Statistically speaking, I believe it goes nicotine/smoking, alcohol, prescription painkillers and then all the rest. The government measures it in preventable deaths per year, but there are also financial statistics in terms of impact on GDP, lost productivity, medical costs, etc. We tend to hear more about painkillers, heroin and meth in the news because the stories typically involve members of higher socioeconomic classes or there's violence involved, but nicotine and alcohol continue to march on in the top spots.
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