Hayden Panettiere’s death has been ruled accidental, according to the Greenville County Coroner’s Office in South Carolina. The actress died from toxic effects of fentanyl combined with other medications, including alprazolam, methocarbamol, and quetiapine.

The autopsy performed found no signs of trauma that could have contributed to her death. Along with fentanyl, a potent synthetic opioid, traces of alprazolam—a medication commonly prescribed for anxiety—methocarbamol, a muscle relaxant, and quetiapine, an antipsychotic drug used for conditions such as schizophrenia and bipolar disorder, were detected in her system.

Panettiere, 36, was found unresponsive on August 16 at her apartment in Greenville, South Carolina. Emergency responders administered advanced cardiac life support and other resuscitation measures but were unable to revive her.

At the time of her death, Panettiere was in the company of Brian Hickerson, her on-and-off boyfriend who has a history of legal issues related to abusive behavior toward her. Authorities have not implicated Hickerson in connection with her death. Police reports indicate that Hickerson showed officers a bag containing medications she had been prescribed.

The actress had spoken openly in recent years about her struggles with addiction, chronic pain, and mental health challenges. In her memoir published earlier this year, Panettiere described her experience with substance use and the difficulty of managing pain and addiction. Her hairstylist, Erick Orellana, noted that she frequently complained of back pain caused by a prior injury severe enough to impair her mobility.

Panettiere disclosed that her drug use began in childhood, initially through medications given to her to manage the demands of her career. She also cited several injuries sustained during her work as an actress, including a serious neck injury resulting in two fractured vertebrae.

Fentanyl has been identified as a leading cause of overdose deaths in the United States, with recent data showing it contributed to a significant portion of fatalities among young adults. Following Panettiere’s death, the federal Drug Enforcement Administration joined local investigations. While the DEA typically focuses on dismantling drug trafficking networks, it often collaborates with local authorities on cases involving illicit substances such as fentanyl.