JACKSON (AP) — Drug overdose deaths have reached a record high in Mississippi.

The Clarion-Ledger reported Sunday that the at least 211 deaths in 2016 were the most in Mississippi’s history. Mississippi Bureau of Narcotics director John Dowdy says the number is derived from death certificates, but he suspects it’s much higher as drug-testing evidence increases the deaths to 220, with oxycodone detected in 45 and fentanyl detected in 33.

Dowdy says not every coroner uses the state crime lab, and that Mississippi’s health department puts the number of drug poisoning deaths, excluding homicides and suicides, at 274.

Mississippi’s health department says the number of heroin addiction patients treated has more than tripled the past three years from 99 to 306. Heroin-related overdose deaths in Mississippi rose from one in 2011 to 35 in 2015.