Insurers were out paying $21.4 billion for the crisis last year, with Medicaid paying for the largest share at $8.7 billion. Rhyan says in the report that after Medicaid expansion in 2014, more people who suffered from opioid abuse became insured. The epidemic cost Medicare an estimated $6.4 billion, with private payers and the uninsured forking over a combined $6.3 billion.

The remaining costs taking a bite out of the economy were accounted for by criminal justice and education expenditures, and child and family assistance spending. The report finds that many 2016 cases of child neglect were associated with parents with opioid addiction. Child and family assistance spending related to the epidemic reached about $6.1 billion in 2016.

Rhyan also says in the report that the analysis only takes into account the economic burden and not the emotional impact on those addicted and their families. Such a cost can’t be monetized, but is just as important. Says Rhyan, “I think it takes both pieces to tell the story of this epidemic.”

Despite the massive damage that the epidemic has wreaked, not just on the economy, but in human terms, when the Trump administration finally declared it a national public health emergency, it did so without calling for new funding to support treatment efforts and was the target of withering criticism.