Antipsychotics, antidepressants, and benzodiazepines are commonly used among patients with psychotic disorders. The use of psychotropic medication, alcohol, and illicit drugs may have a major role in the fatal motor vehicle accidents (FMVA) involving drivers with psychotic disorders. This study on drivers involved in FMVAs in Finland investigates the post-mortem toxicology findings regarding the presence of psychotropic medication, alcohol and illicit drugs among 94 drivers with psychotic disorders and their 188 matched controls without psychiatric disorders. Drivers' suicidal intention, death category, and role in the accident were also investigated. Psychotropic medication was present in 53.2% of drivers with psychotic disorders and in 9.6% of controls at the time of their FMVA. Among the drivers with psychotic disorders, the presence of antipsychotics was detected in 30% of them, and their suicidal intentions behind FMVA were significantly associated with the presence of antipsychotics (OR 2.7) and mood stabilizers (OR 6.0). Our results suggest that, in some cases, traffic suicides among drivers with psychotic disorders may originate from long-term suicidal thoughts and occur despite antipsychotic medication. A thorough fitness-to-drive assessment should be conducted for patients with psychotic disorders, irrespective of their antipsychotic medication status.