WASHINGTON, D.C. (AP)– A new study finds that the opioid crisis cost the U.S. economy $631 billion over the past four years.

The Society of Actuaries released its report on Tuesday. It found the highest cost was in lost earnings for those who died in the crisis. Next was health care, a cost borne largely by Medicaid and Medicare.

The society’s tally was higher than a cost estimate contained in a 2016 U.S. Centers for Disease Control and Prevention study, but lower than one from the White House Council of Economic Advisers in 2017.

The report was released less than a week before the first federal trial on the opioid crisis is scheduled to begin.

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