The findings come from a Public Health Wales report.
Drug related deaths in Wales are higher than ever.
Public Health Wales has revealed the number dying from drug poisoning has increased by almost 80 percent in just 10 years.
The report highlights a rise in deaths of young people from substances such as cocaine and MDMA.
In a third of all drug deaths reviewed, "no known contact" was reported between the deceased and any local health, social care or criminal justice services in the 12 months prior to death.
The report recommends action to influence the current legislative approach to drugs policy in the UK, as well as a medical amnesty policy to protect people seeking medical attention relating to drug poisonings.
Drug misuse deaths, a subset of drug poisoning deaths, have increased by 52 per cent over the last decade and by 12 per cent in the last year up from 185 deaths in 2017 to 208 in 2018 – with a current rate of 72 deaths per million population. Wales has the second highest rates of drug misuse deaths in England and Wales regions.
Josie Smith, Head of Substance Misuse in Public Health Wales, said: "Drug markets have changed and expanded over the last few years, both in terms of availability, and range of drugs, and this trend is set to continue. One of the most distressing impacts of these changes is the rise in premature deaths.
"Across Wales there are effective interventions in place to reduce premature drug deaths including specialist substance misuse services and, for opioid deaths, the provision of Take-Home Naloxone.
"However, expansion of the Naloxone programme will be required to ensure widespread access to this life-saving intervention. In addition it is vital that the range of people using drugs are able to make better use of services that can support them, and reduce their risk of harm and premature death.
"Given the scale of problem drug use in Wales, it is likely that every member of the population will know someone affected by, or experiencing difficulties with drugs be they illegal or prescribed, but may be unaware.
"Evidence is clear that seeking support early on can prevent escalation of problem use and dependency, however, fear of stigmatisation and social exclusion may be barriers to this. Consideration needs to be given to how this can be overcome in Wales to prevent future tragic deaths."
As in previous years, opioids including heroin were involved in the just over half of drug misuse deaths reported in 2018. Poly-drug use, the use of other drugs including benzodiazepines and cocaine, was reported in 49 per cent.
In addition, there has been a more than four-fold increase in the number of deaths involving cocaine over the last five years. In 2018, cocaine was recorded in 31 of deaths, representing 15 per cent of all drug misuse deaths.