Diabetes is a well-known health threat in the U.S., with rates that have reached epidemic levels in recent years. But now researchers are reporting that another scourge has surpassed it in terms of deadliness: suicides and deaths from drug overdoses.

Diabetes is officially ranked the seventh leading cause of death nationwide. Self-injury, as the combination of suicide and drug-related death is known, killed as many people as diabetes in 2014 and is continuing to accelerate. The primary consequence of this unchecked crisis will be decreasing U.S. life expectancy, said Ian Rockett, a professor of epidemiology at West Virginia University in Morgantown.

“Sadly, I don’t think we are doing a good job in terms of getting our arms around it,” said Rockett, the senior author of a study published Monday in the journal Injury Prevention. “It’s a growing problem.”

While there’s increased awareness of the dangers of narcotics and prescription pain medication, the true extent of the U.S. opioid crisis and the path to addressing it have been obscured by how medical examiners report deaths, according to the report. In the absence of a suicide note, most overdoses are recorded as accidents. Meanwhile, suicide rates have been rising since 2005, and the most common form of suicide attempt is a drug overdose.

“The rising suicide and opioid mortality rates aren’t really independent,” Rockett said in a phone interview. “If you put the focus on the behavior, most of these deaths are from self-harm. We don’t want to blame the victim, but descriptively they belong together.”

Keeping them separate masks the national burden of deaths caused by purposeful, self-injurious behaviors, the researchers said. Fully understanding the scope of the problem may help public health officials devise effective methods to intervene in the crisis.

Prevention strategies have found success with other socially complex health problems, including reducing death from smoking-related lung cancer, heart disease, HIV and car crashes. The key is accurately defining and measuring the problem and then finding the political will to address it, they said.

“Without the former, it’s impossible to build the latter,” the researchers said.

Medical examiners and coroners shouldn’t spend more time investigating suicides, Rockett said. Instead, the two categories should be joined so that self-injury, and the mental health issues that underlie it, can be examined more broadly.

“We have a major mental health crisis underway in America, and it’s very much underestimated when we think of suicides and drug intoxication deaths as different phenomenon,” he said. “We need to get mental health on the front burner. It’s an even bigger problem than people realize.”