Tag Archives: Drugs

FENTANYL—HEROIN’S DEADLY LITTLE SISTER

F20Imagine a serial killer causing 256 deaths in your town—within the first four months of this year. Your place would panic. Your doors would be locked. Windows barred. Your streets would be bare with the cops falling flat-out to find the fiend. Does this sound like a far-fetched plot for the next best-seller? Nope. It’s real. It’s happening right here at home and the killer is known. Her name is Fentanyl. She’s heroin’s deadly little sister.

British Columbians, in Canada, are among the world’s most prolific illicit drug consumers and the B.C. Coroners Service just released some figures. They’re projecting over 800 drug overdose deaths for 2016. Maybe a thousand. Most will involve fentanyl.

Who is this lethal lady? Where does she come from? And why is she suddenly so popular?

F12Fentanyl is a high-potency, rapid-onset synthetic opioid drug prescribed for the treatment of chronic pain. It was developed in the 1950’s as an intravenous anesthetic for surgery and evolved into a breakthrough cancer pain treatment in the form of tablets, lozenges, lollipops, and patches. It’s legal and readily available with a prescription and is listed on the U.S., Canadian, and U.K. Schedules as a controlled drug.

Like heroin and morphine, fentanyl works by binding to the body’s opiate receptors and driving up dopamine levels in the brain’s reward areas, producing a state of euphoria and intense relaxation. That’s all and well when used in moderation and highly effective when properly prescribed.

001But fentanyl is 100 times more potent than morphine and 50 times stronger than pharmaceutical grade, 100% pure heroin. It’s also far more available on the street than heroin and the reason is profit. One kilogram of heroin sells in Vancouver for $60,000—if you could find one. One kilo of fentanyl powder goes for $125,000 and is readily available. Not hard to figure out what’s going on.

But with fentanyl being so powerful, the inevitable deaths tag along. The mechanism of death by fentanyl overdose is the same as heroin in that the central nervous system is depressed and respiratory failure occurs. Fentanyl is much quicker than heroin, though. One street source was quoted, “With fentanyl you just hit the ground. Light’s out, that’s it. They don’t know there’s fentanyl in their fix till it’s too late.”

F22The toxicity of all drugs is rated on an LD50 scale, whereas the Lethal Dose of 50 percent of humans occurs at a certain scale which is proportionate to body mass. Fentanyl’s LD50 rating is .03 mcg/kg (micrograms per kilogram). Given that a microgram is .001 of a milligram, this equals an average 70 kilogram (155 pound) person requiring 2.1 mgs of fentanyl to kill them. Some, already tolerant to opioids, require more. Some, with no tolerance, require less. Especially if mixed with other drugs or alcohol.

So why the sudden rise in the availability of fentanyl?

There’ll always be the demand. The answer’s in the supply and the reason’s found on the internet. The digital drug highway. The internet has done to drugs what Amazon has done for books.

F23Ten years ago, when heroin was so popular, it was available from a natural product through a complex delivery system which requires a chain from the country of source—China, Afghanistan, and Vietnam to name a few—through international couriers, middle-men, and street dealers before it ever reached the end-user. The junkie in the alley.

The process of profit required “stepping-on” or “cutting” at every level and, by the time the drug reached the consumer, it was of low purity and the chances of an accidental overdose were slim.

Today’s plentiful purity is what’s killing the customers and it’s not about to change.

002Now you can go online and order any amount of fentanyl—a synthetic and easily mass-produced opioid—you want, as long as your money goes through. Visa, Mastercard, Paypal, and Bitcoin are fine and UPS will deliver it right to your door. Presto, you’re in the illicit drug business.

Don’t believe me?

Well, I tried it out.

I started Google-searching “where to buy fentanyl online without a prescription” and snooped around. Then I hooked-up with a few shadowy and shady, sinister people through email. It’s easy to get information when you’re anonymous and they think you have money. They steered me to the Silk Road Online Pharmacy—the Walmart of internet black market pharmaceuticals. It’s in Karachi, Pakistan. Click here.

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I paged through a menu of everything from Molly to Ecstacy to Pure MDMA to Phentermine to LSD to Viagara to Pregnyl to Humatrope. The site is nicely organized in departments with pretty much everything you could be surreptitiously looking for—men’s & women’s health, weight loss, pain-killers, things for ADD/ADHD, stuff for highs, shit for lows, a great selection of steroids, plus lots and lots of research chemicals and powders.

Then I found what I wanted.

Abstral.

F31Abstral is a brand name for a formulation of fentanyl citrate (the salt produced by combining the chemical base for fentanyl with citric acid) and is available as a sublingual tablet—one you dissolve under your tongue and is absorbed in your buccal mucosa to provide rapid analgesia. And it comes with this warning:

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Silk Road Pharmacy sells Abstral in two strengths: 400 mcg and 800 mcg. I chose the stronger. There’s more bang for the buck.

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They also have a minimum order of 50 tablets so, being a first-time customer, I selected the lesser and clicked “Buy” on my cart. That took me to the checkout page where, for $300.00 plus fifty bucks for shipping and handling, the deal was done through my Mastercard. A client-needs agent by the name of Asha Ali guaranteed delivery to North America within two weeks. He even gave me his email at contact@silkroad.pharmacy.com if there’s a problem.

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So, getting back to the not-so-hypothetical Fentanyl serial killer, this is what I’ve calculated. I have 50 – 800 microgram tabs of Abstral on the way. That’s a total of 40 milligrams. If it takes 2.1 mg to kill the average person, then I’ve got enough to do in nineteen people. Fifteen to be sure. Ten at the absolute least.

F33Now, I don’t have anything against anyone in particular so I propose to do this randomly.

What I’ve got in mind is cruising the coffee shops downtown. There’s Starbucks at the mall. The Vault on the corner. Serious Coffee in the conference center. Perkins up the street. And there’s got to be twenty restaurants with three blocks. It’ll be so easy to grind up my e-mail pills and sprinkle the fentanyl powder into momentarily unattended lattes. I might even lace sugar packets.

Hey! Imagine the bars where they’re drinking.

F35Talk about a return on the dollar. That’s under twenty-five bucks a death—the price of five coffees at Starbucks—three beers and a burger at The Palace. The chances of getting caught are practically nil. Random stranger-to-stranger killings are the hardest to solve and the easiest to get away with. Just ask the Chicago Tylenol Poisoner.

Anyway, I have a couple weeks before my precious pills get here—a couple weeks plotting serial kills with fentanyl poisoning. It’s my next novel.

And I’m planning a plot with a random twist that you’ll never see coming… in Deadly Little Sister.

WAS MARILYN MONROE MURDERED?

A1No movie star lived on after death like Marilyn Monroe. She was far more than a bleached-blonde bombshell with a voluptuous frame and a lusty voice—she intuitively knew her craft. Born in poverty as Norma Jean Mortenson (aka Baker) to a mentally unstable mother, Marilyn Monroe rose to Hollywood glamor, fame, and idolization beyond what few ever reached. Tragically, by the time she died at age thirty-six, her performing career had spiraled into the same abyss her personal relationships and head space were already in.

MM10Marilyn Monroe was found dead in her Beverly Hills bed at 3 a.m. on Sunday, August 5, 1962. The scene suggested nothing suspicious—no foul play, that is—and the toxicology results from her autopsy proved she’d succumbed to a lethal dose of prescription drugs. The coroner ruled her death as “probable suicide” but, like the deaths of other uber-celebrities, many mumbled murder. Monroe’s death was reinvestigated in 1992 by the Los Angeles District Attorney who came to the same conclusion—“probable suicide”.

In today’s coroner-speak, “probable” is not in the official vocabulary. Neither is “possibly”. Everywhere in the civilized world, coroners are mandated by legislation to rule a manner of death as being in one of five categories: natural, homicide, accidental, suicide, or undetermined. Now, fifty-four years later, an impartial look at Monroe’s case facts indicate her manner of death should not be ruled as a suicide.

But was Marilyn Munroe actually murdered?

A7On the day of her death, Marilyn Monroe was in the company of many people, none of who reported any immediately implied threat or perceived action from Monroe that suggested an imminent danger of suicide, nor any behavior that was outside of her already troubled mental state of manic highs and depressive lows. She’d a history of emotional instability that, today, would likely be classified as Bipolar II Disorder and she was under the continual care of a general physician and a psychiatrist. Monroe was no stranger to prescription pharmaceuticals, specifically anti-depressants and sleeping pills, but she was a relatively light alcohol drinker.

Marilyn Monroe had a difficult year in 1961. She worked very little due to health issues. Besides her emotional imbalance and substance dependency, she underwent surgery for endometriosis (uterus ailment) and a cholecystectomy (gall bladder removal), then suffered a painful attack of sinusitis. Her stress level soared from a lawsuit with 20th Century Fox where they sued Monroe for breach of contract—her erratic behavior led to delays in filming, disputes with cast and crew, then finally a stop of production.

A14On Saturday morning, August 4, Marilyn Monroe met with her official photographer and discussed an upcoming Playboy deal, then kept a massage appointment, a meeting with her publicist, talked with friends on the phone, and signed for deliveries for her house renovation. She was visited by her psychiatrist, Dr. Ralph Greenson, in the late afternoon for a scheduled therapy session. Greenson left around 7 p.m. and reported no alarming behavior, however he ensured that Monroe’s housekeeper, Eunice Murray, would be staying overnight.

Marilyn Monroe retired to her bedroom around 8 p.m. The last person to have contact with Monroe was actor Peter Lawford who invited her to a Hollywood party. He reported that in their phone conversation Monroe sounded tired—sleepy—as under the influence of drugs. After their call, Lawford became alarmed and phoned back to the house where he got Murray. She assured him everything was fine with Monroe.

A22At 3 a.m. on Sunday morning, Eunice Murray woke and noticed light coming from under Monroe’s bedroom door. Sensing something not right, Murray tapped on the door. There was no response so she tried the handle and found it locked, which she stated was unusual.

Now alarmed, Murray phoned Dr. Greenson who instructed her to go outside and look through the bedroom window. She did and observed Marilyn Monroe lying facedown on the bed, covered in a sheet, and clutching a telephone receiver in her right hand.

Greenson arrived at approximately 3:20 a.m., broke the window with a fireplace poker, and climbed in. Immediately he could tell Monroe had been dead for some time and it was pointless to call an ambulance or attempt resuscitation. Greenson phoned Monroe’s physician, Dr. Hyman Engelberg, who arrived at around 3:50 a.m. Engelberg examined Monroe by removing the phone receiver and rolling her over, officially pronouncing death. At 4:25 a.m. they notified the LAPD.

MM2The attending detective agreed with the two doctors that there was nothing to indicate foul play and the death was most likely a drug overdose. The detective photographed the scene and recorded the “pill count” of the pharmaceutical vials on Monroe’s nightstand. Dr. Engelberg noted a vial containing twenty-five capsules of the barbiturate Nembutal that he’d prescribed two days earlier was empty. Vials with other prescriptions appeared in order including one containing the sleeping sedative Chloral Hydrate.

Marilyn Monroe was autopsied on the morning of August 6 by pathologist Dr. Thomas Noguchi who would later be known as “Coroner To The Stars” for his many postmortem exams on celebrities. His original autopsy report is on the public record and can be downloaded. Click Here.

A20Noguchi is very clear in his report and many subsequent interviews that he found no evidence of physical trauma—specifically needle marks—on Monroe’s body. Based on his observations and those of Drs. Greenson and Engelberg regarding Monroe’s rigor, livor, algor, and palor mortis conditions, he felt reasonable to estimate her time of death between 8 and no later than 10 p.m. the previous night. Noguchi found no natural cause of death and waited for the toxicology report before forming his final conclusions.

The tox screen was done by the LA County Coroner’s laboratory and released on August 13. The results concluded  Monroe’s blood contained 4.5 milligrams (percent) of Nembutal and 8.0 milligrams (percent) of Chloral Hydrate. Her liver contained 13.0 milligrams (percent) of Pentobarbital. Blood ethanol (alcohol) was absent.

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Noguchi was satisfied the combination of Nembutal and Chloral Hydrate levels in Monroe was sufficiently high to cause her death through respiratory and central nervous system failure and he knew the Pentobarbital stored in her liver was simply indicative of someone who had long exposure to barbiturates and developed a “tolerance”. Noguchi certified the cause as “acute barbiturate poisoning due to ingestion of overdose” but he was reluctant to rule the classification as “suicide”. Though Noguchi was certain no evidence existed to suggest the death was an intentional homicide, he was uncomfortable with there being no clear evidence that Monroe intended to take her own life.

There were no immediate threats, no suicide note, no warning behavior, and not all the Chloral Hydrate pills were consumed, not like the Nembutal.

A23It might be an accidental OD, Noguchi thought, and he was troubled by the fact Monroe had been prescribed the amounts of Nembutal and Chloral Hydrate at the same time—her physician had to have known they’d be lethal if mixed a large quantity.

Noguchi was under pressure—political pressure, if you will—from the elected Chief Coroner of Los Angeles County to shut down media speculation that there might be more to Monroe’s death than a sad case of a despondent star intentionally extinguishing her light. The Chief and Noguchi reached a temporary compromise that they’d say Monroe’s death was a “probable” suicide.

A21Noguchi didn’t go so far as to insinuate negligence by Monroe’s caregivers might be the smoking gun, yet he requested a “psychological autopsy” to investigate Marilyn Monroe’s mental state leading to her death. Without clear evidence of an intentional suicide, the pattern of Monroe’s behavior was crucial in corroborating a suicide rule.

This statement was issued by LA County Chief Coroner Theodore J. Curphey. It’s an addendum to Noguchi’s final autopsy report:

“Following is the summary report by the Psychiatric Investigative Team which assisted me in collecting information in this case. The team was headed by Robert Litman, M.D., Norman Farberow. Ph. D., and Norman Tabachnick, M.D.:

‘Marilyn Monroe died on the night of August 4th or the early morning of August 5th, 1962. Examination by the toxicology laboratory indicates that death was due to a self-administered overdose of sedative drugs. We have been asked, as consultants, to examine the life situation of the deceased and to give an opinion of the intent of Miss Monroe when she ingested the sedative drugs which caused her death. From the data obtained, the following points are the most important and relevant:
Miss Monroe suffered from psychiatric disturbance for a long time. She experienced severe fears and frequent depressions. Mood changes were abrupt and unpredictable. Among symptoms of disorganization, sleep disturbance was prominent, for which she had been taking sedative drugs for many years. She was thus familiar with and experienced in the use of sedative drugs and well aware of their dangers.
Recently, one of the main objectives of her psychiatric treatment had been the reduction of her intake of drugs. This has been partly successful during the last two months. She was reported to be following doctor’s orders in her use of drugs; and the amount of drugs found in her home at the time of her death was not unusual.
In our investigation, we have learned that Miss Monroe had often expressed wishes to give up, to withdraw, and even to die. On more than one occasion in the past, when disappointed and depressed, she made a suicide attempt using sedative drugs. On these occasions, she had called for help and had been rescued.
From the information collected about the events on the evening of August 4th, it is our opinion that the same pattern was repeated except for the rescue. It has been our practice with similar information collected in other cases in the past to recommend a certification for such deaths as a probable suicide.
Additional clues for suicide provided by the physical evidence are:
(1) the high level of barbiturates and chloral hydrate in the blood, which, with other evidence from the autopsy, indicate the probable ingestion of a large amount of drugs in a short period of time;
(2) the completely empty bottle of Nembutal, the prescription for which was filled the day before the ingestion of drugs; and
(3) the locked door which was unusual.’

MM7

Now that the final toxicological report and that of the psychiatric consultants have been received and considered, it is my conclusion that the death of Marilyn Monroe was caused by a self-administered overdose of sedative drugs and that the mode of death is probable suicide.

– Theodore J. Curphey, M.D. Chief Medical Examiner-Coroner for the County of Los Angeles, August 13, 1962.”

There’s that word “probable” again.

A24In my time as a police officer and coroner, I’ve attended many drug overdose deaths. Some were clearly suicides, backed-up by threats and notes. Some were accidents by misadventure, usually mixed with alcohol. And some were undetermined—not shown to have a definite intent by the decedent to take their own life.

I’d say some of the undetermined deaths were probably suicides—if I could say it. But a coroner doesn’t have the legal option to say “probably”. There’s a long-held  court ruling called the Beckon Test that states a death can only be classified as a suicide if it can be determined that the individual knew the consequences of their actions would end in death and intentionally carried them out. There is a high standard of proof required for a finding of suicide as the ruling states:

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“In most legal cases the test to be satisfied is a balance of probability. But a determination of suicide can only be made where there is clear and convincing evidence. There is to be a presumption against suicide at the outset and one must be certain beyond a high degree of probability that the death was a suicide. Where one cannot be absolutely certain, the death must be classified as undetermined.”

Based on my death investigation experience, there are three points about Marilyn Monroe’s suicide ruling that bother me.

First, in all the polypharmacy overdoses I’ve seen where suicide was obvious, the deceased downed the whole darned stash.

A30In Monroe’s case, Dr. Engelberg prescribed her 50 caps of 500 mg Chloral Hydrate on July 31 as a refill for a previous Chloral Hydrate order on July 25. She was taking 10 per day. At her death scene, there were still 10 Chloral Hydrate caps left in her bedside vial. 40 were gone and, at a rate of 10 per day from July 31 till August 4, the pill count is right in order.

In the toxicology world, the effects of drugs are rated on a range scale of Therapeutic, Toxic, and Lethal. In the Lethal range, the substance is given a value called LD50 where it’s expected that 50 percent of the population would be expected to die from the drug’s effect at a certain point based upon the drug’s milligram blood content per the kilogram weight of the person.

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Marilyn Monroe’s autopsy report recorded her weight at 117 pounds or 53.2 kilograms. The Chloral Hydrate level in her blood was determined to be 8.0 milligrams (percent) based on her weight or 80 parts per million (ppm). Looking at my toxicology scale from my coroner days, I see that Chloral Hydrate has a Therapeutic range to 30 ppm and an LD50 value at 100 ppm, so Monroe was 20% under the Chloral Hydrate lethal bar.

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Looking at her barbiturate blood content from the Nembutal, it’s recorded to be 4.5 mg (percent) or 45 ppm. My chart says the barbiturate Pentobarbital, which is what’s in Nembutal, has a Therapeutic range to 12 ppm and an LD50 at 40 ppm. So Monroe was only 12.5 % over the average barbiturate lethal threshold, not taking into account that she was a very “tolerant” user.

However, the combination of Chloral Hydrate and Nembutal was deadly and this had to be known by Dr. Engelberg when he ordered Monroe’s prescription. This brings me to my second point.

A29A physician has a professional duty of care to their patient, especially when prescribing medication to a person with Monroe’s mental history. I find it irresponsible, actually negligent, that Dr. Engelberg failed to ensure Monroe no longer had Chloral Hydrate in her possession when he issued her a prescription for 25, 1500 mg caps of Nembutal four days later, knowing her supply of Chloral Hydrate wasn’t exhausted based on her prescribed consumption.

My third point deals with the “rescue” issue.

This very much applies to the Beckon Test. Intentional overdoses as attention-getting devices are common and always rely on the person’s backup plan that someone will intervene. This was part of Monroe’s previous overdose episodes as noted in the “psychological autopsy” report. And they referenced Monroe’s locked door as being unusual.

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I think the locked door issue is completely negated by the fact that Monroe was found with her telephone receiver in hand. This was stated by Eunice Murray, Dr. Greenson, Dr. Engelberg, and corroborated by the investigating detective who verified they reported this to him and suggested she was phoning for rescue—which was her pattern—but was overcome.

If I were the coroner ruling on the manner of Marilyn Monroe’s death, I’d be legally bound to consider how the facts apply to the parameter of categories.

MM1A natural cause determination is completely eliminated by the autopsy and toxicology evidence. Monroe clearly died as the result of a drug overdose.

Despite kooky conspiracy theories that Bobby Kennedy snuck in and injected Marilyn Monroe to cover up her alleged affair with President Jack or that mobsters Jimmy Hoffa and Sam Giancana knocked her off to keep from ratting them out, no sensible person can make a case that Monroe was intentionally murdered. But a homicide ruling doesn’t just apply to murder. The definition of homicide is “the killing of a human being due to the act or omission of another”.

I believe Dr. Engelberg was professionally negligent in his duty of care to Marilyn Monroe. He had to know—certainly ought to have known—that he was treating an emotionally unstable patient with a history of suicide attempts through polypharmacy. By giving Monroe a potentially lethal amount of barbiturates and not ensuring her chloral hydrate was gone, Engelberg effectively signed her death warrant.

However negligent Engelberg may have been, though, my suspicion falls far short of the burden necessary for establishing a homicide conclusion.

A3That Monroe accidently died from a self-administered overdose is a distinct probability but, again, the Coroners Act and court precedents won’t allow me the liberty to rely on probabilities regarding suicide. I have to come to a clear conclusion based on facts.

Setting aside the locked door and phone receiver in hand—these two negate each other—I must defer to one other glaring fact. There were still 10 caps of Chloral Hydrate left in her pill vial. Marilyn Monroe was a very experienced and tolerant prescription pill user. She knew exactly what she was taking, what their effects were, and she failed to down her whole darned stash which is always proof of a polypharmacy overdose suicide.

A4So deferring to the Beckon Test, I have to presume against Marilyn Monroe’s suicide from the outset and must be satisfied beyond a high degree of probability that her death was a suicide—I must be certain—and I can’t—because no clear evidence exists that Monroe’s death was an intentional act to end her own life. It may well have been an unfortunate, unrescued accident.

Therefore, I find Marilyn Monroe’s manner of death as Undetermined.

ELVIS PRESLEY — WHAT REALLY KILLED THE KING

A10Elvis Presley suddenly dropped in the bathroom of his Graceland mansion on the afternoon of August 16, 1977. He was rushed to Baptist Memorial Hospital in Memphis, Tennessee, pronounced dead, then shipped to the morgue and autopsied the same afternoon. Three days later, the coroner issued Elvis’s death certificate stating the cause as “hypertensive cardiovascular disease with atherosclerotic heart disease” — heart attack for short.

However, toxicology results soon identified ten pharmaceutical drugs in Elvis’s system with codeine being ten times the therapeutic level. This started accusations of a cover-up and suggesting conspiracy theories of a sinister criminal act.

Pushing forty years after, modern medicine and forensics took a new look at the Presley case facts and indicated that something entirely different from a heart attack or a drug overdose really killed the King of Rock & Roll.

A14Hindsight being twenty-twenty, let’s first look at how death investigations should be conducted.

Coroners are the judge of death and it’s their responsibility to establish five main facts surrounding a death. (Coroners are not to assign blame.) In the Presley case, the facts determined at the time were:

Identity of Deceased — Elvis Aaron Presley.

Time of Death — Approximately 2:00 p.m. on Tuesday, August 16, 1977.

Place of Death — 3754 Elvis Presley Boulevard, Memphis, Tennessee.

Cause of Death — Heart attack.

Means of Death — Chronic heart disease.

A27There’s a distinct difference between Cause of Death and Means of Death. Cause is the actual event. Means is the method in which death happened. Examples are cause being a ruptured aorta with means being a motor vehicle crash, or cause being massive cerebral interruption with means being gunshot wound to the head.

Once the facts are known, it’s the coroner’s duty to classify the Manner of Death. There are five universal classifications:

  • Natural.
  • Homicide.
  • Suicide.
  • Accidental.
  • Undetermined.

A19Elvis Presley’s death was ruled a natural event, thought at the time as being an acute cardiac event from existing cardiovascular disease. If the coroner determined Elvis died from a drug overdose, the ruling would have been accidental. No one ever claimed it was suicide or homicide.

One principle of death investigation is to look for antecedent evidence—preexisting conditions which contributed to the death mechanism or was responsible for causing or continuing a chain of events that led to the death.

Another principle of death investigation is examining the triangle of Scene—Body—History. This compiles the totality of evidence.

Let’s look at the evidence in Elvis Presley’s death.

Scene

A18Elvis was found on his bathroom floor, face down in front of the toilet. It was apparent he’d instantly collapsed from a sitting position and there was no sign of a distress struggle or attempt to summon help. When the paramedics arrived, he was cold, blue, and had no vital signs. Rigor mortis had not set in so he’d probably expired within the hour. He was transported by ambulance to Baptist Memorial Hospital where a vain attempt at resuscitation occurred because “he was Elvis”. He was declared dead at 3:16 p.m. and was shipped to the morgue where an autopsy was promptly performed.

There was no suggestion of suicide or foul play so there was no police investigation. The scene wasn’t photographed, nor preserved, and there was no accounting for what medications or other drugs might have been present at Graceland.

Body

A12Elvis was in terrible health. His weight was estimated at 350 pounds and he was virtually non-functional at the end, being mostly bed-ridden and requiring permanent nursing care. He suffered from an enlarged heart which was twice the size of normal and showed advanced evidence of cardiovascular disease in his coronary vessels, aorta, and cerebral arteries—certainly more advanced than a normal 42-year-old would be. His lungs showed signs of emphysema, although he’d never smoked, and his bowel was found to be twice the length of normal with an impacted stool estimated to be four months old. Elvis also suffered from hypogammaglobulinemia which is an immune disorder, as well as showed evidence of a autoimmune inflammatory disorder.

Toxicology tested positive for ten separate prescription medications but showed negative for illicit drugs and alcohol. The only alarming pharmaceutical indicator, on its own, was codeine at ten times the prescribed manner but not in lethal range.

History

A11Elvis was born on January 8, 1935 in Tupelo, Mississippi and had a twin brother who died at birth. As a youth, Elvis was active and healthy which continued during his time in the army and all through his early performing stage when he was a bundle of energy. He began experimenting with amphetamines, probably to enhance his performances, but shied from alcohol as it gave him violent tendencies.

In 1967, Elvis came under the primary care of Dr. George Nichopoulos who was well-known to celebrities. Then, Elvis was 32 and weighed 163 pounds. His only known medical ailment was slightly high blood pressure, presumably due to his high-fat diet.

Also in 1967, Elvis’s health took a sudden turn with progressive chronic pain, insomnia, hypertension, lethargy, irrational behavior, and immense weight gain. Over his remaining years, Elvis was seen by a number of different doctors and was hospitalized a number of times, all the while resorting to self-medication with a wide assortment of drugs from dozens of sources.

A20Doctor Nick, as Nichopoulos was called, stayed as Elvis’s personal physician till the end and was present at the death scene, as well as during the autopsy. Doctor Nick concurred with the coroner’s conclusion that the cause of death was a natural cardiac event resulting from an arrhythmia, or sudden interruption of heartbeat, and agreed that Elvis’s death was not due to a drug overdose.

When the toxicology report  was released, it came with a qualifier:

“Diazepam, methaqualone, phenobarbital, ethchlorvynol, and ethinamate are below or within their respective ranges. Codeine was present at a level approximately 10 times those concentrations found therapeutically. In view of the polypharmacy aspects, this case must be looked at in terms of the cumulative pharmacological effect of the drugs identified by the report.”

A21Because the tox report appeared to contradict the autopsy report’s stated cardiac cause of death, a prominent toxicologist was asked to review the findings. His opinion was:

“Coupled with this toxicological data are the pathological findings and the reported history that the deceased had been mobile and functional within 8 hours prior to death. Together, all this information points to a conclusion that, whatever tolerance the deceased may have acquired to the many drugs found in his system, the strong probability is that these drugs were the major contribution to his demise.”

The Tennessee Board of Health then began an investigation into Elvis’s death which resulted in proceedings against Doctor Nick.

A22Evidence showed that during the seven and a half months preceding Elvis’s death—from January 1, 1977, to August 16, 1977—Doctor Nick wrote prescriptions for Elvis for at least 8,805 pills, tablets, vials, and injectables. Going back to January 1975, the count was 19,012.

These numbers might defy belief, but they came from an experienced team of investigators who visited 153 pharmacies and spent 1,090 hours going through 6,570,175 prescriptions and then, with the aid of two secretaries, spent another 1,120 hours organizing the evidence.

The drugs included uppers, downers, and powerful painkillers such as Dilaudid, Quaalude, Percodan, Demerol, and Cocaine Hydrochloride in quantities more appropriate for those terminally ill with cancer.

A23Doctor Nick admitted to this. His defense was because Elvis was so wired on pain killers, he prescribed these medications to keep Elvis away from dangerous street drugs, thereby controlling Elvis’s addiction—addiction being a disease.

One of the defense witnesses was Dr. Forest Torrent, a prominent California physician and a pioneer in the use of opiates in pain treatment who explained how the effects this level of codeine would have contributed to Elvis’s death.

Central to misconduct allegations was the issue of high codeine levels in Elvis at the time of death—codeine being the prime toxicological suspect as the pharmaceutical contributor. It was established that Elvis obtained codeine pills from a dentist the day before his death and Doctor Nick had no knowledge of it.

The jury bought it and Doctor Nick was absolved of negligence in directly causing Elvis Presley’s fatal event.

Continuing Investigation

A24Dr. Torrent was convinced there were other contributing factors leading to Elvis’s death. In preparation for Doctor Nick’s trial, Dr. Torrent had access to all of Elvis Presley’s medical records, including the autopsy and toxicology reports. Incidentally, these two reports are the property of the Presley estate and are sealed from public view until 2027, fifty years after Elvis’s death.

Dr. Torrent was intrigued by the sudden change in Elvis starting in 1967 and discovered that while in Los Angeles filming the movie Clambake, Elvis tripped over an electrical cord, fell, and cracked his head on the edge of a porcelain bathtub. Elvis was knocked unconscious and had to be hospitalized. Dr. Torrent found three other incidents where Elvis suffered head blows and he suspected Elvis suffered from what’s now known as Traumatic Brain InjuryTBI—and that’s what caused progressive ailments which led to his death.

Dr. Torrent released a paper titled Elvis Presley: Head Trauma, Autoimmunity, Pain, and Early Death. It’s a fascinating readrecently published in Practical Pain Management.

A25Dr. Torrent builds a theory that Elvis’s bathtub head injury was so severe that it caused brain tissue to be jarred loose and leak into his general blood circulation. This is now known to be a leading cause of autoimmune disorder which causes a breakdown of other organs. This was unknown in 1967 and Elvis went untreated. Side effects are chronic pain, irrational behavior, and severe bodily changes such as obesity and enlarged organs like hearts and bowels.

Today, TBI is a recognized health issue in professional contact sports.

A26With a change in mental state and suffering chronic pain, Elvis Presley entered a ten year spiral towards death. He became hopelessly addicted to pain killers, practiced a terribly unhealthy diet and lethargic lifestyle, and resorted to the typical addict’s habit of sneaking a fix wherever he could. This led to early coronary vascular disease and, combined with his escalating weight and pill consumption, Elvis was a heart attack ready to burst.

Recall that I used the term antecedent, like all coroners do when assessing a cause of death. Given Dr. Torrent’s observations—and all the facts compiled from forty yearsif I were the coroner completing Elvis Presley’s death certificate today, I’d write it like this:

Identity of Deceased — Elvis Aaron Presley.

Time of Death — Approximately 2:00 p.m. on Tuesday, August 16th, 1977.

Place of Death — 3754 Elvis Presley Boulevard, Memphis, Tennessee.

Cause of Death — Cardiac arrhythmia antecedent to hypertensive cardiovascular disease with atherosclerotic heart disease antecedent to polypharmacy antecedent to autoimmune inflammatory disorder antecedent to traumatic brain injury.

Means of Death — Cumulative Head Trauma.

A8Therefore, I’d have to classify Elvis’s death as an Accident.

There’s no one to blame—certainly not Elvis. He was a severely injured and sick man. There’s no specific negligence on anyone’s part and definitely no cover-up or conspiracy of a criminal act.

If Dr. Forrest Torrent is right, there simply wasn’t a proper understanding back then in determining what really killed the King of Rock & Roll.