After studying many hundreds of such cases, it is clearly established that 75 mg to 80 mg is the maximum lethal dose for even the most severe heroin addicts. Note that in a low tolerance person, in an average hospital setting, a small effective therapeutic dose of intravenous heroin is only 3 mg to 4 mg.

The important thing to note here is that the problems associated with establishing a "lethal dose" for intravenous heroin primarily relates to the problem of establishing a "minimal lethal dose," i.e. the smallest amount of heroin which will kill. The "maximum lethal dose," i.e. the highest dose of intravenous heroin a severe heroin addict can withstand without immediately collapsing into a coma and/or immediately dying, is very well documented.

The blood morphine level of 1.52 mg per litre found in Cobain's body represents a heroin dose which is substantially higher than this well established maximum lethal dose.

Another study points to the potential lethality of even low doses, with 5 fatalities showing an average of a mere 0.021 mg per liter of blood, representing an approximate intake of 3 mg, i.e the average functioning dose. The average person without pain or addiction will overdose with 60 mg of morphine (18 mg heroin), yet a patient in serious pain will likely require the same dose, 60 mg of morphine (18 mg heroin) to relieve such serious pain symptoms.

Platt also mentions a particular study where severe heroin addicts were monitored, and the maximum dose seen was a daily total of 260 mg heroin, taken in four divided doses, i.e. 65 mg heroin each dose (75).

Again, the maximum lethal dose of heroin is shown to be 75 mg - 80 mg for a 150 lb. severe addict. Such a lethal dose, of about 75 mg - 80 mg heroin, will give the soon-to-be-dead individual a blood morphine level of approximately 0.5 mg of morphine per litre of blood. Astonishingly, this is less than one-third of the level that was found in Cobain's tiny body at least three days after his death.

...More than 100mg of morphine (30 mg heroin) almost always presents major complications. Doses over 250mg morphine (75 mg - 80 mg heroin) are usually associated with certain death, i.e. 75 mg - 80 mg of heroin, leads to a blood level of approximately 0.5mg per liter, the high end of toxic doses. Thus it is clear that Cobain ingested at least triple the lethal dose for even the most severe addict. If he were not a severe addict, then 1.52 mg per liter potentially represents up to 75 times the lethal dose.

Details regarding common heroin doses are explained by Tong & Pond who state that, "the basic unit of sale is the 'tenth,' which is 1/10 of a gram or 100 mg of pure drug. This unit... provides approximately 4 'hits' or doses. A quarter of a tenth (25 mg powder) contains 20 mg to 24 mg of heroin, which is more than the usual street addict is used to per dose." (94). Severe addicts may require 3 such hits in 1 dose, 4 times daily, while Cobain's blood morphine level represents a dose of approximately 8 to 10 such "hits."

Additionally, Platt remarks on the amazing rapid action of intravenous heroin by explaining that "...the high uptake of heroin...indicates that an abrupt entrance of heroin into brain tissue probably occurs 10 to 20 seconds after the usual intravenous injection by addicts...15 seconds, 68% uptake into brain with heroin compared to 42% for methadone, 24% for codeine, and morphine too small to measure. "(75).

Basically, a high lethal dose of heroin will either cause immediate death, or, in an unlikely scenario, immediate incapacitation by rendering the recipient comatose. This is described by Staub, et. al. as follows: "...we have shown that in 85% of the cases, the death should be attributed to a so-called 'golden shot'. In the remaining cases, the death is not so rapid and a survival period in a comatose state has to be taken into consideration." (90).

Similarly, Garriot & Sturner, describe how "...morphine in the blood was found to correlate with the time of survival and ranged from 10 to 93 mcg per 100ml (.1 to .93 mg per litre, ed.) in the short-term interval group...6 mcg per 100 ml (.6 mg per litre, ed)." (28).

Notably, as of 1973, Garriott & Sturner did not find any blood morphine level over 0.93 mg per litre, i.e. Cobain's blood level was over 50% higher than the highest level they had ever encountered. Regarding the common sequelae of heroin overdoses, Nakamura explains " there are vivid accounts of victims lapsing into a deep coma immediately following a 'fix' with a syringe still afixed in the arm or on the floor underneath the body, and/or with an improvised tourniquet still in place around the arm." (63). Gossell & Bricker report that "for a large overdose, the victim rapidly lapses into coma and is not arousable by verbal or painful stimuli." (32).

Whatever the physical source of heroin was, it does not really matter; the only thing that makes one type of heroin stronger than another is concentration of dose, so it was approximately 225 mg to 240 mg of some type of heroin. If the purity was 40%, a more common figure, then the lethal dose, including adulterants, would have been around 600 mg. Thus there is a definite chance of up to 350 mg of procaine or acetyl procaine as an adulterant. Note that procaine is commonly found in samples of Mexican black tar heroin. Regarding the potential toxicity of procaine, it should be noted that procaine levels would likely be undetectable in Cobain's blood due to the fact that the body was found at least three days after death.

Still, the importance of procaine's potential toxicity is emphasized by Nakamura, who says "Nearly all the contraband heroin in the western areas is obtained from Mexico and contains an appreciable amount of procaine, or acetyl-procaine, as a filler material. ...The potential danger of a large concentration of this dilutent in street heroin needs to be better understood. (63).

The Significance Of Diazepam Presence

The lethality of the combined use of heroin and diazepam are discussed by Nakamura, who mentions them in reference to occassional problems with finding a postmortem blood morphine level. The lethality of the heroin is so greatly increased that very small doses kill, meaning that "...the interaction of drugs in eliciting acute responses and causing deaths even when sublethal amounts of two or more drugs are present in postmortem specimens from the same cadaver may be a factor." (63).

The Possibility Of Fast Acting Benzodiazepines

While diazepam is effective at a dose of 5 mg, the effective dose of Xanax is merely 250 mcg, with a half-life of 10-20 hours. Thus Xanax works as well as Diazepam at one-twentieth of the dose. Diazepam works in 30 minutes, while Xanax works immediately, and has a half-life of 10-20 hours. That means that 10-20 hours after taking it, half of it has been rendered useless. When injected, benzodiazepines in general are twice as potent. Thus a significantly toxic oral dose of 30 mg of diazepam would be easily achieved by an approximate equivalent of 500 mcg to 750 mcg of intravenously administered Xanax.

Diazepam is measured usually by its secondary metabolites in the liver, and the metabolites for Xanax and Diazepam and Valium are all very similar, so often no differentiation is made during testing, which is often only conducted to determine presence, not quanitity. If the benzodiazepine in Cobain's blood was indeed a fast-acting one, then it very likely played a major role in making the massive dose of heroin even more deadly.

Some Deaths Involving Heroin And Diazepam

Three of these cases involved diazepam and intravenous heroin or morphine (33). The first and second cases both involved oral diazepam plus intravenous heroin and/or morphine. The first case showed a blood morphine level of only 0.13 mg/L and diazepam at 1.4 mg/L, and the body was discovered approximately nine hours after death.

Case 2 showed 0.3 mg/L blood morphine and 6 mg/L diazepam, and was discovered about seven hours after death.

Case 3 included the possibility that the diazepam might have been injected with the morphine, and the blood levels were 0.02 mg/L morphine and 0.3 mg/L diazepam, with the body discovered about 24 hours after death. The third case in particular shows an extremely low blood morphine level can be lethal when combined with a low dose of diazepam.

CASE UNPARALELLED IN SUICIDE & OVERDOSE REPORTS:

Very High Blood Morphine Levels Are Rare

Appendix A: Compendium of Intravenous Heroin Related Deaths Where Blood Morphine Levels Were Measured, shows the rarity of occurance of a blood morphine level equal to or greater than Cobain's. Many thousands of opiate related deaths were rewiewed, and for the purposes of this report, over 3000 of these deaths were determined to be specifically related to overdoses among addicts involving the intravenous use of morphine or heroin.

Next, this group was further narrowed to eliminate those cases in which blood morphine levels were not available. Cases where the drug was known to be morphine were eliminated, as were cases where the cause of death was determined to be other than overdose. The 1526 cases remaining showed 26 instances where the blood morphine levels were equal to or above Cobain's, an occurance rate of 1.7%.

None of the above cases reportedly involve a gun or violent suicide. Additionally, no case reported overdose sequlelae of a nature which would even imply the possibility of anything other than immediate incapacitation and/or death. Where data was available, it was remarkably clear in presenting images of addicts with tourniquets in place, syringes in hand, and other evidence of abrupt death.

Self-poisoning & Violent Suicide Rare Among Addicts

He also states the effects of heroin "...is of such short duration and is so intense that it inhibits any type of physical activity, either criminal or non-criminal." (9).

Also, no case of violent or traumatic suicide reviewed compared well with the Cobain case. Gatter studied "...1862 postmortem examinations of suicides carried out in north west London over a 20 year period from 1957-1977...," (29) with only 20% (369 cases) committing suicide by physical injury, none of which involved opiates.

Maurer and Vogel state plainly "...the general rule that opiates inhibit tendencies toward violence." (59).

Similar findings are reported by Nowers, in his study of "...51 consecutive gunshot suicides in the County of Avon, England between 1974 and 1990," where it is apparent that suicide by gunshot is uncommon. "Of the 1,117 cases identified, 51 were gunshot suicides (4.5 per cent)...39 used a shotgun." (65). Again, no case reported blood morphine levels.

The 1862 suicides studied by Gatter included 369 violent deaths, with 51 gunshot suicides as well as a significant degree of drug overdoses, yet again, no parallel exists to Cobain's case. Cooper & Milroy's study involved 536 suicides, 246 of which were violent, 10 of which involved a gun. (15).

Thus, in 3586 total suicides, including 208 suicides by gunshot, no case remotely resembles a situation where a gunshot of any kind and a heroin overdose of even minor proportions occurred.

Review Of Rare Overdose Cases In Cobain's Range

However, it is vital to note that all these cases involved abrupt death immediately following injection, and none of any of the 52 cases studies was reported to have committed suicide with a gun of any kind.

Basically, their study showed a remarkable consistancy in abrupt reactions, indicating an 85% probability of instant death, and 15% chance of instantaneous collapse into a comatose state. Still, it is worth pointing out that this is the single largest group of cases at or above Cobain's range. Coumbis & Balkrishena (16) show four high level cases, while Gottschalk & Cravey (33) and Hine, et. al. (42) each show 3 such cases. Studies which found only one such level are Richards, et. al. (77), Paterson (70), and Monforte (62).

Finally, Nakamura (63), mentioned previously, also found only one very high level case, with 1.8 mg/L, and the manner of death was known to be instantaneous.

WASHINGTON STATE HEROIN OVERDOSES

The focus of their research basically concerned testing the reliability of postmortem blood samples over time, and the variabilities between morphine levels when collected from different tissues, including different "sites" of blood collection, eg. femoral, iliac, and ventricular sites. Also of specific relevance to the Cobain case is the the authors noted "...the pattern of opiate use in this population is almost exclusively one of Mexican black tar heroin."

Generally, they conclude that "Although both site dependant differences and time dependant changes have been shown to affect the concentration of some drugs in postmortem samples, neither appears to be the case with morphine." (58).

The main point is that the Cobain blood data is generally regarded as reliable, despite the fact that the body was discovered at least three days after death. More importantly, note that only one case of 32 was suicide, with the remainder listed as accidents or probable accidents. The highest total blood morphine level, collected initially from the iliac site, is 0.4 mg/L, shows black tar heroin use among a population of addicts does not appear to necessarily lead to significantly higher blood morphine levels than those found in addict populations where black tar heroin is uncommon.

Sperry also discovered the highest level of purity in black tar heroin ever reported, 93 % in some rare cases. No case involved "...the so-called acute idiosyncratic reaction...," further supporting the findings that acute heroin overdoses are dose-related primarily. While it is obvious that many adulterants can increase lethality, it would be completely mistaken to think that pure heroin lacks toxicity as a result of it's purity or the lack of toxic adulterants. None of the cases studied by Sperry showed evidence of other drugs, and no case was reported to involve a gun or trauma. While it is unfortunate that Sperry does not provide a detailed list of blood morphine levels and other data, it is important to note that even in a population of addicts overdosing on black tar heroin, levels over 1 mg/L are considered "...very high..." (89)

This contrasts with Cobain's level, which registers 50% higher. Due to lack of specific blood data, Sperry's report is excluded from Appendix A.

Preponderance Of evidence

Only one of the 128 deaths involved secondary self-inflicted trauma of any kind, in which one person committed suicide by hanging. Notably, despite evidence of intravenous heroin and/or morphine use, and despite the fact that morphine levels in other tissues confirmed death by overdose, there was no morphine detectable in the blood at all, which helps explain how the individual had time to hang himself.

The individual in question tested positive for several drugs, as is common in cases of self-poisoning, and this accounts for the lethality of the otherwise low dose of opiates. Specifically, oral methadone was also consumed, thus there would be a moderately delayed reaction before the combined effects of the drugs took effect and killed the victim before he died from the hanging itself. None of the 128 deaths involved a gun of any kind.

The average, or "mean," blood morphine level was high, at 1 mg/L, with a range of 0.19 mg/L to 1.9 mg/L, indicating at least one case in which the concentration was at or above Cobain's range (probably only one, which would raise the mean beyond normally seen mean levels). No other details are provided concerning the route of administration, i.e. whether or not the morphine or heroin were administered orally or intravenously. Intravenous administration is a significant possibility.

Since Paterson's study includes at least one case in seven in Cobain's range, the data is used in this study to determine the specific probability and/or possibility of an individual attaining such a high blood level. Note that if the data is interpreted as 1 case in 189, then the chances of an individual attaining such a blood morphine level via self-poisoning, during a nine year period, is less than 0.0054%, i.e. extremely remote.

Yes it does happen...staged deaths are unfortunately not rare. Furthermore, criminology textbooks clearly state that when someone who is drugged supposedly commits suicide, the "...fair supposition..." is murder. Also, when an adult goes "missing," the chances of suicide are very slim. Read a sampling for yourself from O'Hara's, Charles E., Fundamentals of Criminal Investigation, (66). "

...V. Beck examined forty suicides, whose skulls were smashed... Naturally in such cases the muzzle of the barrel must be placed directly under the chin or in the mouth. It is not therefore impossible that a murder may be committed in this way, and all the more likely as it lends itself easily to the suspicion of suicide; it is a fair supposition that a person asleep, stupefied, or bound, may thus be killed."

CASE PARALLELS MANY HOMICIDE PATTERNS:

Victims of murder are usually men, and for both sexes, the most vulnerable age group is between 25 and 34 years of age. Both sexes were "...killed most often at home. Both were killed more often with guns..." Regarding the statistical possibility of spouse murder, Levin & Fox state that "...though only 15% of all homicides are committed by females, more than 40% of all poisonings are committed by them." (55).

Lester reports on Wolfgang's 1956 Philadelphia study which concluded that "Wives killing husbands constituted 41% of female murderers...Men killed by women were most often killed by their wives." Furthermore, again consistant with Cobain case, "...spouse murders were more often violent and brutal than other murders...85% of spouse murders took place in the home." (54).

Another study showed "...murderers more often attacked people they knew." A 1972 study in New York City by Baden found "...215 homicides, 19 suicides, and 46 accidents among narcotic addicts. Narcotics homicides (versus other homicides versus other addict deaths) were more often male..." (54).

Simulated Suicides A Major Concern

To draw a conclusion of suicide, the wounds should be physically not improbable...". Additionally, he makes the point "Murder: The conclusion that a particular homicide is a murder is often made by the exclusion of accident and suicide." (66).

The above quotes show how a charge of murder can result from disproving the possibility of an accident or suicide. Motives aside, the main issue here is described above as an "incapacitating sequence." Indeed, the simple fact that Cobain was drugged at all is considered a major indication of murder. Truthfully, Cobain's death should have been treated as murder from the start; as the victim he should have received the benefit of the doubt.

O'Hara remarks on the rarity of suicide among missing persons. He describes how the myth of a suicidal missing person perpetuates homicides staged to look like suicides; "To the layman the suicide theory is one of the first to suggest itself in a disappearance case. Statistically, however, it can be shown that the odds are greatly against the suicide solution.

Approximately one out of 2,000 missing persons cases develops into a suicide case...A voluntary disappearance is motivated by a desire to escape from some personal, domestic, or business conflict...A disappointment in love seldom results in a self-inflicted death...In the disappearance of approximately 100,000 people annually in this country, it is to be expected that personal violence should play a significant part in some of the cases.

Murder, the unspoken fear of the relatives and the police, must always lie in the back of the investigator's mind as a possible explanation. The suspicions of a shrewd investigator have not infrequently uncovered an unsuspected homicide. The two most popular motives for this type of homicide are money and love."

Thus it is made clear that the police and relatives routinely view the possibility of murder with a certain degree of horror, while the investigator must remain suspicious to a degree which others may find ghoulish and/or paranoid, but which is nonetheless the call of duty.

Burgess wrote, in Understanding the Autopsy, that "There are many jurisdictions in this country where you would not have to be half-smart to get away with murder, quite literally...the fact remains that, in all too many places, the investigation of possible murder is undertaken only after pressure is brought by relatives or other interested parties, and when such investigation is instituted, it is done so incompetently that murder after murder goes unsolved and unpunished." (8).

"The question whether a fatal injury was homicidal, suicidal, or accidental is as common in real life as it is in detective fiction. ...It is natural for a murderer to try to escape detection by making his crime look like suicide or accident, and such attempts have doubtless been going on for a long time. One cannot say how long, for one never hears about them when they succeed. However, records of failures take us quite far back." Smith, Sir Sydney (87)

The addition of a benzodiazepine of any kind, especially in combination with Cobain's low body weight, points to complete incapacitation at best, and strongly, if not conclusively indicates Cobain was dead before the gunshot wound.

The official statement that Cobain ingested triple the lethal dose of heroin is probably an underestimate, yet it must not be understated that triple the lethal dose of intravaneous heroin is three times more than the amount which kills even the most severe addict.

Dead men don't pull triggers.