Hayden Panettiere died from a toxic mixture of the powerful opioid fentanyl, antipsychotic and antianxiety drugs, and muscle relaxants, the Greenville County Coroner’s Office said Tuesday, adding that her death was ruled an accident.

An autopsy showed no signs of trauma that would have contributed to the actor’s death, the coroner’s statement said.

Authorities said that in addition to fentanyl, alprazolam, methocarbamol and quetiapine were also found in 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.

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 Centers for Disease Control and Prevention mortality data.

On Aug. 16, paramedics arrived at an apartment building in Greenville, South Carolina, where emergency responders administered advanced cardiac life support and resuscitation efforts. Panettiere, best known for her roles on “Heroes” and “Nashville,” was pronounced dead at 36.

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 Hickerson showed an officer a bag of medications she had been taking. 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.

Panettiere 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 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.

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This article originally appeared in The New York Times.

By Derrick Bryson Taylor/Josh Haner
c. 2026 The New York Times Company