The Greenville County Coroner's Office in South Carolina has ruled that actress Hayden Panettiere died accidentally from the toxic effects of fentanyl and four other substances. The findings, released September 22, list fentanyl, 4-ANPP, alprazolam, methocarbamol, and quetiapine as the cause of death, CBS News reported. An autopsy found no signs of trauma.
Panettiere, 36, known for her roles in Heroes and Nashville, was pronounced dead August 16 at a residence in Greenville where she had been staying. The ruling closes the coroner's case, but it also highlights a danger public health officials see in thousands of deaths each year: fentanyl combined with other sedating drugs can stop a person's breathing, even when some of those drugs are common prescriptions.
What the Coroner Found
According to the coroner's office, a 911 call reporting a cardiac arrest came in at about 1:51 p.m. on August 16. Emergency crews attempted advanced cardiac life support, but Panettiere was pronounced dead at 2:32 p.m. The coroner's office investigated alongside the Greenville City Police Department and has now closed its case.
Each substance plays a different role. Fentanyl is a powerful synthetic opioid. 4-ANPP is a chemical associated with illegally made fentanyl, and it can also appear as fentanyl breaks down in the body. Alprazolam, sold as Xanax, is a benzodiazepine used to treat anxiety and panic disorder. Methocarbamol is a muscle relaxant. Quetiapine, sold as Seroquel, is an antipsychotic used to treat conditions such as schizophrenia, bipolar disorder, and depression.
According to the coroner's report obtained by the Associated Press, an investigator found blue pressed pills and a straw at the residence that later tested positive for fentanyl. The coroner's findings do not say where the drugs came from. Drug Enforcement Administration agents and Los Angeles-area authorities have been examining whether she obtained counterfeit drugs, CNN reported, citing a source familiar with the case.
The Greenville Police Department said its own investigation "remains active and has not been closed."
Why the Combination Is So Dangerous
Dr. Kendall Von Crowns, chief medical examiner in Tarrant County, Texas, who was not involved in the case, told CNN that fentanyl alone can be fatal but that this combination "is a deathly mixture that we see often in cases." He explained that all of these drugs depress breathing and can keep the brain from recognizing that it is not getting enough oxygen. He also said the presence of 4-ANPP can point to fentanyl that was not made in a pharmaceutical lab.
Federal regulators have warned about this pattern for a decade. In 2016, the FDA required its strongest warning, known as a boxed warning, on prescription opioids and benzodiazepines, citing risks that include extreme sleepiness, slowed or difficult breathing, coma, and death when the two are used together, according to the FDA's drug safety communication. The agency also cautioned against combining opioids with other drugs that depress the central nervous system.
Nationally, overdose deaths are falling but remain high. An estimated 69,973 people died of drug overdoses in the United States in 2025, down almost 14% from 2024, according to provisional data from the CDC. In 2023, about 69% of overdose deaths involved synthetic opioids, mainly illegally made fentanyl, and deaths involving more than one drug have increased, according to the CDC's overdose prevention overview. MedicalDaily has also reported on what experts say is behind the recent decline.
Warning Signs and Steps Families Can Take
People at higher risk include anyone using pills or powders obtained outside a pharmacy, which may contain fentanyl without the buyer knowing, and people who combine opioids with benzodiazepines, sleep aids, muscle relaxants, or alcohol. People who have recently stopped using opioids, including those leaving treatment, are also vulnerable because their tolerance may be lower.
Signs of an opioid overdose include pinpoint pupils, slow or stopped breathing, choking or gurgling sounds, blue or gray lips and fingertips, and being unable to wake up. Call 911 immediately. If naloxone is available, give it, and place the person on their side while waiting for help. Naloxone reverses opioids but not benzodiazepines, muscle relaxants, or other sedatives, and it can wear off before an opioid does. That is why emergency care is still essential after a dose, even if the person starts breathing again.
Naloxone nasal spray is sold over the counter, and many local health departments distribute it for free. Anyone taking an opioid along with an anxiety medication, sleep drug, or muscle relaxant should ask a doctor or pharmacist to review the combination. Do not stop a prescribed medication suddenly without medical guidance, since withdrawal from some drugs, including benzodiazepines, can be dangerous.
Free, confidential help is available 24 hours a day through the SAMHSA National Helpline at 1-800-662-4357. The 988 Suicide and Crisis Lifeline can be reached by call or text.
Panettiere spoke openly about her past struggles with alcohol and drugs. Her death is a reminder that combining sedating drugs, including some that are prescribed, can sharply raise the risk that an overdose will be fatal.
Key Questions Answered
What did the coroner rule? The Greenville County Coroner's Office ruled Panettiere's death an accident caused by the toxic effects of fentanyl, 4-ANPP, alprazolam, methocarbamol, and quetiapine.
Were there signs of trauma? No. The autopsy found no signs of trauma that contributed to her death.
Is the investigation closed? The coroner's case is closed. Greenville police said their investigation remains active.
Why is mixing these drugs dangerous? Opioids, benzodiazepines, muscle relaxants, and some antipsychotics can all slow breathing. Taken together, they raise the risk that breathing will stop.
What are the warning signs of an opioid overdose? Watch for slow or stopped breathing, blue or gray lips, pinpoint pupils, and unresponsiveness. Call 911 and give naloxone if it is available.
Where can people get help? The SAMHSA National Helpline, 1-800-662-4357, offers free, confidential treatment referrals around the clock. Pharmacists can also review risky medication combinations.
Published by Medicaldaily.com
