Sex differences in fatal poisoning among drug users in France: An exploratory analysis of the DRAMES register (2026)

BACKGROUND: The DRAMES register (Décès en Relation avec l'Abus de Médicaments Et de Substances) is a French database of drug-related deaths reported by forensic toxicology experts. This study evaluated sex differences in the substances involved in deaths, with the aim of improving public policy on prevention and care for women with substance use disorders.
METHODS: We assessed 6,068 drug-related deaths that occurred from January 1, 2010, to December 31, 2023, in France (1,120 women [18.5%] with a mean age of 38 +/- 11 years and 4,948 men [81.5%] with a mean age of 38 +/- 10 years). Individual demographic characteristics and medical history, forensic autopsy findings, and toxicology reports were evaluated.
RESULTS: The proportion of deaths related to polydrug use was higher in women than in men (39.4% vs. 28.4%; p < .001). Female sex was significantly associated with mortality from taking antidepressants (p < .001), antipsychotics (p < .001), benzodiazepines and z-drugs (p < .001), codeine (p = .002), other anxiolytics and hypnotics (p = .029), pholcodine (p = .005), and tramadol (p < .001), all of which are legal prescription medicines in France. Male sex was significantly associated with mortality from taking amphetamine-type stimulants (p = .044), buprenorphine (p = .042), cannabis (p < .001), gamma-hydroxybutyrate (p = .002), heroin (p < .001), and new psychoactive substances (p < .001). Apart from buprenorphine, all of these drugs are illegal in France.
CONCLUSION: The observed differences in causes of death between women and men, specifically more polydrug related-deaths (especially with pharmaceuticals), highlight the need to address female-specific concerns. Further studies and resources are needed to develop programs dedicated to women with substance use disorders. [Author's abstract]