Drug overdoses rose in every corner of the nation in 2016, according to the analysis, indiscriminately afflicting people of nearly all ages, genders, races and ethnicities, and locales. Of the 63,632 lethal overdoses that year, nearly two in three involved opioids, prescription or otherwise. “No area of the United States is exempt from this epidemic—we all know a friend, family member, or loved one devastated by opioids,” said CDC principal deputy director Dr. Anne Schuchat in a statement. Overall drug overdose death rates rose 21.5% in 2016 compared with the previous year, and the largest increase in opioid overdose deaths was in Americans aged 25 to 44.

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But certain kinds of opioids are growing in popularity (and deadliness) relative to others, driving the epidemic to ever-new heights. For instance, overdose deaths from staggeringly powerful, dangerous synthetic opioids like fentanyl more than doubled from 2015 to 2016, according to the CDC. New Hampshire, West Virginia, and Massachusetts saw the highest death rates from these manufactured opioids; in other regions like Washington, D.C. and Ohio, heroin-related deaths have spiking sharply.

This latest analysis underscores earlier findings indicating that the opioid epidemic is only getting worse, thanks in large part to the new kinds of drugs making their way into city and rural communities. A study published earlier this month in the journal Pediatrics found that the number of children admitted to hospitals because of an opioid overdose doubled between 2004 and 2015 to 1,504 kids.

The public health crisis will take an all-hands effort to solve, experts say. “Effective, synchronized programs to prevent drug overdoses will require coordination of law enforcement, first responders, mental health/substance-abuse providers, public health agencies, and community partners,” said Dr. Puja Seth, the new CDC report’s lead author.