Life expectancy among Americans has fallen for the second year in a row as the opioid crisis continues to drive up overall death rates in the United States, the Centers for Disease Control and Prevention said on Thursday.

A total of 63,000 people died from drug overdoses in 2016, up 21 percent from 2015, according to the CDC report. Opioid-related overdoses surged 28 percent, killing 42,249 people, mostly in the 25-to-54 age group.

“The escalating growth of opioid deaths is downright frightening – and it’s getting worse,” John Auerbach, chief executive officer of the public health advocacy group Trust for America’s Health, said in a statement.

The increase largely stemmed from the continued escalation of deaths from fentanyl and other synthetic opioids, which jumped to 19,410 in 2016 from 9,580 in 2015 and 5,540 in 2014, according to a TFAH analysis of the report.

Heroin, an illegal opioid, accounted for around 15,500 deaths, and prescription painkillers were involved in about 14,500, TFAH reported.

“These are not simply numbers – these are actual lives,” said Benjamin F. Miller, chief policy officer of Well Being Trust, a non-profit foundation focused on mental health issues. “Seeing the loss of life at this dramatic rate calls for more immediate action.”

President Donald Trump in October declared the opioid crisis a public health emergency, which senior administration officials said would redirect federal resources and loosen regulations to combat abuse of the drugs. However, he stopped short of declaring a national emergency, a move he had promised months before and which would have freed up more federal money.

The surge in overdose deaths has depressed recent gains in U.S. life expectancy, which fell to an average age of 78.6, down 0.1 year from 2015 and marking the first two-year drop since 1962-1963.

Overdose rates rose in 40 states and in Washington, D.C., between 2015 and 2016, with 17 states seeing increases of 25 percent or more, according to the TFAH analysis.

“Every community has been impacted by this crisis,” Auerbach said, adding that the government was not making the investments needed to “turn the tide.”

As the opioid epidemic has worsened, many state attorneys general have sued makers of these drugs as they investigate whether manufacturers and distributors engaged in unlawful marketing behavior.