by Max Wallace
The tolerance argument in Cobain’s case has always relied on the premise that he was a longtime heroin user whose body had gradually over the months and years built up a tolerance to higher and higher levels of the drug. And, despite his own frequent public denials, there is no question that Cobain was at times a heavy heroin user. However, it is still an open question just how much heroin he was actually using during the final months of his life. According to the musicians who played with him during his final European tour in February and March 1994, Kurt was almost certainly heroin-free during that tour. In April 1994, Tony Barber, bassist of the Buzzcocks, who opened for Nirvana during several dates on their European tour, toldMelody Maker magazine, “I know he was not taking drugs on that tour. He was walking around drinking Evian water and looking clean every time I saw him.” In the same article, Buzzcocks guitarist Pete Shelley echoed Barber’s assessment: “He seemed really clean when we were on tour. In some ways it was a bit awkward because he wasn’t really joining in the very mild debauchery that went on.”
Were these musicians simply unaware of Kurt’s heroin use? Perhaps, but there is another more reliable source that appears to back them up. When Kurt was rushed to the hospital after his overdose in Rome on March 4, doctors said they found no traces of narcotics in his blood, only the prescription tranquilizer Rohypnol. Thus, exactly one month before his death, Kurt’s blood was free of heroin, and probably had been for some time. According to Courtney’s own account, Kurt started using heroin again eight days after he returned to Seattle. For the sake of argument, we can assume he continued using it during the last two weeks before he entered rehab, building up a renewed level of tolerance. However, even the Seattle medical examiner who cited tolerance as the mitigating factor said a user would have had to increase his dose “gradually over months or years” to function with the amount of drugs found in Cobain’s system. But Denise Marshall cautions against reading too much into the length of his drug use. “Tolerance can build quite quickly,” she explains. “Nevertheless, I still don’t think anybody could be that tolerant.”
According to Geoffrey Burston’s medical textbookSelf-poisoning, “The effect of heroin is of such short duration and is so intense that it inhibits any type of physical activity, either criminal or non criminal.” In 1996, we asked eleven different heroin addicts whether they believed it was possible for somebody who had injected as much as Cobain had to have then shot and killed himself immediately after injecting, as the police and medical examiners claim. Each insisted it would be impossible, no matter what their tolerance level. Said an eight-year addict, “Anybody who says you can do that has never shot smack.”
Coroners and medical examiners without the requisite training in opiate toxicology will often cite tolerance in cases like Cobain’s, says Marshall. “My specialty is in pharmacology, specifically opiates, so I understand these issues better than a doctor who doesn’t have that kind of specialized pharmacological training. They would know the basics but wouldn’t have a grasp of the studies that provide the necessary data about a specific issue in our field. I run into these kinds of cases all the time where it’s difficult for me to make my case because the coroner may not properly understand the science behind opiates or another type of drug. If you consult the medical and scientific literature, it just won’t back up their explanation of ‘tolerance’ as a factor when it comes to this kind of dose. With most drugs, there is a therapeutic level, there is a toxic level and there is a lethal level. But there is no exact ceiling lethal level with opiates because the tolerance level keeps moving up. Everybody has a ceiling, of course, otherwise you wouldn’t have people dying of overdoses. With opiates, as your toxic level goes up, so does your lethal level. That’s why opiate users can use a lot before they die. But if you get anywhere near Cobain’s levels or much lower even, you’re going to be immediately incapacitated.”
Blood is often described as “an honest witness.” Lethal opiate levels generally vary according to factors such as tolerance and body weight, and, although there is no officially recognized ceiling, the maximum lethal heroin dose should be slightly higher than the highest known dose someone has taken and survived. Historically, toxicologists have relied upon previously published case reports of fatal intoxication to determine the concentrations of a given drug required to produce a measured blood level. In his 1986 bookHeroin Addiction, Jerome J. Platt—former director of the Institute for Addictive Disorders at Allegheny University—concluded that the maximum known lethal dose for a 150-pound male would result in a blood morphine level of approximately 0.5 milligrams per liter. A few months before his death, Cobain weighed in at 115 pounds. According to Denise Marshall, this would have made his lethal dose even lower. “Generally, the less you weigh, the lower the lethal dose,” she explains. Other studies cited in theJournal of Forensic Sciences also suggest the maximum known lethal dose for heroin would result in an approximate blood morphine level of 0.5 milligrams per liter. In other words, Cobain’s level of 1.52 milligrams per liter was more than three times the accepted maximum lethal dose.
It would be inaccurate, however, to simply state that Cobain took a triple lethal dose of heroin. In fact, according to the medical literature, the dose he took was approximately seventy-five times the lethal dose for the average person. What’s crucial is that it was triple the lethal dose for even the mostsevere addict.
Yet this statistic does not tell the entire story. While the heroin Kurt took was undeniably enough to kill him three times over, there are many studies that demonstrate he may not have died immediately after injecting such a dose. The literature indicates he could have stayed alive for as long as several hours, even after injecting this massive amount of heroin into his system. The real question that must be asked is whether he could have remainedconscious long enough after shooting up to have picked up the shotgun and killed himself. According to the leaked autopsy results, in fact, the cause of death was most probably the gunshot wound rather than the heroin injection, suggesting that Kurt was still alive for some time after shooting up.
In 1973,The New England Journal of Medicine published a comprehensive study, “Morphine Concentrations and Survival Periods in Acute Heroin Fatalities,” by pharmacologists J. C. Garriott and W. Q. Sturner, who examined hundreds of heroin-related overdoses. In all the fatalities they studied to that point, the two scientists had never encountered a single case with a blood morphine level over 0.93 milligrams per liter—more than 50 percentlower than Cobain’s level.
However, although neither Denise Marshall nor Garriott and Sturner had ever found a blood morphine level as high as Kurt’s, a number of such cases do exist. A comprehensive review of blood morphine levels in 1,526 deaths involving intravenous heroin-related overdoses found twenty-six cases, or 1.7 percent, where levels were equal to or higher than Cobain’s level of 1.52 milligrams per liter.
The statistics are telling. According to a study cited in theInternational Journal of Legal Medicine, approximately 85 percent of cases with levels this high will result in a so-called “golden shot,” culminating in immediate death. But in the balance of the cases, the study concludes, “the death is not so rapid and a survival period in a comatose state has to be taken into consideration.” Another 1996 study of survival times following opiate overdose, reported in theJournal of Forensic Sciences, confirms that the user experiences a state of acute shock “within seconds” after injecting the fatal dose.
In all of the twenty-six known heroin overdose cases where blood morphine levels were equal to or higher than Cobain’s level, however, the tourniquets were still in place when the body was discovered, and the syringe was still affixed in the victim’s arm or lying on the floor next to the body—suggesting either instant death or unconsciousness.
Yet, as Denise Marshall notes, the police reports describe no such scenario when Kurt’s body was found: “Was it suicide? I don’t see how physically that could have been done. I do not see how he could have injected himself
with the amount of heroin to cause those levels, put the syringe and other drug paraphernalia away, folded his sleeve down, grabbed the gun, positioned it backwards in his mouth and pulled the trigger. I do not see it.”
Marshall was not the only expert with doubts about the official story. In 1997, the NBC-TV showUnsolved Mysteries presented Cobain’s autopsy results to Dr. Cyril Wecht, one of America’s most prominent forensic pathologists. Harvard law professor Alan Dershowitz has described him as the “Sherlock Holmes of forensic science.” Dr. Wecht was immediately dismissive of the tolerance argument cited by Nikolas Hartshorne. “For most people,including addicts, 1.52 milligrams per liter of morphine is a significant level,” Wecht cautiously explained, “and for most of them, a great percentage, it will be a level that will induce a state of unconsciousness quite quickly. We’re talking about seconds, not minutes…. It does raise a question, a big question, as to whether or not he shot that shotgun.”
On camera, however, Dr. Wecht refused to rule out completely the possibility of suicide, declaring it “within the realm of possibility.” Thus, a leading authority appeared to believe that, however remote the possibility, Cobain could indeed have shot himself, as the official version indicates. In the years since this interview took place, however, we learned that there was more to Dr. Wecht’s interview than NBC broadcast that night. According to the segment’s producer, Cindy Bowles, Wecht had never been fully informed of the circumstances of Cobain’s death before his interview, knowing only that he had been found shot through the mouth and with a postmortem blood morphine level of 1.52 milligrams per liter. What Wecht actually said off cameraafter declaring suicide within the realm a possibility was this: “If itwas suicide, he probably would had to have been holding the gun in his hand while he was injecting himself with the heroin, and then shot himself immediately after the injection.”
Of course, we know from the police reports that this is not what happened. Before picking up the gun, Cobain took the time to roll down his sleeves, remove his drug paraphernalia and place it back into a nearby cigar box. Again, the official scenario appears to be scientifically impossible.
The new revelation regarding Dr. Wecht’s verdict, however, is not the only crucial piece of information that has emerged in recent years. In 1995, after Nikolas Hartshorne and his supervisor, Dr. Donald Reay, informed us that tolerance was the mitigating factor that allowed Cobain to shoot himself—even after injecting such a massive dose of heroin—we challenged each of them to point to a single case in which somebody had taken a dose equal to Cobain’s and remained conscious for more than a few seconds. Neither of them was able to cite such a case.
Two years later, in his BBC documentaryKurt & Courtney, filmmaker Nick Broomfield believed he had met this challenge. In the film, Broomfield featured an interview with a British physician, Dr. Colin Brewer, who insisted that somebody could indeed shoot himself after taking the amount of heroin found in Kurt’s bloodstream. To prove his point, the doctor took out a photograph he had taken of one of his patients. In this photo, featured in Broomfield’s film, a man could be seen balancing on one leg fifteen minutes after supposedly taking “twice the amount as Kurt.” When the documentary was released in 1998, this photo alone proved a near fatal blow to the murder theory. In fact, this evidence was the single element cited by Broomfield when he changed his mind about how Cobain died. Before interviewing the doctor, the filmmaker reveals, he was leaning toward the belief that Kurt had been murdered. After the interview, Broomfield became convinced that Cobain had committed suicide.
If, in fact, a case existed where an addict remained conscious for fifteen minutes after taking such a large dose, it would indeed prove that Kurt might still have been able to shoot himself after injecting the level of heroin found in his system.
However, it has since emerged that Broomfield made a crucial error in his film—a mistake that has inflicted lasting damage to the credibility of the murder theory. The patient depicted in the photo had not actually injected heroin after all. Rather, he had swallowedmethadone —a synthetic opiate commonly used for heroin withdrawal. The doctor later conceded that he was not even licensed to administer heroin, so he could not have duplicated the results even if he wanted to. The difference between methadone and heroin, explains Denise Marshall, is immense.
“Methadone is meant to be swallowed, not injected,” she explains. “Anytime you have to swallow a drug, it has to go through your gastrointestinal tract, and that can take thirty-five to forty minutes. But when you inject a drug, the effect is instantaneous: it goes right into the bloodstream. You feel the effect within seconds.”
She says the example cited in Broomfield’s documentary is completely inappropriate and misleading.
“The man in the photo swallowed methadone. It’s comparing apples and oranges,” she says. “Yes, methadone is an opiate. I can take that much orally and go jump around, too. I don’t know how I’d be in forty-five minutes, though. But methadone is also different on how it works on the body. We have opiate receptors in our brain, and that’s what the drug binds to. And once the drug binds to those receptors, the receptors release another drug called dopa-mine, and that’s what makes you feel the high. Methadone doesn’t work in quite the same way as heroin.
“Clearly the filmmaker, and probably even the doctor, didn’t understand the science of opiates,” she says. “I can explain it like this: if you’ve ever had surgery or any kind of IV sedation, the moment they tell you to start counting backwards, they’re putting the drug into your vein, and you’re asleep before the plunger ever finishes. That’s what heroin can do. And with the amount Cobain took, I’m fairly certain that’s what happened to him. He was probably unconscious while the needle was still in his arm.”
How, then, could Nikolas Hartshorne have got it so wrong? Renowned forensic pathologist Samuel Burgess writes in his 1992 book,Understanding the Autopsy, “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.” Burgess points to faulty autopsies as one of the main culprits.
Denise Marshall agrees. “Unfortunately, that’s true. A lot of autopsies are conducted very poorly, especially when the pathologist has already come to a conclusion about the cause of death before-hand. This particular case amazes me, but I see these mistakes happen every day. You know, watching all these crime shows on TV, if you went as a visitor to a crime scene, you would just think everything goes according to the book, but it’s like any other job, it just doesn’t. You have people that are lazy and incompetent, just like any other job. You can spend a lifetime just researching all the deaths that were ruled incorrectly by coroners and medical examiners, especially coroners that have preconceived ideas about junkies. Opiate addicts really have a bad deal. I can’t imagine how many deaths are out there that were ruled accidental overdoses or suicides with junkies that were probably homicides.”
One of the best examples of autopsy misdiagnosis, in fact, involves another notorious rock-and-roll suicide. In November 1997, Michael Hutchence, lead singer of the band INXS, was found dead in a Sydney, Australia, hotel room with a belt around his neck. He had apparently hanged himself from a doorjamb before the buckle of the belt broke, sending him sprawling to the floor. Finding no signs of foul play, the Sydney coroner immediately ruled the death a suicide. But within hours, Hutchence’s wife, Paula Yates, declared that she was certain her husband had not committed suicide and hinted cryptically that she knew the real cause of death. Soon after, she confessed to friends that Hutchence had almost certainly hanged himself accidentally while engaging in a sex game known as autoerotic asphyxiation (AEA).
The bizarre sex act, practiced by millions, involves an
intentional act of self-strangulation performed to heighten orgasm by constricting the flow of blood to the brain during masturbation. Practitioners, nearly all male, tighten belts around their necks or suspend themselves by a noose, often using a rafter or tree branch. The resulting breath deprivation, known as cerebral anoxia, results in a woozy, heightened orgasm. Yates revealed that Hutchence was a devotee of this and other dangerous sex acts such as bondage and S & M, and that he must have died when the self-asphyxiation went wrong. Said Yates at the time, “He did everything. He’s a dangerous boy, dangerous, wild. He could have done anything at any time. The only thing he wouldn’t have done is just left us [her and their daughter, Tiger Lily].”
When the details of Hutchence’s death scene leaked out, they seemed to confirm her story. Police revealed that when his body was found, he was completely naked, sprawled out on the floor. Nevertheless, the coroner maintained it was a suicide and refused to call an inquest to investigate whether AEA was involved. His reluctance was probably due to the fact that the fetish is virtually unknown in Australia, although in the UK, where Hutchence lived, some two hundred people die during the act every year. Two years after the case was closed, McMaster University professor Stephen Hucker, considered the world’s leading authority on AEA, agreed to investigate the circumstances of the rock star’s death. At the completion of his probe, Professor Hucker declared, “I have concluded that this is most likely a death due to an act of autoerotic practice that went wrong.” In the Sydney coroner records, however, Hutchence’s death remains a suicide to this day.
In 1995, a Canadian chemist named Roger Lewis became suspicious of the circumstances of Cobain’s death, largely because of the remarkably high blood morphine levels involved. On his own initiative, he conducted a yearlong survey of the existing forensic and criminological literature. During the course of his review, he studied 3,226 heroin-related overdoses, more than 3,586 self-inflicted deaths, including 760 violent suicides, and a considerable number of known staged deaths. His resulting essay, “Dead Men Don’t Pull Triggers,” is a scientifically rigorous “reinterpretation of the officially released evidence” that argues strongly for a reopening and independent investigation of the Cobain death.