaths. If you or someone you know is in crisis, you can call the National Suicide Prevention Lifeline at 800-273-8255, or text HOME to 741741. You can also visit SpeakingOfSuicide for additional resources.