The opioid crisis cost the U.S. economy $631 billion from 2015 through last year — and it may keep getting more expensive, according to a study released Tuesday by the Society of Actuaries.

The biggest driver of the cost over the four-year period is unrealized lifetime earnings of those who died from the drugs, followed by health care costs.

While more than 2,000 state and local governments have sued the drug industry over the crisis, the report released Tuesday finds that governments bear less than one-third of the financial costs. The rest of it affects individuals and the private sector.

The federal government is tracking how many lives are lost to the opioid crisis (more than 400,000 Americans since 2000), but pinning down the financial cost is less certain.

A U.S. Centers for Disease Control and Prevention report from found the cost for 2013 at $79 billion. That’s less than half the cost that the latest report has found in more recent years. The crisis also has deepened since 2013, with fentanyl and other strong synthetic opioids contributing to a higher number of deaths. Overall, opioid-related death numbers rose through 2017 before leveling off last year at about 47,000.

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