Final answer:
The substance with the greatest death toll among the options provided is cigarettes, due to their connection with preventable diseases such as cancer, heart, and respiratory diseases. Heroin and opioids have also caused a significant number of deaths, but they do not surpass those caused by tobacco use. Alcohol also poses a risk but is not the leading cause of death compared to cigarettes.
Step-by-step explanation:
The death toll, which is defined as the total number of people who die as a result of a related cause, is greatest for cigarettes among the substances listed. Smoking is a major cause of respiratory disease, cardiovascular disease, and cancer, particularly lung cancer, which is the leading cause of cancer death. The Centers for Disease Control and Prevention (CDC) recognizes tobacco use as the leading cause of preventable death in the United States. Comparatively, while deaths from heroin and opioid painkillers have significantly increased, contributing to the opioid crisis, and deaths from cocaine carry risks including heart attack and infectious diseases, the death rates from these substances do not surpass those caused by cigarette smoking. Additionally, the use of alcohol can lead to numerous health problems and is associated with a risk of death from various causes.