Heroin use is increasing rapidly across the United States among all age, race, income and ethnic groups, the Centers for Disease Control and Prevention announced Tuesday. And the increase comes with a devastating price: Deaths from heroin-related overdoses nearly quadrupled between 2002 and 2013.

Heroin use doubled among women and young adults ages 18 to 25, and more than doubled among non-Hispanic whites. Some of the highest increases were in groups with historically low rates of abuse: women, people with higher incomes and people who are privately insured.

“What is causing the increase? Our best information suggests two main reasons,” CDC director Dr. Thomas Frieden told CNN. “First, more and more people are susceptible to heroin because they have been prescribed prescription opiates, like OxyContin. And the second reason is that heroin itself seems to be cheaper and more widely available.”