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Fatality / Death Case Report Submission Form

If you know of a fatality directly related to a psychoactive drug that you think we should know about, you can use this form to submit information and documentation about the death.

All other types of information or queries posted to this form will be deleted without response.

It is very important for this form that you include at least some external references, citations of papers, articles, copies of toxicology reports, or other type of documentation which supports the direct relationship between the substance and the death. Include links where possible, as well as names of authors or organizations that have commented on the fatality.

Substance(s) Related to Fatality:
Name or Identification of Decedent?
Your Name:
Your Email:
Your Relationship to Decedent: (none, family, doctor, media, etc.)
References / Bibliography / Documentation / Links: