when doing an autopsy, how can they determine the cause of death to be an “accidental” overdose rather than a regular one?
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Context clues.
Medical examiners don’t just do ‘the autopsy’, they conduct an entire medicolegal investigation.
In addition, the opposite of an ‘accidental’ overdose isn’t a ‘regular’ overdose. It’s either accidental or purposeful, i.e. suicidal overdose (and it is also possible to overdose and not die as well, but I am assuming OP is speaking about fatal overdoses).
There is no such thing as a regular overdose. Presumably an overdose will either be accidental or intentional. From a forensic perspective, an accidental overdose will be one that has serum concentration of the acting agent near to a therapeutic/recreational dose while if the serum concentration is far, far beyond what could remotely be considered normal it can reasonably be presumed that the overdose was intentional.
Context – an accidental overdose will typically be somewhere in the same order of magnitude as a regular dose. A purposeful overdose will generally be higher again then that.
An accidental overdose _is_ the regular sort. The alternative, an overdose that’s not by accident, is suicide (or a suicide attempt).
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