dead men dont pull trigger

DEAD MEN DON'T PULL TRIGGERS: OBSERVATIONS ON THE DEATH OF KURT COBAIN by Roger Lewis, Revised January 4, 1998
DISCLAIMER: Please note that the research for this essay was done as an independent project and has not been directed by or overseen by any other researcher or investigator. This research is based on high quality references which are listed at the end. All rights reserved.
ABSTRACT
A comprehensive review of 99 forensic, criminological, and other scientific references was undertaken with regards to analyzing the postmortem blood morphine level of Kurt Cobain. The following essay reports on this review, which includes 19 studies of 1526 deaths specifically involving blood morphine levels of intravenous heroin related overdoses, as shown in Appendix A. Other studies which were reviewed include thousands of heroin-related deaths in general, over 3226 heroin related overdoses, over 3586 suicides, 760 violent suicides, several significant staged deaths, autopsy procedures & discrepancies, postmortem pharmacokinetics of drugs, and, with respect to the traces of a "diazepam-like" substance found in Cobain's blood, several references were reviewed regarding benzodiazepines. Table 1, below, shows a seven point summary of the material reviewed, which provides a clear picture of Cobain's true cause of death, homicide. Thus, in contrast with the "official" verdict of suicide by shotgun, the scientific facts point to a series of events which probably included a massive, lethal "hot shot" dose of heroin and a benzodiazepine administered to Cobain, which would have either immediately rendered him incapacitated in a comatose state or killed him instantly. No suicide or overdose case exists, in any of the many references reviewed, which parallels the Cobain case, most likely because the chain of events which occurred cannot be duplicated. This chain of events specifically resembles homicide patterns, not suicide, and should be re-opened to allow an independent re-investigation of the serious discrepancies in the verdict, which should be changed.
Table 1
7 Point Summary
1.) TRIPLE MAXIMUM LETHAL DOSE EVEN FOR SEVERE ADDICTS: At least three days after his death, Kurt Cobain's blood contained 1.52 milligrams of morphine per litre (mg/L) plus traces of a "diazepam-like" substance. This level is widely known to represent three times the lethal dose of heroin, but it is not commonly understood that this level is three times the lethal dose even for severe heroin addicts. Generally, a blood morphine level of 0.5mg/L is caused by 75 mg - 80 mg of heroin, the established maximum lethal dose, even for severe addicts. A blood level of 1.52 mg/L generally indicates an original dose of approximately 225 mg - 240 mg of heroin.
2.) INCAPACITATED OR DEAD BEFORE GUNSHOT:Large overdoses of heroin by heroin addicts are a phenomenon which is well understood. Research clearly shows that an overdose in the range of that received by Cobain would lead to immediate and complete incapacitation and/or immediate death.
3.) OTHER FACTORS ENSURED OVERDOSE LETHALITY: The 1.52 mg/L blood morphine level does not compensate for the presence of diazepam, or Cobain's low body weight, both of which are well proven to substantially increase the lethality of the heroin.
4.) CASE UNPARALLELED IN SUICIDE & OVERDOSE REPORTS: A review of 3586 suicides, including 760 violent suicides, shows no case involving both a gun and narcotic overdose of any kind, supporting theories regarding the absence or extreme rarity of violent suicide among addicts.
5.) CASE CONSISTENT WITH HOMICIDE PATTERNS: A review of cases involving homicides shows many similarities with patterns in the Cobain case.
6.) OTHER EVIDENCE INDICATES HOMICIDE: Officially acknowledged evidence exists which indicates the possibility of homicide, including a misleading missing persons report, postmortem credit card usage, handwriting discrepancies on the "suicide" note, and the lack of legible fingerprints on the weapon. It appears the police were prejudicially in favour of a suicide ruling, and that the coroner was involved in a conflict of interest predisposing him towards this major discrepancy in the evaluation of his findings.
7.) CONCLUSION: HOMICIDE: The evidence indicates that a massive intravenous dose of heroin, and possibly a benzodiazepine, was administered to Cobain. The final of the two known injections incapacitated and/or killed Cobain, and the gunshot is evidence of a homicide staged to look like a suicide. The case should be re-opened by an independent investigatory body.
INTRODUCTION
Kurt Cobain's untimely death is admittedly a morbid subject. This essay is intended solely to contribute to the efforts of thousands of Cobain admirers and others who seek to put an end to the copy-cat suicides, and to discover the truth behind this horrible tragedy. Estimates from 1995 listed over 150 acknowledged copy cat suicides, some of which are described in Appendix B. Concerns regarding potential lawsuits from bereaved parents against the Seattle Police Department has been suggested to be a factor in their determination to keep the case officially closed unless "new evidence" comes forward. One such piece of new evidence is the following re-interpretation of the officially released evidence. The official time of death is unknown, but is estimated as occurring no later than towards the evening of Tuesday, April 5th, and the body was found Friday, April 8, at 8:40 a.m. This will be the starting point for the following research and observations which attempt to present the facts supporting the claim that Cobain was incapacitated or dead at the time he supposedly shot himself, a situation which would obviously completely eliminate the possibility of suicide. The essay is somewhat technical, so efforts have been made to simplify and explain these matters for those who are not familiar with the scientific
nature of this research. Additionally, some are details of the Cobain case are presented for those who are unfamiliar with the case in general.
1.) TRIPLE MAXIMUM LETHAL DOSE EVEN FOR SEVERE ADDICTS:
1.52 MG MORPHINE PER LITRE OF BLOOD Cobain's death in April, 1994 led to wide media coverage, and it was soon revealed that his blood morphine level was 1.52 mg per litre (mg/L). One biographer mistakenly claimed that Cobain "injected" 1.52 mg of heroin. The figure 1.52 mg actually refers to the level of drugs found in Cobain's blood, not the amount he originally injected. This can be seen in other reports, both biographical and mass media, where the 1.52 mg level is sometimes further described as "per litre of blood" or "triple the lethal dose," usually with subsequent notes that an addict has higher tolerance. Cobain would have needed to inject much more than 1.52 mg of heroin to help even the most mild headache. Additionally, the Seattle Police Department reported that a cigar box of drug paraphernalia was beside the victim, including pieces of what appeared to be black tar heroin, generally regarded as Mexican in origin. Also, according to the Seattle Police Reports, two puncture marks were found on Cobain's body, one in each arm, in the inside crooks of the elbow region.
TOLERANCE HAS A WELL DEFINED LIMIT The fact that there is "higher tolerance among addicts" is commonly misunderstood. This concept is evoked apparently as an attempt to describe how it could be remotely possible that Cobain was alive and functioning well enough to fire a shotgun, despite the otherwise triple maximum lethal dose. The "1.52 mg" figure refers specifically to the morphine per litre of blood. No doubt exists that a blood level of 1.52 mg of morphine per litre represents just a little bit over three times the maximum lethal dose, but the implications of this fact are not well understood.
WHAT IS THE LETHAL DOSE OF HEROIN? Table 2, below, shows that the lethal dose range of intravenous heroin is generally regarded as 10 mg to 12 mg. Sometimes even a tiny dose can kill, so the lethal dose of intravenous heroin can go as low as 3 mg, possibly even lower. Some people get confused and think that high variability in the minimum lethal dose means that a similar variability exists for the maximum lethal dose. The most serious heroin addicts will die with virtual certainty with much less than a dose of 75 mg to 80 mg of heroin. 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.
Table 2
Therapeutic, Toxic, & Lethal Dose Ranges of Intravenous Heroin in Relation to Low & High Tolerance Levels
Degree of Toxicity or Lethality Dose Range
Therapeutic (low tolerance) 3 mg - 4 mg Toxic (low tolerance) 3 mg - 10 mg Lethal (low tolerance) 10 mg - 12 mg Therapeutic (high tolerance) 10 mg - 60 mg Toxic (high tolerance) 10 mg - 70 mg Lethal (high tolerance) 75 mg - 80 mg
INTERPRETING THE NUMBERS The "1.52mg per litre" level in Cobain is one several standard measurements referring to the blood level of morphine. For example, 1.52 mg per litre could also be expressed as "152 mcg per 100 ml," because mathematically they are the same amounts. Those unfamiliar with metric conversions should note that basically, a litre is 1000 ml, so 1 mg per 1000 ml is equivalent to 0.1 mg per 100 ml. Those of you more familiar with metric will note that 100 ml is one-tenth of a litre, thus the abbreviation "dL" stands for "decilitre,"which is of course the very same 100 ml. Throughout this report, whenever a source is quoted using a blood drug amount in a format other than mg per litre, I have supplied a non-italicized, bracketed conversion following the quoted figure, eg. "93.0 mcg/dL...(0.93 mg/L, ed.)."
TESTING METHODS ACCURATE Approximately 25 years ago, it became increasingly clear that accurate postmortem detection of morphine in blood was a problem which had finally been resolved scientifically. Garriott & Sturner, in 1973, note that "With the recent advent of improved methodology for the determination of morphine in the blood...it has now become possible to quantitate small amounts of this narcotic drug metabolite some time after the last previous heroin injection (28)." Nakamura explained in 1979 that "Until recently, the toxicologic determination of heroin death was extremely difficult because of the lack of a sensitive method for the detection and quantitation of small amounts of morphine in postmortem blood and other tissues. " (63). Data is not available regarding the testing method used to determine the level of morphine in Cobain's blood, although the scientific literature suggests strongly that GC (Gas Chromatography) is the current standard method. Other major testing methods exist, such as GLC (Gas-Liquid Chromatography), GC-MS (Gas Chromatography-Mass Spectroscopy), HPLC (High Pressure Liquid Chromatography), RIA (Radio-immuno Assay), and all of these methods have been determined to be very reliable indicators for establishing the levels of morphine in postmortem blood.
HEROIN TURNS INTO MORPHINE There will be no discussion blood "heroin" levels, because heroin is almost instantly transformed into morphine when it enters the blood. Heroin itself can indeed be measured in the blood and other tissues, especially the urine, but it should be noted that heroin levels are largely irrelevant to this case. Special laboratory conditions are often elaborately constructed to measure these actual "heroin levels," because in everyday life they almost never exist. Again, simply put, when heroin is injected into the blood it rapidly transforms into morphine. There is virtually no heroin left in the blood as "heroin" after about nine minutes, with the heroin going through a deacetylation process, sometimes called de-esterfication. This is known as a "pharmakokinetic" process, and is known to continue after death. Consequently, it is virtually always that morphine, instead of heroin, is measured in the blood of both the living and dead to give forensic scientists an indication of the amount of heroin originally injected, the likely time of injection, and very importantly, an indication
as to the events following the injection.Morphine toxicity, whether found in the blood, bile, urine, liver, or other tissues, is the standard measurement for opioid toxicity in general, and heroin in particular, because heroin immediately turns into morphine in the body.
TOLERANCE TESTS IN SEVERE ADDICTS One study involved a small group of severe addicts who used high doses ranging from 150 mg to 200 mg of morphine four times daily (75). This is equivalent to an intake of approximately 45 mg to 60 mg of heroin, four times daily. These addicts showed some signs of serious effects, but continued for several years without fatality and showing average blood levels of 0.3 mg per liter. 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.
Table 3
Dose Equivalents of Heroin & Morphine
Drug Equivalent Dose
Heroin 3 mg
Morphine 10 mg
table 3 shows that heroin is approximately 3 to 4 times stronger than morphine, so 3 mg of heroin is equal to about 10 mg of morphine. It should be noted that generally the data is very supportive of this equivalence between certain doses of morphine and heroin, an equivalence
which is three-fold, including pharmacological effect, blood morphine levels, and most importantly, toxicological effect. To the extent that differences have been established, there is no doubt that a large intravenous heroin overdose is even deadlier and faster acting than an "equivalent" large intravenous morphine overdose.
Table 4, below, shows the generally accepted dose and blood level equivalents of intravenous heroin. 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. This is basically a linear conversion, which is not true for all drugs, but is shown to be true for intravenous morphine and heroin overdoses in addicts, as shown in the several of the studies referenced. 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." More importantly, it must be remembered that the actual size of the dose does not matter very much, rather it is the blood morphine level in particular, a what it tells us, which is the true forensic evidence, the incontrovertible fact. Although it is definitely possible to make a reasonable estimate at the obviously massive dose Cobain received based on data from other intravenous heroin overdoses in addicts, an exact dose figure cannot be determined without a full forensic report regarding the morphine levels in various other organs and tissues. Regardless of the specific dose of heroin, the 1.52mg/L blood morphine level in Cobain allows for the conclusion to be made that he was immediately incapacitated or dead based on the simple fact that no other instance exists on record indicating otherwise, even remotely.
Table 4
Dose & Blood Level Equivalents of Intravenous Heroin
Dose Equivalent Blood Morphine Level
75 mg - 80 mg 0.5 mg/L
150 mg - 160 mg 1.0 mg/L
225 mg - 240 mg 1.5 mg/L
RELEVANCE OF BLOOD DATA The overall importance and relevance of such toxicological data is emphasized eloquently by Prouty, et. al., as "One of the most fundamental questions of postmortem forensic toxicology is...'How much drug did the decedent take?' Historically, to answer this question, toxicologists have relied upon published case reports of fatal intoxication, in which the amount of ingested drug was known or reasonably approximated, and upon reports in the clinical literature that contain information concerning drug concentrations after single or chronic dosing. In recent years, pharmakokinetic equations have been increasingly used in an effort to estimate more precisely the total amount of a drug in the body and, subsequently, estimate the dose of the drug required to produce a measured blood concentration." (76). The use of blood morphine levels to establish criminal intent dates back over 100 years. Nakamura points out that "As early as 1893...Thorwald describes a celebrated court proceeding involving a physician who allegedly poisoned his wife with morphine." (63).
BLOOD IS LIKE AN HONEST WITNESS Analyzing the morphine level of a dead person can help determine the time and the manner of death. Such tests are useful in cases where there is no eyewitness, or, for example, in the Cobain case, where there are officially no witness, but where forensic evidence suggests the presence of a witness, i.e. Cobain was either dead or so severely incapacitated by the massive dose heroin, that someone else had to have pulled the trigger. Nakamura remarks similarly that "Many...witnesses are unavailable because they either flee from the scene upon the death of their companion or they discard the body in a location less discriminating than their own domicile." (63) Thus the very idea of investigating a suspicious death using forensic testing of the morphine levels is a well established phenomenon, due at least partly to the tendency of those associated with the event to flee, discard the body elsewhere, and provide otherwise unreliable information in an attempt to avoid implication of their involvement. With respect to Nakamura's comment regarding "...they discard a body in a location less discriminating than their own domicile," it is noteworthy that Cobain's body was suspiciously enough found in his own domicile, even though he was supposedly a "missing person."
2.) INCAPACITATED OR DEAD BEFORE GUNSHOT:
HEROIN IS VERY FAST ACTING The following quotes from Krivanek describe the rapid action of this deadly narcotic, especially when taken intravenously, "Heroin has a far more positive slope than either morphine or methadone- that is, its effects begin, and reach a peak more rapidly...3 mg of heroin...given by subcutaneous injection will provide adequate analgesia in about 70 per cent of patients with moderate to severe pain. At that dose sedative effects and respiratory depression should both be minimal. As dose increases, they become more pronounced, and the respiratory depression will become life-threatening with about 30 mg morphine (9 - 10 mg heroin, ed.) ...Intravenous doses, on the other hand, can be considerably smaller, - about one-fifth of the subcutaneous dose." (53). 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). It would be a mistake to think that even a severe addict could intravenously inject triple the maximum lethal dose of heroin and survive 10 to 20 seconds. First, it must be understood that the injection process itself takes a considerable amount of time such that the lethal effects of the drug often take effect with the needle still in the arm. This specific case supposedly involved the injection, the removal of the needle & tourniquet, the placement of paraphernalia in a box, sitting on the floor, and positioning and firing the shotgun. Secondly, it is important to note that an intravenous heroin overdose is very different from the previously described "usual injection" because an overdose produces much more serious effects much faster than the "usual injection".
SOME DATA ON SPEED OF DEATH The Lange manual for Poisoning & Drug Overdose states that for opiates, "with higher doses, coma is accompanied by respiratory depression and apnea often results in sudden death." (68). 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." (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).
ACUTE HEROIN OVERDOSES ARE DOSE RELATED Garriott & Sturner describe the relation between dose and speed of death as follows: "The cases in the intermediate-survival range - namely, from three to 24 hours - showed values for morphine in the blood of 3 to 10 mcg per 100 ml (.03 to .1 mg per litre, ed.). ...It is of interest that the three cases in the short-survival group demonstrating the highest concentrations of morphine in the blood (50, 50, and 93 mcg per 100 ml) (0.5, 0.5, and 0.93 mg per litre, ed.) showed neither froth in the air passages nor extensive pulmonary edema, supporting the concept that a very sudden death may be due to other mechanisms after injection. Rapid central-nervous-systems and respiratory depression as a direct effect of the narcotic drug would account for this phenomenon. ...(ed. note: as of 1973) The highest observed blood morphine value in an acute heroin "overdose" is 100 mcg per 100 ml (1 mg per litre, ed.). ...relatively high concentrations of free morphine tend to indicate the importance of the final injection in producing the lethal reaction." (28). Nakamura explains "In more cases, it can be now shown that narcotic was taken and rapidly distributed by the body to the various organs, and it may now be unnecessary to explain narcotic deaths by blaming excipients or hypersensitivity responses." (63). Thus, although some rare overdoses can be attributed partially to hypersensitivity, allergic, and other reactions to adulterants in street heroin, it is now widely accepted that heroin overdoses are primarily dose related.
DEFINING THE PROCESSES OF DEATH Some confusion exists in the literature regarding estimates of "speed" of death following intravenous heroin overdose, primarily due to two reasons. The first reason for confusion concerns the minimum lethal dose, i.e. a small blood morphine level does not rule out instant collapse or death. The second reason for confusion concerns the true nature of death, which technically involves the death of different organs over a period of time. Burgess describes this as "Death does not occur all at once. One organ or system of organs may die some time before another." (8). Thus, even in those rare cases when an addict takes a large overdose and does not immediately die, immediate incapacitation occurs via a coma, and a comatose person may continue to technically "live" for hours or even days. The variability in survival periods specifically concerns the lower doses, not the higher doses, and when it comes to "massive" doses, eg. the Cobain case, the data is remarkably clear in stating that such a dose would immediately incapacitate even a heroin addict with the highest of tolerance levels.
JAMES INQUEST LEADS TO CHANGED VERDICT One specific case which bears special significance with regard to the Cobain case is the case of Cindy James. The James case, as described by Dinn (20), involves the tragic death of a nurse who was reported as missing for two weeks before she was found dead. The case was changed m a suicide verdict to a verdict of "undecided," and the basic point of comparison concerns the methodologies used to reach the change in verdict. Before continuing with the similarities between the James case & the Cobain case, it is important to note several differences. The James Case did not involve a gun, there was no drug paraphernalia found near the body, and there was evidence that she was mentally unstable and possibly staged her own death to appear as murder. Also, James received morphine, not heroin (heroin is significantly faster and stronger than morphine). The cases are similar in that both James and Cobain died of a massive drug overdose which appeared to police, initially at least, to be suicides, and which later, to varying degrees, were suggested to be homicides based significantly upon the massiveness of the overdoses in relation to degree of incapacitation and speed of death.
IMPORTANT PRECEDENT OF METHODOLOGY It was conclusively determined that if the scenario of intravenous injection was indeed true, then "Following an injection, morphine at this concentration would have induced a rapid state of unconsciousness and death...Given the level of consciousness and the time required to create the scene...then the death would appear to have been a homicide." (20). Thus it is important to note that the only reason the case was not then determined to be a homicide is because there was no way to verify whether the morphine was taken orally or otherwise. The mere possibility of murder was enough to change the James verdict to "undecided," even though the case involved significant evidence of suicide. The James case establishes an important precedent of methodology, which is that the blood levels of morphine can be used to determine time of death and/or incapacitation with regards to recreating the events surrounding the death in question for the purposes of determining whether the death was due to murder or suicide. The same methodology, when applied to the Cobain case, indicates that due to death or incapacitation following the intravenous injection of a massive lethal dose of heroin (much stronger than morphine), Cobain's death would be even more certainly a homicide.
THE HIGHER THE DOSE, THE FASTER THE DEATH Nakamura conducted a study in which he "..selected for toxicologic analyses seven cases of heroin fatalities in Los Angeles County, all of whom had a common history of what appeared to be sudden death. ...The blood level of morphine ranged from 0.2 to 1.0 mcg/ml." (0.2 to 1 mg per litre, ed.). "Blood morphine levels in most acute heroin-involved deaths range from 0.1 to 1.0 mcg/ml (0.1 to 1.0 mg per litre, ed.)...Blood levels of morphine also appear to be regulated by dosage." (63). Only one case in the 7 case study by Nakamura had a blood morphine level in Cobain's range, at 1.8 mg per litre, and the next closest was 0.9 mg per litre. The rest were 0.5 mg per litre and lower, with levels as low as 0.1 mg per litre causing immediate death. Nakamara also refers to his related 1974 doctoral thesis from the School of Criminology at the University of California, Berkely, where he "...examined blood specimens from 64 fatalities...whose survival time could be estimated." The highest blood morphine level was 0.8 mg per litre, and there was a clear indication that the higher the dose, the faster the death.
3.) OTHER FACTORS ENSURED OVERDOSE LETHALITY:
COMPENSATING FOR BODY WEIGHT A blood morphine level of 1.52 mg/L indicates a heroin intake of approximately 225 mg - 240 mg. Thus, despite suggestions that Cobain may have simply been incapacitated by a normal, large dose fit for an addict, it must be noted that his body weight was at highest 130 lbs., and he was listed as being 115 lbs. in late 1993. This would generally increase his susceptibility to overdose by as much as 20%, since toxicity data is based on a 150 lb. adult.
COMPENSATING FOR ADULTERATION Heroin purity has been shown to vary widely, with samples containing as little as 1% heroin. Mexican black tar is usually no higher than 40% pure, but is not uncommonly up to 80% pure, while highest recorded purity level for Mexican black tar heroin is 93% pure (89). If the heroin used in this case was indeed Mexican black tar heroin, and it was in the range of the highestpotency recorded, i.e. 93% purity, then the dose required to reach a blood morphine level of 1.52 mg per litre would be approximately 245 mg to 260 mg. 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 Diazepam is generally synonymous with the more well-known drug Valium, and sometimes the term diazepam refers to the generic category of drugs known as benzodiazepines. This class of drugs is regarded as sedative-hypnotic, and is not cross-tolerant to opioids. That means addicts can use diazepam and similar drugs in the same way that non-addicts use them. Conversely, even a heroin addict will experience toxicity to benzodiazepines in the same manner as a non-addict. A junkie is not immune to the toxic effects of a benzodiazepine overdose simply because he or she can handle a big dose of heroin. Cassidy, et. al. report "as both drugs cause respiratory depression...the likelihood of death resulting as a consequence...is greater than if either drug were taken alone." (10). Oldendorf reports on the effect of relaxation as increasing heroin absorption in the brain (67), a factor which addicts often attempt to manipulate, eg. by using heroin with a relaxant such as a benzodiazepine.
BENZODIAZEPINES & HEROIN COMMON PARTNERS IN DEATHS Diazepam poisoning in particular, and benzodiazepine poisoning in general, is rare in isolation, but not at all uncommon in combination with other similar drugs, notably heroin. Several current studies from sources as disparate as the USA, Australia, Denmark, and the U.K., show that benzodiazepine abuse frequently occurs with heroin abuse, and that resultant death is a serious, growing concern. The two drugs have a definite added effect, increasing the likelihood of respiratory failure associated with heroin overdose by a very significant amount, which has now been relatively well quantified. The lethality of the combined use of heroin and diazepam are discussed by Nakamura, who mentions them in reference to occasional 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
The previous relative safety of benzodiazepines has become especially challenged lately with the misuse and abuse of related drugs such as Halcion and Xanax. Notably, these newer ultra-short acting benzodiazepines have a much shorter half-lives. This means that they clear out of the body very fast. Also, they have been considered the sole cause of death in recent forensic cases. Their potential lethality is especially increased when injected, and is the most common form of benzodiazepine-related respiratory failure. 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 quantity. 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 & DIAZEPAM Gottschalk and Cravey, in their large compilation of deaths involving psychotropic drugs, found 129 cases where morphine, predominantly intravenous heroin, was determined to be the primary cause of death. 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.
4.) CASE UNPARALLELED IN SUICIDE & OVERDOSE REPORTS:
VERY HIGH BLOOD MORPHINE LEVELS ARE RARE As mentioned previously, the strongest forensic evidence indicating Cobain was murdered is the sheer lack of a parallel case in forensic literature concerning violent suicides and/or overdoses. Overdose reports normally show results similar to those from Logan & Luthi, who described 16 deaths caused by intravenous heroin or morphine in which blood levels were measured, and the highest serum morphine level seen was 0.920 mg/L. (57). Appendix A: Compendium of Intravenous Heroin Related Deaths Where Blood Morphine Levels Were Measured, shows the rarity of occurrence of a blood morphine level equal to or greater than Cobain's. Many thousands of opiate related deaths were reviewed, 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 occurrence 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. Clearly, the level found in Cobain is among the top 2% of the highest blood morphine levels ever discovered, even in severe addicts.
SELF-POISONING & VIOLENT SUICIDE RARE AMONG ADDICTS The fact that the Cobain case as it supposedly happened has no parallel in the references reviewed concurs with Burston's finding that "self-poisoning with morphine or heroin is very uncommon." (9). 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. This is illustrated in Table 5, below.
Table 5
Absence of Parallel Case Among 760 Violent Suicides
No. of Violent Deaths / Violent Deaths Including Heroin O.D. / Source
96 / 0 / Selway 369 / 0 / Gatter 51 / 0 / Nowers 246 / 0 / Cooper & Milroy
NONE OF 3586 SUICIDES SHOW PARALLEL TO COBAIN CASE Additionally, Selway's (83) study of all 96 gunshot suicides in Victoria, Australia during 1988, demonstrates that none of the 64 cases where the blood was analyzed involved narcotics. Only two cases had taken an overdose of any kind, one drinking Paraquat, and the other taking oxazepam, alcohol, and imipramine. Selway's and Nowers' studies collectively deal with 147 suicides in which a gunshot was the cause of death, yet not one single case even distantly resembled the supposed scenario for Cobain's "suicide." 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 Remarkably, 8 studies out of 19 reported on at least one of the 26 rare blood morphine levels in Cobain's range. Staubb, et. al., listed 12 cases in particular out of the 52 cases studied which showed total blood morphine levels equal or above Cobain's level. (90). 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 consistency 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 Regarding Washington State heroin overdose deaths, including Seattle, a 1996 report by Logan & Smirnow in a study of 32 cases of "...deaths involving morphine." (58). 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 authors noted "...the pattern of opiate use in this population is almost exclusively one of Mexican black tar heroin." (58). 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.
BLACK TAR HEROIN DEATHS IN NEW MEXICO The high lethality of black tar heroin due to increased purity levels is discussed in Sperry's 1988 paper (90). Most of the 129 deaths involved "...very high (greater than 1 mg/L) concentrations of opiates in the blood..." (89). 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 Further confirmation of these findings is seen ubiquitously throughout the scientific literature, creating a preponderance of evidence. Gottschalk & Cravey's study of 128 heroin-related deaths showed only 3 cases in Cobain's range. (33). 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.
DECONSTRUCTING THE MYTH OF THE SUICIDAL HEROIN ADDICT Paterson (70) discusses 189 cases of fatal self-poisoning in North and West London between 1975 and 1984. These cases involved only one drug each, and each case was determined to be the direct result of an overdose of that specific drug, with no other contributing causes. The study
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further confirms that the myth of the suicidal heroin addict is indeed a myth, with only seven cases involving morphine, i.e. less than 0.04% of the cases studied. 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, and 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.
5.) CASE CONSISTENT WITH HOMICIDE PATTERNS:
BENEFIT OF THE DOUBT GOES TO THE VICTIM The idea that a person could intentionally kill someone is hard to truly accept, and it is even harder to imagine someone staging a murder to look like a suicide. It seems normal to ask "does this really happen?" 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
Rarity of Suicide Among Missing Persons
Incidence of Suicide in Missing Persons Reference
1 in 2000 O'Hara
2,000 TO 1 ODDS AGAINST SUICIDE AMONG MISSING PERSONS Table 6, above, demonstrates O'Hara's findings regarding the rarity of suicide among missing persons. It must be noted that this data does not specifically regard heroin addicts, and reflects the findings of one criminologist, yet it provides a general indication as to 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.
CASE PARALLELS MANY HOMICIDE PATTERNS A review of Lester's book on murder statistics shows the conflicting nature of much of the research into the possible relationships between homicide and suicide, yet establishes very clearly that "Narcotics were more likely to be present in the homicides." (54). 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 consistent 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 Similarly, O'Hara remarks on the common phenomenon of "Simulated Suicides: These are usually planned by persons wishing to defraud insurance companies or to arrange for a change of spouse...A search for motives should include an inquiry into insurance policies...," as well as a concept especially relevant to this case, the "Incapacitating Sequence: Certain combinations of wounds suggest a physical impossibility. 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.
Homicidal Poisoning by Intravenous Heroin: Hot Shots
Heroin Related Deaths % Homicidal "Hot Shots" Reference
174 3.5 % (6 cases) Froede & Stahl
HOMICIDAL "HOT SHOTS" NOT UNCOMMON Froede and Stahl, in their paper "Fatal Narcotism in Military Personnel," reviewed 1.3 million U.S. military autopsies between 1918 and 1970, and found 174 cases due to "fatal narcotism." (26). Such deaths have been an ongoing problem for the U.S. military, especially since the expanded military presence of U.S. personnel in Asia since WW II. Interestingly, there were only two deaths involving a gun shot wound, both of which were determined to be accidents while under the influence. These 2 cases did not involve lethal levels, and were thus excluded from Appendix A. Only 14 cases, i.e. 8 %, were determined to be suicide. Thus, despite the overwhelming prevalence of guns in the military, a factor well known to increase the likelihood of a gunshot related suicide, no such case occurred. Additionally, 6 cases, i.e. 3.5 %, were determined to be the result of an intentional homicidal administration of a lethal dose of heroin, a "hot shot." Thus if a similar figure existed for civilian cases, i.e. a 3.5% occurrence of homicidal hot shots amongst heroin deaths, then it appears clear that the Cobain case, statistically speaking, is much more likely to be the result of such a "hot shot" than any other scenario put forth.
OVERTURNED CASES Levin & Fox (55) report on a series of staged deaths perpetrated by Doreathea Puentes, who allegedly poisoned up to nine people. The first victim was thought to have committed suicide by an overdose of codeine, a verdict which changed when other deaths were correlated with Puentes. As mentioned elsewhere in this essay, other cases have been re-opened an resolved more successfully, eg. the James case (20) in section two, the Winek case (97) in section seven, and the " postmortem credit card use" case (8) in section six.
6.) OTHER EVIDENCE INDICATES HOMICIDE:
NO LEGIBLE FINGERPRINTS ON WEAPON There is an officially acknowledged lack of legible fingerprints on the shotgun. The weapon was handled by two or more people several times before Cobain's death, so it is possible someone wiped the gun clean to intentionally avoid detection. Another well known fact is that Cobain's credit card was used several times after death. Postmortem credit card use has, in and of itself, has been the sole precedent in reopening and solving at least one homicide case staged to appear like a suicide according to Burgess (8). The missing persons report was filed by the widow, who told the SPD that Cobain had escaped a rehabilitation centre, purchased a shotgun, and was suicidal. Truthfully, the purchase occurred before Cobain entered the rehabilitation centre. The report seemingly predisposed the SPD to the idea that they were investigating a definite suicide, not a possible homicide. Despite SPD claims that the case was investigated as a possible homicide from the beginning, the SPD reports on the incident clearly state that the first officer on the scene viewed the case as a suicide. Furthermore, Cobain's behaviour following his departure from the rehabilitation centre included signing autographs at the Seattle airport, hardly the behaviour of a "missing person." Also, misleading accounts of details in the case have mistakenly claimed the room in which Cobain was found was barricaded.
POSSIBLE NOTE ADDITIONS AND MOTIVE Additionally, the note found at the scene of Cobain's death was determined by the SPD handwriting expert to be a suicide note written by Cobain, yet significant disagreement among handwriting experts points to the definite possibility that the most crucial "suicidal" lines, i.e. the
last four lines, were written by a separate person. The note reads like a retirement letter, written to Cobain's "fans," explaining his resignation from the music industry. This retirement included a refusal to perform for a major tour, thus forgoing an estimated $7 to $9.5 million dollars. The estimated revenue from Cobain's music is millions of dollars, clearly enough to be a motive for homicide. The widow continues to deny several reports claiming she and Cobain were about to be divorced and that she was involved in an extra-marital affair.
CORONER DR. HARTSHORNE IN CONFLICT OF INTEREST The coroner, Dr. Nikolas Hartshorne, was interviewed by a newspaper reporter for the Vancouver Province in April 1996, and he insists Cobain died from a self-inflicted shotgun wound. The doctor's credibility has been questioned due to a conflict of interest, because he knew Cobain and the widow personally. Previous investigative reports indicated this conflict of interest, but the newspaper interview clearly confirms the problem. This was the first time it was ever declared, for example, that not only had Hartshorne booked Seattle "punk" bands frequently, he actually booked Cobain's band, Nirvana. Additional to the conflict of interest issues is the simple fact that even the best coroners make mistakes. The most common cause of mistakes made by coroners is basic human error. Gruver & Freis (1957), studied 1,106 autopsies, who concluded that "...lack of mental alertness or awareness on the part of the physician in attendance seemed to be a most common cause for diagnostic errors. More often than not, the correct diagnosis could have been made if the responsible physician had been less mentally stagnant about the problem."(41).
Table 8
Prevalence of "Major" Autopsy Discrepancies
No. of Autopsies % Cases With At Least 1 Major Discrepancy
6000 11.7 % to 33.8 %
DIAGNOSTIC DISCREPANCIES IN AUTOPSIES When a diagnostic discrepancy occurs in an autopsy, it is twice as likely to be due to something missed than something found, or, as Hill & Anderson say, "...significant underdiagnosis occurs more often than overdiagnosis by a factor of almost 2:1."(41). This fact conforms with the Cobain case, where the massive level of blood morphine was mistakenly deemed irrelevant and thus "underdiagnosed." Table 8, above, summarizes a study including over 6,000 autopsies, and provides statistics which show that it is far more likely that the Cobain case involved a serious "major" diagnostic discrepancy (a likelihood of at least 11.7% to 33.8%) than any other scenario put forth officially. 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).
7.) CONCLUSION: HOMICIDE
"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).
HOMICIDE AN OBVIOUS ASSUMPTION Wecht, in the forward to an article by Winek (97), stated that "One of the most useful and relatively new areas of toxicology has to do with the significance and practical importance of drug and chemical blood levels. Identification and more importantly, quantitation, of blood levels is essential in many civil and criminal actions involving drugs. Without such information, the cases become matters of pure speculation and are predicated on circumstantial evidence (which may or may not prove to be correct ultimately)."(97). Winek's article, "Drug and chemical blood levels," mentions the following amazing case: "A lethal level of a drug or chemical found in an individual's blood does not by itself establish the cause of death. For example, a known narcotic addict was shot to death. Analyses of various body tissues (brain, bile, blood, etc.) revealed levels of morphine that have been found in other deaths attributed to overdose with heroin or morphine. However, in this case the cause of death was due to the bullet wounds!" (97). The indication is that a morphine overdose simultaneous with a gun shot wound is an overwhelmingly rare phenomenon at most, and that in the only such incident reported, the most obvious conclusion was homicide.
Table 9
Some Probability Summaries
Description of Event Probability
Suicide in Missing Persons 1 in 2000 Violent Suicides 760 in 3586 Suicides Violent Suicide with GSW 208 in 760 Violent Suicides Violent Suicide with GSW & MTA O.D. 0 in 760 Violent Suicides Overdoses with Serum Morphine >1.52 mg/L 26 in 1526 MTA Related Overdoses Suicides Involving MTA O.D. & GSW 0 in 3586 Suicides O.D.s with Serum Morphine >1.5 mg/L & GSW 0 in 3226 MTA Related Overdoses MTA Related O.D.s Involving GSW 0 in 3226 MTA Related Overdoses

CASE SHOULD BE RE-OPENED & VERDICT CHANGED Table 9, above, summarizes several probability statements regarding this case. A large dose of two drugs administered by intravenous injection thus appears to be a definite possibility. Specifically, Cobain was probably given an injection of no less 225 mg of some type of heroin and a benzodiazepine. The suggestion that Cobain's tolerance to heroin was so high that he could have withstood the dose described above is clearly mistaken. 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 intravenous heroin is three times more than the amount which kills even the most severe addict. Dead men don't pull triggers
Appendix A
Compendium of Intravenous Heroin Related Deaths Where Blood Morphine Levels Were Tested
No. of Cases Reference
69 Baselt, et. al. 20 Coumbis & Balkrishena 172 Froede & Stahl 22 Garriott & Sturner 9 Gerostamoulos & Drummer 128 Gottschalk & Cravey 202 Hine, et. al. 28 Irey & Froede 5 Karch 16 Logan & Luthie 32 Logan & Smirnow 435 Monforte 71 Nakamura 7 Paterson 114 Richards, et. al. 1 Robinson (79) 8 Robinson (80) 52 Staub, et. al. 243 Steentoft, et. al.
Total No. Cases: 1526 Total No. Cases >1.5 mg/L: 26 (1.7%) Total No. Cases Which Parallel Cobain Case: 0
Appendix B
19 Cobain Related Sympathetic "Copycat" Suicides
CASES NO. 1-4. S. DALLAIRE, M. COTE, S. LANGLOIS, & AN UNNAMED FRIEND Steve Dallaire, from Labrador City, Newfoundland, and two other young men, Michael Cote and Stephane Langlois from Fermont, Quebec (Fermont is near the Labrador border, hence the case has become known as "the three teenagers from Quebec"). A basic report can be found in many sources, such as the Globe & Mail, Thurs., Oct. 20, 1994 (Toronto, Canada). This story broke the heart of a nation, and shocked many people who had previously not considered the impact of Cobain's death. The RCMP stated clearly that the case of the three teenagers was Cobain related. The later suicide of their unnamed friend is also considered to be Cobain related. Basically, the 3 young men travelled on a cross-continent trip which ended in Langley, B.C., where they committed suicide in their car by carbon monoxide poisoning. They left a full journal, and a pair of worn, denim jeans covered in hand written ink with Cobain's lyrics and some other writings. A cassette tape by Nirvana was found in the car's cassette deck. The incident attracted major national and international news coverage, including a feature cover story in the widely circulated MacLean's Magazine, and a full 1 hour television documentary by CBC TV's award winning investigative journalism program, The Fifth Estate. CASE NO. 5. UNNAMED 17-YR. OLD QUEBEC MALE The Quebec provincial police reported that the young man jumped off the Jacques Cartier Bridge on Oct. 15, 1994 listening to a Walkman containing a Nirvana cassette tape. (Globe & Mail, Toronto, Can., Oct. 20, 1994) CASE. NO. 6. SIMON NOLIN An eleven-year-old boy, Simon Nolin was found hanged in the basement of his family's home in Ile d'Orleans, near Quebec City, on Wed., Jan. 10, 1995. At his feet his father found a note that read "I'm killing myself for Kurt." (Jed Stuart, St. Pierre, Que., for the Times Colonist, Victoria, B.C., Can., Fri., Jan. 13, 1995) CASES NO. 7-8. LYNDON GAGNON & LINDA GOLDSMITH Lyndon Gagnon, a "...devotee of the rock group Nirvana..." committed suicide on April 10, 1995, followed by his girlfriend Linda Goldsmith on April 15. Both were 13 years old. (Richard Watts for the Times Colonist, April 20, 1995, Victoria, British Columbia, Can.). CASES NO. 9-10. RICH TRUMAN AND AN UNNAMED 16 YEAR-OLD CANADIAN MALE Rich Truman from Leduc, Alberta, an 18-year-old, hanged himself in an apparent Cobain related suicide. The unnamed 16-year-old male from the same region committed suicide by gunshot. (David Staples, for the Edmonton Journal, Jan. 19, 1996, Alberta, Can.) CASE NO. 11. COLLEEN FROM VANCOUVER, CANADA A Vancouver woman referred to only as "Colleen" committed suicide following the Cobain-related suicides of the "three teenagers from Quebec" (see Cases #1-3 above). (Vancouver Sun, Dec. 8, 1994, B.C., Can.) CASE NO. 12. BOBBY STEELE The tragic death of Bobby Steele is a well established Cobain related suicide in Edmonton, Alberta. He committed suicide at age eighteen, at home, on July 3, 1994. The bereaved father,
Major Robert Steele, claims to have prevented 6 other Cobain related suicides in Edmonton by the end of 1994 alone. (Ottawa Citizen, Dec. 1, 1994, Ontario, Can.). CASE NO. 13. UNNAMED 16-YEAR-OLD FEMALE FROM DUBLIN, IRELAND An unnamed 16-year-old young woman killed herself in Dublin leaving a suicide note reading in part "...done it for Kurt." (Daily News, Nov. 25, 1994, Dartmouth, Nova Scotia, Can.) CASE NO. 14. DANIEL KASPAR Committed suicide at age 28 with a shotgun shortly after returning from the Cobain memorial service at the Flag Pavillion in Seattle , April 10, 1994.(Sandford, C., Kurt Cobain, Victor Gollancz, London, U.K., 1995) CASES NO. 15-16. TWO DEAD IN NIAGARA FALLS Two unnamed young men died in Niagara Falls, Ontario, both labelled Cobain-related suicides. The first death was a 17-year-old, who hung himself in his basement bedroom. The other death was the young man's 19-year-old friend, who hung himself from a tree in the park the day after his friend's funeral. (Calgary Herald, Alberta, and Winnipeg Free Press, Manitoba, Canada, Nov. 24, 1994 - C.P.) CASE NO. 17. GASTON LYLE SENAC According to Sgt. Jim Hanson of Tracy, California, the 20-year-old Gaston Lyle Senac accidentally shot and killed himself when he was joking with friends and emulating Cobain's reported suicide by propping a 12 gauge shotgun on the floor, kneeling with his mouth over the barrel. (Montreal Gazette, Canada, Thurs., Dec. 8, 1994 - A.P.) CASE NO. 18. UNNAMED TEENAGER IN SOUTHERN TURKEY: Circa April, 1994. (Sandford, ibid) CASE NO. 19. UNNAMED TEENAGER IN AUSTRALIA: Circa April, 1994. (Sandford, ibid