Background: Poly drug use is a public health threat causing morbidity and mortality all over the world.
Combined use of licit and illicit drugs is among the possible causes of death. In this retrospective analytical
study, we evaluated forensic toxicology analysis results from 2011 to 2016 in Tehran province, Iran.
Methods: All deaths related to poly drug use and referred to the Legal Medicine Organization, Tehran during
the 6-year study period were evaluated. Postmortem samples were analyzed to detect alcohols, and
prescription and illicit drugs using headspace gas chromatography (HSGC), high performance liquid
chromatography (HPLC), and gas chromatography/mass spectrometry (GC/MS) in a forensic toxicology
laboratory. Manner of death, demographic characteristics, and different drug categories in postmortem
samples were analyzed.
Findings: A total of 1388 poly drug use-associated deaths were investigated during the 6-year study period.
Overall, victims were mostly young men of 20-40 years of age (56.8%). The male to female ratio was 7:16.
Methadone (n = 660; 47.6%) and amphetamine type stimulants (ATS) (n = 657; 47.3%) were in the highest
category for poly drug use-associated deaths. Moreover, in some cases, opium (n = 458; 32.9%), tramadol
(n = 389; 28.0%), and tricyclic antidepressants (n = 151; 10.9%) had been used with other drugs.
Conclusion: The present study provides information about poly drug use-associated deaths in Tehran and
highlights the major role of substance abuse in death.