The opioid epidemic killed 33,000 in 2015. That could climb to nearly 94,000 in 2027.

In 2015, about 90 people in the US died every day from opioid overdoses. If the opioid epidemic continues, the toll could hit more than 250 daily deaths by 2027.

That’s the worst-case scenario laid out in a new analysis by STAT. By asking top public health experts across 10 universities, STAT calculated that the number of people who died from opioid overdoses in one year could rise from 33,000 in 2015 to nearly 94,000 in 2027. That would total more than 650,000 deaths to opioids — not including all other drugs — over the next decade.

“That’s almost as many Americans as will die from breast cancer and prostate cancer during that time period,” Max Blau wrote for STAT. “Put another way, opioids could kill nearly as many Americans in a decade as HIV/AIDS has killed since that epidemic began in the early 1980s.”

In the best-case scenario forecasted by STAT, the number of opioid overdose deaths would drop to more than 21,000 in 2027 — but the figures still get worse before they get better, and still top 300,000 in the next decade.

The average death toll between all 10 forecasts provided by STAT was nearly 500,000 over the next decade.

Whether the US lands on the worst- or best-case scenario — or something in between — depends how America reacts to the epidemic. Do doctors stop overprescribing opioids? Do states monitor and regulate prescribing more stringently? Does the country build up its drug treatment infrastructure? Do states deploy the overdose antidote naloxone? Does law enforcement succeed in stopping supplies of the deadly synthetic opioid fentanyl and its analogs? If all goes right, based on STAT’s estimates, the US could avert hundreds of thousands of deaths. (Read the full story at STAT for more details.)

There are some signs we may be heading in the wrong direction. Congress is considering a bill that would repeal Obamacare and strip insurance from tens of millions of people, leaving potentially hundreds of thousands of opioid users without adequate access to addiction care. And although the US has boosted some funding for drug treatment, the money allocated here and there, such as the $1 billion over two years approved in the Cures Act, falls far short of the tens-of-billions investment that experts say is necessary.

The likely result is America’s opioid epidemic will get much worse for some time. The drug overdose crisis that’s already the deadliest in US history is likely to get much deadlier.

In 2015, more Americans died of drug overdoses than in any other year on record — more than 52,000 deaths in just one year. That’s higher than the more than 38,000 who died in car crashes, the more than 36,000 who died from gun violence, and the more than 43,000 who died due to HIV/AIDS during that epidemic’s peak in 1995.

This latest drug epidemic, however, is not solely about illegal drugs. It began, in fact, with a legal drug.

Back in the 1990s, doctors were persuaded to treat pain as a serious medical issue. There’s a good reason for that: About 100 million US adults suffer from chronic pain, according to a 2011 report from the Institute of Medicine.

Pharmaceutical companies took advantage of this concern. Through a big marketing campaign, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is very weak (despite their effectiveness for short-term, acute pain), while the evidence that opioids cause harm in the long term is very strong.

Painkillers proliferated, landing in the hands of not just patients but also teens rummaging through their parents’ medicine cabinets, other family members and friends of patients, and the black market.

As a result, opioid overdose deaths trended upward — sometimes involving opioids alone, other times involving drugs like alcohol and benzodiazepines (typically prescribed to relieve anxiety). By 2015, opioid overdose deaths totaled more than 33,000 — close to two-thirds of all drug overdose deaths.

Seeing the rise in opioid misuse and deaths, officials have cracked down on prescriptions painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.

Ideally, doctors should still be able to get painkillers to patients who truly need them — after, for example, evaluating whether the patient has a history of drug addiction. But doctors, who weren’t conducting even such basic checks, are now being told to give more thought to their prescriptions.

Yet many people who lost access to painkillers are still addicted. So some who could no longer obtain prescribed painkillers turned to cheaper, more potent opioids: heroin and fentanyl, a synthetic opioid that’s often manufactured illegally for nonmedical uses.

Not all painkiller users went this way, and not all opioid users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found 75 percent of heroin users in treatment started with painkillers, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to painkillers are 40 times more likely to be addicted to heroin.

So other types of opioid overdoses, excluding painkillers, also rose.

That doesn’t mean cracking down on painkillers was a mistake. It appeared to slow the rise in painkiller deaths, and it may have prevented doctors from prescribing the drugs to new generations of people with drug use disorders.

But the likely solution is to get opioid users into treatment. According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment. The report found that the low rate was largely explained by a shortage of treatment options.

So federal and state officials have pushed for more treatment funding, including medication-assisted treatment like methadone and buprenorphine.

Some states, such as Louisiana and Indiana, have taken a “tough on crime” approach that focuses on incarcerating drug traffickers. But the incarceration approach has been around for decades — and it hasn’t stopped massive drug epidemics like the current crisis.