The Most Dangerous Drugs in the U.S.

One of the most common questions my friends and family ask me about addiction is “What is the most dangerous drug?” There are certainly many metrics for quantifying the risks of drugs of abuse including commonly known measures such as morbidity and mortality. To me the mortality rate, or lethality of a substance, is a pretty solid marker for danger.

While I often hear heroin or methamphetamine suggested, an article I recently came across suggests that some of the most dangerous drugs are ones you are probably very familiar with and likely have in your home. However, they are not likely the drugs you might have guessed are the most dangerous...

The article “The 3 deadliest drugs in America are all totally legal” was recently published online at

It utilized data from the Centers for Disease Control and Prevention (CDC) and reported “tobacco, alcohol, and opioid-based prescription painkillers were responsible for more direct deaths in one year than any other drug”.

Here are some of the specifics from this article:

1. Tobacco

The medical profession eventually got this one right... as more than 1/2 of smokers end up dying from a smoking related illness. 

2. Alcohol

Alcohol negatively effects every organ system in the body. photo credit:

3. Prescription Painkillers  

The overdoses that make the news are the tip of the iceberg when it comes to opioid abuse.
photo credit:

While Cigarettes, Alcohol and Prescription Pain medications are all addictive and dangerous, they are all currently legal. Their heightened lethality and the problems associated with them could simply be a result of the increased access that their legality affords. You can buy cigarettes or alcohol at almost any corner in the U.S. and I would venture to say that most households in the U.S. have at least one bottle of pain medication in their medicine cabinet.

This article also discussed a separate article which I have seen before. I found this second article eyeopening, included it in a substance abuse lecture I gave to medical students, and previously discussed it here. The article was published in the Lancet and provides a nice graph which clearly ranks and differentiates the harm of different drugs both to users and the harm caused to others. It supports the premise that alcohol is one of the most dangerous drugs. However, it ranks tobacco after several other substances including heroin and stimulants like amphetamines and cocaine. This data also provides a little perspective as to the harm of marijuana, which is currently a topic of much debate in the media. (see below)

Figure: Drugs ordered by their overall harm scores, showing the separate contributions to the overall scores of harms to users and harm to others

Would heroin, methamphetamine, cocaine, LSD and other illegal substances be more lethal if they were legalized and became more accessible? I plan take a deep look into this research. I’m also interested to know if countries with more open access to these substances have higher or lower morbidity and mortality rates associated with their use as compared to our rates in the U.S. Do countries that have programs like needle sharing, more access to rehabilitation or residential recovery have less deaths and crime associated with drug use? I think these are questions worth asking.

A look at how U.S. consumption and production of Amphetamines (ATS), cocaine and opioids compares to our other areas around the world. Credit:

In the meantime, consider these facts the next time someone asks “What is the most deadly drug in America?”. If you think of other important questions to ask regarding drug use, legalization, rehabilitation/addiction treatments and how other counties are doing things differently, please leave a comment below.

Stay Tuned!

Dr. Goldenberg
Twitter: @docgoldenberg

The Huffington Post:
Matthew Goldenberg, D.O. Matthew Goldenberg D.O. is double Board Certified in Psychiatry and Addiction Psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and is an addiction specialist for adults in his private practice in Santa Monica, California. Dr. Goldenberg also provides addiction psychiatry consultations to some of the nation’s top residential and outpatient treatment programs in the Los Angeles area and is experienced in the evaluation and treatment of professionals working in safety-sensitive positions. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He also volunteers his time as a Clinical Instructor in the Department of Psychiatry at UCLA and is an Assistant Professor of Psychiatry at Cedars Sinai Medical Center.

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