Introduction: King hits are when a single blow to the head causes a victim to fall to the ground unconscious, either from the punch itself or the impact between the head and the ground. This can result in fatal skull fractures and subdural hematomas. This study aimed to establish the prevalence of king hit deaths in Australia and determine the involvement of drugs in these violent fatalities. Methods: The National Coronial Information System was used to retrieve all cases involving a king hit within Australia between 2000 and 2012. Results: 90 cases were identified with a median age of 33 years (range 15-78). There were 4 females. Most cases occurred in the state of New South Wales (n= 28), followed by Victoria and Queensland (24 cases each), at a hotel or pub before 3. a.m. Toxicology reports were available in 68 cases. Of these, 53 cases involved the use of alcohol or other drugs (other than those used in hospital treatment). Forty-nine cases (73 ) involved the use of alcohol, with a median alcohol concentration of 0.144. g/100. mL and 0.191. g/100. mL in ante-mortem and post-mortem specimens, respectively. Illicit drugs were detected in 10 cases of which most involved cannabis. Other pharmaceutical drugs were detected in 3 cases. Discussion: Assaults are an ongoing problem in Australia and king hits form a large group of these substance-related and often unprovoked attacks. Importantly, this study indicated that alcohol intoxication increases the risk of victimization, not just aggressive offending. This reiterates the serious consequences of alcohol-fueled violence in Australia.