In the current poly-drug use context, the contribution of each detected drug to the cause of death in a fatal poisoning may be difficult to assess. In this study, we aimed to investigate whether the analysis of drug paraphernalia found at the death scene could assist in the cause-of-death determination. Over a period of about four years, drug paraphernalia were analysed whenever paraphernalia was available for the analysis and a drug-related death was suspected. A total of 134 syringes and other kinds of paraphernalia were analysed in 77 death cases. Amphetamine, buprenorphine, and alprazolam were the most common findings. One single substance was detected in 51% of the analysed items, but some items contained up to 5 different substances, typically amphetamine or buprenorphine together with a benzodiazepine. Of the cases in which drug paraphernalia were analysed, in 57%, at least one detected substance was finally implicated as the cause of death in fatal poisonings, and in 14%, the detected substance was assessed as a contributing factor to death. Analysis of drug paraphernalia generated completely new drug findings in only a few cases. Comparing the results of the analysis of drug paraphernalia recovered at the death scene with the results of post-mortem toxicology allows for better understanding of circumstances of death, and in some cases enables more accurate determination of the cause of death by identifying the freshly administered drugs. In cases with new psychoactive substances, the analysis of paraphernalia can provide information that could otherwise be difficult to obtain as the concentrations in biological samples can be low.