How many Americans are using prescription opioid painkillers? About one in three. That’s the stunning number in a new survey released Monday from the National Institute on Drug Abuse, which calculated that a whopping 91.8 million Americans used drugs like OxyContin or Vicodin in 2015. And nearly five percent of the adults surveyed told researchers they took these drugs without their doctor’s permission, the study reported. They didn’t get their meds from some seedy drug dealer, either. “The most commonly reported sources were friends and relatives for free,” the study reported. “Or a physician.”

The NIDA study was released on the same day that the presidential opioid commission, chaired by New Jersey Gov. Chris Christie, released its first report and recommendations for tackling an opioid plague that killed more than 15,000 people in 2015, according to the federal Centers for Disease Control and Prevention. The study urged President Donald Trump to “declare a national emergency” and noted that “America is enduring a death toll equal to September 11th every three weeks.” “As access to prescription opioids tightens, consumers increasingly are turning to dangerous street opioids, heroin, fentanyl alone or combined, and mingled with cocaine or other drugs,” the commission stated in an interim report to Trump. NIDA said the treatment of pain is at the root of the problem. “Our results are consistent with findings that pain is a poorly addressed clinical and public health problem in the United States and that it may be a key part of the pathway to misuse or addiction,” the group stated in the study. NIDA’s recommendations included “better prevention and treatment of the underlying disorders are necessary to decrease pain and the morbidity and mortality associated with opioid misuse,” the study said.