Background In Finland, post-mortem toxicology is performed in 13% of all deceased as part of medico-legal cause-of-death investigation. Of all toxicology cases, approximately every 6^th case is determined by a forensic pathologist to be a fatal poisoning. Medicinal and illegal drugs form the biggest group of intoxicants causing fatal poisonings.

Methods All fatal drug poisoning cases in 2013 were examined in terms of toxicological findings, background information and the manner of death. In these cases, comprehensive post-mortem toxicology had been performed by using chromatographic and mass spectrometric techniques in an accredited central laboratory serving the whole country.

Results There were 476 fatal poisonings by medicinal and illegal drugs in 2013. Buprenorphine, tramadol, pregabalin, codeine, oxycodone, amitriptyline, quetiapine, paracetamol, venlafaxine and insulin were the ten most prevalent major factors in the cause of death. The most common manner of death in all drug poisonings was suicide (41%, median age 49), followed by unintentional poisoning (40%, median age 37), and unknown manner of death (18%, median age 51). Unintentional poisoning was the most common manner of death in opioid poisonings, especially with the strong opioids possessing high abuse potential. In cases involving antipsychotics and antidepressants, such as quetiapine, amitriptyline and venlafaxine, as well as with insulin, the percentage of suicide was higher than that of unintentional poisoning.

Conclusions Information on fatal poisonings reveals trends in drug use, which can help monitor adverse effects of medicines as well as the emergence of new abused substances. The extensive post-mortem toxicology data collected in the cause-of-death investigations in Finland enable reliable statistical analysis and research on a population-based level.