The actress Hayden Panettiere died from a toxic mixture of the powerful opioid fentanyl, antipsychotic and anti-anxiety drugs and muscle relaxants, the Greenville County Coroner’s Office said on Tuesday, adding that her death was ruled an accident.
An autopsy showed no signs of trauma that would have contributed to the death, the coroner’s statement said.
The authorities said that in addition to fentanyl, alprazolam, methocarbamol and quetiapine were also found in Ms. Panettiere’s system. According to the Cleveland Clinic, alprazolam, the generic version of Xanax, is used to treat anxiety. Methocarbamol is the generic version of the drug known as Robaxin, a muscle relaxant. And quetiapine, the generic version of Seroquel, is an antipsychotic used to treat schizophrenia, bipolar disorder and depression.
According to Dr. Kevin Simon, an assistant professor of psychiatry at Harvard Medical School, the drugs found in Ms. Panettiere’s system represented a potentially “deadly combination.”
While fentanyl alone can be fatal, he said, combining it with three other drugs that can also depress the central nervous system — alprazolam, methocarbamol and quetiapine — can compound that risk. While all three medications can be prescribed together safely, if they are taken in excess or combined with an opioid such as fentanyl, “your breathing could slow down so much it stops altogether,” he added.
Fentanyl has contributed to a sharp rise in overdose deaths in the United States in recent years. It was responsible for a third of deaths among Americans 25 to 34 in 2022, according to a New York Times analysis of C.D.C. mortality data.
On Aug. 16, paramedics arrived at an apartment building in Greenville, S.C., where emergency responders administered advanced cardiac life support and resuscitation efforts. Ms. Panettiere, best known for her roles on “Heroes” and “Nashville,” was pronounced dead at 36.
Ms. Panettiere was with Brian Hickerson, her on-and-off boyfriend who had served jail time for abusing her, at the time of her death. He has not been accused of wrongdoing in connection to the death.
In a police report, an officer who responded to the scene said Mr. Hickerson showed an officer a bag of medications she had been taking. Ms. Panettiere had recently been vocal about her struggles with drugs, alcohol and debilitating chronic pain.
“I’ve said it before and I’ll say it again: Addicts aren’t patient,” she wrote in her memoir, “This Is Me: A Reckoning,” which was published in May. “When we’re shaking, nauseated, anxious, lonely or depressed, we need instant relief that sends us into that pain-free place called denial.”
Panettiere’s hairstylist, Erick Orellana, said in an interview that she had often complained about back pain.
“It was a back injury that was making it hard for her to walk,” he said.
The actress had written extensively about her history with drugs, which began as a child. At first it was “happy” pills that her team gave her at an industry event that gave her “energy.” Those drugs, she said, were the gateway that ushered her toward “the good of pharmaceuticals and the downfall of addiction.”
She had also said in an interview with Women’s Health that she had been injured several times during her acting career, including being bucked off a zebra while shooting “Racing Stripes” and repeatedly falling while learning to figure skate for the movie “Ice Princess.” Two vertebrae in her neck were smashed at one point, she said.
Days after Ms. Panettiere died, the federal Drug Enforcement Administration joined the investigation into her death. Its work typically includes large-scale investigations into drug cartels accused of bringing cocaine, fentanyl and methamphetamine into the country, but it does also work with local law enforcement.
Christina Caron contributed reporting.
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