Rock n' Roll Doggie
Join Date: Sep 2004
Location: Kettering, Ohio
Local Time: 03:51 AM
Originally Posted by BonoVoxSupastar
I've read it, but nowhere does it explain how an accurate reading was taken 3 or 4 days after death.
This is an excerpt written by somebody else that the PI quoted and credited in the PDF:
ìDEAD MEN DON�T PULL TRIGGERSî
Written by ROGER LEWIS
With the assistance of LORI CLERMONT
NOTE: Sources are shown as a number in
parenthesis. The complete list of sources has been
listed at the end of this essay. The essay was revised
and expanded by the author on March 2, 1997.
It begins by considering the inaccuracy of several media reports claiming that
Cobain injected 1.52 mg of heroin, and continues...
...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 ìper liter of bloodî or ìtriple the lethal dose,î 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. (In fact Cobain would have had to inject as much
as 225 to 240 mgs of heroin to reach a blood morphine level of 1.52 mg.)
No doubt exists that a blood level of 1.52 mg of morphine per liter is over three
times the lethal dose, (for a hard-core heroin addict), but the implications of this
fact are not well understood. There is no such thing as a ìblood heroin levelî
because heroin is transformed into morphine when it enters the blood.
What Is A Lethal Dose Of Heroin?
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
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 ìlethal doseî for intravenous heroin primarily relates to the problem of
establishing a ìminimal lethal dose,î i.e. the smallest amount of heroin which will
The ìmaximum lethal dose,î 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 liter found in Cobain�s body represents
a heroin dose which is substantially higher than this well established maximum
How Much Heroin Can A Severe Addict Survive?
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
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 liter 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, ìthe basic unit of sale is the ëtenth,� which is 1/10 of a gram or 100 mg of
pure drug. This unit... provides approximately 4 ëhits� 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.î (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 ìhits.î
INCAPACITATED OR DEAD BEFORE GUNSHOT:
The following quotes from Krivanek describe the rapid action of this deadly
narcotic, especially when taken intravenously, ìHeroin 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
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.î(53).
Additionally, Platt remarks on the amazing rapid action of intravenous heroin by
explaining that ì...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
SOME DATA ON SPEED OF DEATH
The Lange manual for Poisoning & Drug Overdose states that for opiates, ìwith
higher doses, coma is accompanied by respiratory depression and apnea often
results in sudden death.î (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: ì...we have shown that in 85% of
the cases, the death should be attributed to a so-called ëgolden 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.î (90).
Similarly, Garriot & Sturner, describe how ì...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 liter, ed.) in the short-term interval group...6 mcg per 100 ml (.6 mg
per liter, ed.).î (28).
Notably, as of 1973, Garriott & Sturner did not find any blood morphine level over
0.93 mg per liter, 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 ì there are vivid accounts of victims lapsing into a
deep coma immediately following a ëfix� with a syringe still affixed in the arm or on
the floor underneath the body, and/or with an improvised tourniquet still in place
around the arm.î (63). Gossell & Bricker report that ìfor a large overdose, the
victim rapidly lapses into coma and is not arousable by verbal or painful stimuli.î
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 highest potency recorded, i.e. 93% purity, then the dose required
to reach a blood morphine level of 1.52 mg per liter 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 ìNearly 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 dilutor 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-
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 ìas
both drugs cause respiratory depression...the likelihood of death resulting as a
consequence...is greater than if either drug were taken alone.î (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 ì...the interaction of drugs in
eliciting acute responses and causing deaths even when sub-lethal amounts of
two or more drugs are present in postmortem specimens from the same cadaver
may be a factor.î (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
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