The purpose of this study is to determine the pattern of drug related deaths in Romania between 2008 and 2011 by analyzing the medical-legal cases, from a significant proportion of Romanian Counties (out of 41 plus the capital), in which the direct causal link between drug overdose and death was drug related. Material and methods. 446 forensic toxicology cases were analyzed in a four year period, obtained from more than two thirds of the counties in Romania. Results. 54.26% yielded a positive toxicological analysis, most often with benzodiazepines, opiates, barbiturates and cannabinoids. Males around 31 years old represented the most affected group. Illegal drug related deaths were more frequent in males and non-illegal drug related deaths were proportionally more frequent in females. Discussions and conclusions. The pattern of consumption is similar to the one obtained by similar studies in neighboring countries. The city capital has a very distinct pattern of consumption compared to other cities/counties.