Heroin is the top drug threat in the United States, the Drug Enforcement Administration (DEA) aid Wednesday. Availability of heroin is up across the country, as are abuses, overdoses and overdose deaths, NBC News reports.

Deaths from all drug overdoses rose to 46,471 in 2013, according to the agency’s 2015 National Drug Threat Assessment Summary. More than half of the overdoses were caused by prescription painkillers and heroin.

“Sadly this report confirms what we’ve known for some time: drug abuse is ending too many lives too soon and destroying families and communities,” DEA Acting Administrator Chuck Rosenberg said in a news release. “We must reach young people at an even earlier age and teach them about its many dangers and horrors.”

A recent survey by the Substance Abuse and Mental Health Services Administration found a 51 percent increase between 2013 and 2014 in the number of people who reported using heroin within the last 30 days. Heroin seizure amounts in the U.S. have almost doubled since 2010, from 2,763 kilograms to 5,013 kilograms in 2014.

The DEA report found since 2002, there have been more prescription drug deaths than deaths caused by cocaine and heroin combined. The report also found abuse of controlled prescription drugs is higher than that of cocaine, methamphetamine, heroin, MDMA, and PCP combined.

The powerful synthetic opioid fentanyl caused more than 700 deaths in the U.S. between late 2013 and early 2015. Fentanyl is sometimes added to heroin batches, or sold by itself as heroin. The DEA found synthetic designer drugs from China continue to cause large problems in the United States, particularly synthetic cannabinoids and bath salts.

Rosenberg said turf wars among criminal gangs for control of heroin distribution may have played a role in the recent increase in violent crime in some American cities.