About 53 million people worldwide use opioids or their natural counterparts and nearly half of them develop substance-abuse disorders leading to about 118,000 overdose deaths every year, According to the World Health Organization.

More recent data from the U.S. Department of Health and Human Services reveal that out of the 2.1 million Americans who suffer opioid-use disorders, nearly 48,000 die from this class of drugs derived from the opium poppy or its synthetic counterparts. According to the Centers for Disease Control and Prevention, accidental poisoning, mainly from drug-overdose deaths, was the leading cause of death among young Americans.

But according to an annual global survey released Thursday, opioids are significantly less popular than other mind-altering substances.

The 2019 Global Drugs Survey compiled data late last year from nearly 124,000 people from more than 30 countries and found that opioids ranked eighth among the most popular drugs people reported using over the previous 12-month period.

Excluding alcohol and tobacco, opioid use ranked eighth behind marijuana, MDMA (ecstasy), cocaine, amphetamines, LSD, psychedelic mushrooms, and benzodiazepines, a class of anti-anxiety drugs that includes Valium and Xanax.

Out of the global list of the most abused drugs, some are more dangerous than others. Excluding alcohol and tobacco, benzodiazepines, opioids, cocaine and MDMA are among the most dangerous manufactured drugs.

The fact that opioids aren’t the most-abused substances really underscores how dangerous they can be.

According to a report by HealthGrove, hydrocodone (marketed under the Vicodin brand) is the most popular opioid in the U.S., with a recreational-use prevalence of about 3% of the population, far lower than the rate of marijuana use (nearly 18%), tobacco use (31%), and alcohol consumption (61%). The most popularly abused opioid after hydrocodone is oxycodone (OxyContin), with a 2 percent recreation-use rate.

The number of deaths linked to opioid addiction is clearly alarming, especially in the United States where opioids claim more lives every year than guns and the number keeps growing. This increasing abuse of opioids in the U.S. has led to a national soul-searching over how and why so many Americans have become hooked on a dangerous pain-killing pharmaceutical product when effective pain treatments that aren’t opioids, according to doctors, exist.

Purdue Pharma, the privately held maker of OxyContin, and its owners, the Sackler family, are at the center of this storm, facing a raft of lawsuits from states over allegedly downplaying the dangers of opioid abuse in a relentless quest for higher sales and profits. Adding to the problem of the U.S. opioid epidemic is that the counties most-affected by the opioid epidemic tend to be poorer and least able to confront the growing addition epidemic in their backyards. These are the counties with the worst drug problem in every state.

Opioids claim many lives, but they still lag far behind the top two killers: alcohol and tobacco. The U.S. National Institute on Alcohol Abuse and Alcoholism, a government agency, estimates that about 88,000 Americans and more than 3 million people worldwide succumb to alcohol-related deaths annually. Meanwhile, smoking tobacco is the leading cause of preventable death in the U.S., killing 480,000 Americans annually while 16 million live with diseases caused by smoking tobacco, according to the U.S. Centers for Disease Control and Prevention. Globally, 7 million people die from smoking tobacco. To understand why it’s so dangerous, you should know exactly what happens to your body once you start smoking.

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