Background: Compared with their contemporaries, individuals abusing illicit drugs suffer a higher risk of premature death; with difficulty to determine the total usage of illicit drugs in the population.Study design: a retrospective, descriptive study of drug abusers fatalities at Zeinhoum morgue (Cairo). Statistical analysis was performed to analyze differences between groups. Results: from 2003 to 2007, 241 autopsies revealed substance abuse; 218 (90.5%) victims were males; their age clustered at 3rd and 4th decades (7 tenth). Alcohol, opioids and cannabis were the commonest toxicological findings at postmortem screening represented more than 43.2%, 21.6% and 18.3% respectively. 40.2% (97/241) deaths caused by overdose toxicity; from those 49.5% and 42.3% due to alcohol and opioids respectively. Others causes of deaths mainly caused by stab wounds and head injury& trauma which constitute 14% (35/241) for each. The pathological causes scored 12.4% (30/241). Pathological investigations were conducted for specific and selected cases to determine or approval causes of deaths. Circumstantial evidences at scene of deaths most significant in opioids abusers.Conclusion: Although most deaths by direct overdose toxicity, other causes of deaths collectively (as contributory to substances abuse) scored highest proportion. Our believe, prospectively this categorization of deaths among drug addicts constitutes simple means of standardizing the surveillance of the death toll among drug addicts that could allow for comparisons over time and between countries and provide evidence for politicians to tackle pandemic drugs abuse surge.