<p>This article presents findings specific to antidepressants and narcotics use in fire-related deaths. The findings in this article originate from a larger study on illicit drug, prescription drug, and over-the-counter (OTC) sleep aid use in fire related deaths and drug impact on human behavior in fire. The larger study considered drug impact on fire cause and human behavior factors, i.e., receipt of cue, perception of threat, response to threat, and movement time. Drug and alcohol use data was collected from the State of Maryland, Office of the Chief Medical Examiner (OCME) for fire deaths occurring between 2005 and 2019. Data on fire origin and cause and occupant actions was gathered from fire investigation reports issued by the State of Maryland, Office of the State Fire Marshal (OSFM), local county and city jurisdictions, and from the National Fire Incident Reporting System (NFIRS). Antidepressant and narcotic user cohorts were significantly overrepresented in the dataset when compared to individuals using other types of drugs. The most predominant fire cause in these cohorts was smoking, and there is a known interdependence between antidepressant and narcotic use and smoking. The combination of smoking while taking an antidepressant or narcotic (which may cause drowsiness) is likely an important factor. Research shows that smoke alarms provide little benefit to those intimate with (and often ignited by) fire, such as individuals that fall asleep while smoking. The results of this study indicate that risk reduction solely focused on technology-driven fire protection approaches, such as smoke alarms, is insufficient in addressing the occurrence of fire deaths in all drug user populations. Fire prevention approaches must also include community risk reduction programs focused on improving safety culture through a reduction in high-risk behaviors.</p>