In terms of annual deaths, which substance ranks highest?

The ranking of substances in terms of annual deaths can be attributed to their widespread use and the health complications associated with them. Tobacco consistently ranks as the leading substance in terms of annual deaths worldwide. It is associated with a variety of severe health issues, including lung cancer, heart disease, respiratory illnesses, and many other conditions that contribute to high mortality rates. The World Health Organization (WHO) estimates that tobacco use causes more than 8 million deaths each year, greatly surpassing the number of deaths linked to alcohol, cocaine, or heroin.

Alcohol-related deaths are significant and include those from diseases like cirrhosis and accidents related to excessive consumption, but they do not reach the staggering numbers associated with tobacco. While cocaine and heroin also pose serious health risks and have associated mortality rates, primarily from overdose and related complications, their numbers are not comparable to those linked to tobacco use. Thus, tobacco's extensive impact on public health through its addictive properties and long-term health effects makes it the highest-ranking substance in terms of annual deaths.