Opioid abuse is on track to kill nearly half a million Americans over the next decade, STAT News reported Tuesday.

STAT asked 10 leading public health experts for predictions of the future of America’s opioid epidemic; they predicted that opioid-related deaths by 2027 could top 650,000, which is almost as many Americans that have died from the HIV/AIDS virus entered the population in the 1980s.

Almost all of the STAT forecasts predict opioid-related deaths in the U.S. will surpass 50,000 per year, with the most optimistic forecasts predict the rate slowing to 21,000 deaths per year by 2027, a trend which assumes that doctors act immediately to cut back on opioid prescriptions, insurers enact major reforms to improve treatment access and states embrace prescription drug monitoring programs.

The worst-case scenario is much more bleak: The rate of Americans dying from opioid abuse could triple to more than 93,000 deaths a year, a trend line which increases exponentially by STAT’s calculations. This scenario assumes no change in the current system, and that opioid users increasingly come in contact with synthetic opiates such as Fentanyl, a dangerous substance which can make an adult violently ill simply through touch.

Experts surveyed by STAT do agree on one factor: Opioid-related deaths likely won’t even level off until at least 2020. STAT predicts in its report that it will be years before the effects of government and private efforts to combat the opioid epidemic are even registered.

The study places blame on prescription practices. According to STAT, the number of opioid prescriptions in America tripled between 1991 and 2001.

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“It’s like cigarettes in the ’50s: We look back at the way people smoked and promoted cigarettes as laughably backwards — magazine ads with doctors saying, ‘Physicians prefer Camels,” Dr. Michael Barnett of Harvard told STAT.

“We have the same thing now — Oxycontin ads in medical journals where doctors would say, ‘Opioids are good for treating pain. They don’t have addictive potential.’ It’s possible 20 years from now, we’re going to look back and say, ‘I cannot believe we promoted these dangerous, addictive medications that are only marginally more effective.’”

According to the Center for Disease Control, 33,091 Americans died of opioid abuse in 2015, a rate of almost 100 per day.