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This analysis of drug harms in Canada found that alcohol causes the most harm overall Alcohol was followed by tobacco, nonprescription opioids (like fentanyl), cocaine, methamphetamine, and cannabis. Tobacco ranked first in 4 of the 16 harm categories: drug-related mortality, drug-specific damage to physical health, dependence, and environmental damage, the researchers wrote

forever, drastically reducing the number of small farms with widely spread quota plantings and giving rise to several concentrated areas of significantly larger-scale tobacco fields