For the first time, Americans have scored the pharmaceutical sector lowest of 25 major industries in Gallup’s annual poll of the matter.

58 percent of respondents rated the drug industry poorly, while only 27 percent rated it positively, for a net rating of -31, the lowest in the poll, and the lowest for the industry since 2001, when Gallup began studying the question. The federal government had a -27 net rating, the second-worst of the 25 industries included in the poll, followed by the health-care industry with a -10 net rating. The only other sector with a negative net rating was advertising and pubic relations at -1. The restaurant industry finished with the best net rating at +58.

The U.S. is still in the throes of a crippling opioid epidemic, which many have blamed on misleading marketing by drugmakers. Last month, an Oklahoma judge ruled that drugmaker Johnson & Johnson catalyzed the state’s opioid crisis through deceptive marketing practices that made its opioid products ubiquitous. The case is seen as a harbinger for close to 2,000 separate opioid lawsuits scheduled to go to trial in October before a federal judge in Ohio.

“The new low in the pharmaceutical industry’s U.S. image comes amid a range of criticisms of industry norms, from generating the highest drug costs in the world to spending massive amounts in lobbying politicians to the industry’s role in the U.S. opioid crisis,” Gallup wrote in an analysis accompanying the poll.

The poll surveyed 1,525 adults in all 50 states and Washington, D.C. from August 1–14.