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).
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