OBJECTIVE This study was designed to characterize poisoning deaths in Rhode Island and to determine the incidence of poisoning deaths that are not reported to the regional poison center. METHODS The records of the state medical examiner were reviewed retrospectively for all toxin-related deaths from January 1986 through December 1989, and those deaths were compared with deaths recorded by the poison center during the same period. METHODS All patients whose deaths were due to a toxic substance and were recorded by either the state medical examiner's office or the regional poison center during the four-year study period. METHODS Age, sex, location of death, cause of death (both primary and secondary toxins were noted), manner of death (accidental, suicide, undetermined), and the circumstances surrounding the death were recorded for each victim. Medical examiner and poison center cases were matched and compared using a computerized data base program. RESULTS During the study period, 369 deaths reported to the medical examiner were attributed to poisoning, while 45 poisoning deaths were recorded by the poison center. Of the deaths reported to the medical examiner, the most common reasons for lack of reporting to the poison center were that death occurred at a residence or patients were dead on arrival at the hospital and a toxin was not suspected until an autopsy was performed. Seventy-nine other poisoning victims arrived at the hospital alive with a suspected toxic exposure and hypothetically could have been reported to the poison center but were not. CONCLUSIONS The medical examiner's office represents a significant source of statistics regarding poisoning deaths, the majority of toxic deaths not reported to the poison center are dead on arrival, and using deaths as the dependent measure, the poison center may be underutilized in severe poisoning cases.