A new study estimates prescription opioid overdose, abuse and dependence costs $78.5 billion annually in the United States.

Researchers from the National Center for Injury Prevention and Control said healthcare accounts for about one-third of costs attributable to the prescription opioid epidemic, Newswise reports. An additional one-fourth of costs are borne by the public sector, they wrote in the journal Medical Care. Those costs include public insurance (Medicaid, Medicare and veterans’ programs), as well as other government sources for addiction treatment.

State and local governments also pay $7.7 billion annually in criminal justice costs related to the opioid epidemic.