Actress Hayden Panettiere died from the toxic effects of fentanyl and several other drugs, according to a coroner’s report released after her death at the age of 36. Authorities in South Carolina have ruled the death accidental, while an investigation continues into how she may have obtained the substances. 

Panettiere, best known for her roles in ‘Heroes’ and ‘Nashville’, was found unresponsive at an apartment in Greenville, South Carolina, on August 16. She was in cardiac arrest when emergency responders arrived, and attempts to revive her were unsuccessful. The autopsy found no trauma that contributed to her death.

The circumstances surrounding her death have drawn renewed attention to the actress’s long-publicised struggles with addiction and mental health, which she had discussed openly in interviews and in her recently published memoir.

What was Hayden Panettiere’s cause of death?

The Greenville County Coroner’s Office determined that Panettiere died from the “toxic effects of fentanyl, 4-ANPP, Alprazolam, Methocarbamol, and Quetiapine”.

Fentanyl is a powerful synthetic opioid. Alprazolam is an anti-anxiety medication, while methocarbamol is a muscle relaxant and quetiapine is a prescription medication used to treat certain mental health conditions.

According to the detailed report obtained by The Associated Press, investigators also found blue pressed pills and a straw at the residence. The pills later tested positive for fentanyl. A white powder was discovered inside a sunglasses case in Panettiere’s suitcase.

Forensic pathologist Dr Kendall Von Crowns, who was not involved in the case, told CNN that the combination of substances could be particularly dangerous because several of the drugs can contribute to respiratory depression.

The report also identified 4-ANPP, a chemical associated with the production or metabolism of fentanyl. Crowns said its presence could indicate that the fentanyl was produced illicitly, although the toxicology findings alone do not establish exactly where or how the substance was obtained.

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What happened on the day Panettiere died?

According to the coroner’s report, Panettiere was seen putting on make-up at about 10.30am on August 16.

She was later found unresponsive on a sofa bed. The report said she was lying face down in a seated position with her legs crossed. One of the men at the apartment told investigators that her position was not unusual, but he realised something was wrong when he could not wake her and noticed that her skin had turned a deep purple.

Two doses of Narcan, a medication used to reverse opioid overdoses, were administered before emergency services were called when she remained unresponsive.

The man told the investigator that he was unaware of Panettiere using illegal drugs in the preceding two days, although he added: “she was very good at hiding them.”

Paramedics then carried out CPR and other advanced resuscitation measures for more than 40 minutes, but Panettiere could not be revived.

Was Panettiere’s death linked to counterfeit drugs?

While the coroner has classified the death as accidental, authorities are continuing to examine how Panettiere obtained the drugs.

Investigators in California have been looking into whether she may have received illicit or counterfeit drugs from a dealer in Southern California. The Drug Enforcement Administration and local authorities have reportedly questioned several people as part of that investigation.

One line of inquiry has been whether Panettiere took a counterfeit narcotic and whether it interacted with other substances in her system.

The investigation does not alter the coroner’s current classification of her death as accidental. Authorities are examining whether another person could face criminal responsibility for supplying a potentially lethal substance.

Panettiere’s representative, Kasey Kitchen, said shortly after the coroner’s findings that the circumstances remained complicated and urged patience while investigators continued their work.

“The investigation remains ongoing and the circumstances surrounding the case are complex,” Panettiere’s representative, Kasey Kitchen, said in a statement to CNN shortly after the coroner’s report. “We must all continue to remain patient and allow the investigative process to unfold.”

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Panettiere had recently left rehabilitation

The actress had reportedly been released from a drug rehabilitation facility only weeks before her death.

Her struggles with alcohol and drugs had been part of her public story for years. Panettiere had previously spoken about entering rehabilitation while working on ‘Nashville’ and about using alcohol and drugs as a way of coping with depression and anxiety.

In a 2023 interview with Women’s Health, she described the decision to seek treatment herself.

“I was the one who put myself in the first treatment center. I was drowning,” she said.

Her father also told investigators that Panettiere had plans for the days following her death. She was due to turn 37 on August 21 and had intended to spend her birthday in Greenville before travelling to Ukraine to see her daughter, Kaya.

A childhood spent in the spotlight

Panettiere began working in entertainment before she was a year old, appearing in commercials before moving into television and film.

As a child, she became known for roles in soap operas, including ‘Guiding Light’, before becoming internationally recognised through Heroes. She later starred as Juliette Barnes in the country music drama ‘Nashville’.

Her rapid rise to fame came with pressures that she later explored in her memoir, ‘This Is Me’, released in May.

Panettiere wrote about the impact of growing up in the public eye and described how the difficult experiences portrayed by her early characters affected her perception of fame.

She also discussed addiction, postpartum depression and the difficulties she experienced following the birth of her daughter, Kaya, in 2014.

Addiction, loss and a difficult personal chapter

Panettiere’s personal life was marked by several painful experiences alongside her professional success.

She had spoken publicly about suffering from postpartum depression after becoming a mother. She also experienced the death of her younger brother, actor Jansen Panettiere, who died in 2023 at the age of 28 from a heart condition.

Her relationship with Brian Hickerson also became the subject of public scrutiny. Panettiere had previously spoken about allegations of domestic abuse involving Hickerson. He was charged in 2020 with multiple felony counts and later pleaded no contest to two counts of injuring a spouse or partner. He served a short jail sentence and was also ordered to complete probation, anger management and Alcoholics Anonymous meetings.

Hickerson and his brother Zach were at the Greenville apartment when Panettiere was found unresponsive. Police have said there were no initial signs of foul play, while the wider investigation remains open.