The DRAMES (décès en relation avec l’abus de médicaments et de substances) registry is a French database of drug-related deaths (medications or illicit drugs) among drug users. The DTA (décès toxiques par antalgiques) registry is a French database of analgesic-related deaths among people without a history of drug abuse. Both registries are based on the collection of data on deaths for which forensic toxicology experts have performed analyses.

In the present study, we included drug- and analgesic-related deaths occurring from January 2013 to December 2022 in France. Subject demographic characteristics and medical history, forensic autopsy findings and toxicology reports were evaluated.

Among drug users (DRAMES registry), opioids used alone or in combination were the main contributor to drug-related deaths in France, as they are in most countries. However, licit methadone was the leading cause of opioid-related deaths (ahead of heroin) during the study period. The main trend was the dramatic increase in cocaine-related mortality. Among medical users of analgesics (DTA registry), tramadol was the leading cause of deaths throughout this period.

A large-scale naloxone distribution program is urgently needed in France to prevent opioid overdoses, including among licit methadone users. However, our data do not support the hypothesis of an opioid crisis in France, although close monitoring is still required, particularly for oxycodone.