Official cause of death in Anna Nicole Smith case revealed

DANIA BEACH, Fla. – Playboy Playmate Anna Nicole Smith died of an accidental overdose of a sleeping medication and at least eight other prescription drugs, and she had recently had a bacterial infection from injecting drugs into her buttocks, authorities said Monday.

Broward County Medical Examiner Joshua Perper said Smith died of “combined drug intoxication” with the sleeping medication chloral hydrate as the major factor.

She had been taking a lengthy list of medications, including methadone for pain and valium, but those drugs were at therapeutic levels, he said. A bacterial infection from injecting medication in her buttocks and the flu contributed to her death, according to the report.

Chloral hydrate is a sedative used to treat insomnia and alcohol withdrawal, relieve anxiety and ease post-surgery pain.

The drug is rarely prescribed and is known to be fatal if combined with certain other drugs – including the sedative Lorazepam, which the autopsy showed she was taking, said Dr. Chip Walls, a forensic toxicologist for the Miller School of Medicine at the University of Miami.

“It’s very toxic if you mix it with any other central nervous system depressant drugs,” Walls said. “You could get profound sedation leading up to coma and respiratory arrest.”

Perper said Smith also had been on several antidepressant and antianxiety drugs and had recently taken longevity medications, vitamin B12 and growth hormone. An assistant medical examiner’s report described seeing a table in Smith’s hotel room containing cold medicine, soda cans, SlimFast, nicotine gum and an open box of Tamiflu tablets.

“We found nothing to indicate any foul play,” said Chief Charlie Tiger of the Seminole police department.

Smith, 39, was found unresponsive Feb. 8 in her room at the Seminole Hard Rock Hotel and Casino in Hollywood on one of the tribe’s reservations.

According to the medical examiner’s report, a private nurse had asked a guard to call 911 around 1 p.m. and had started CPR. The Seminole EMS were called about 1:40 p.m. and arrived six minutes later, according to the report. The ambulance reached the hospital at 2:43 p.m., and Smith was pronounced dead shortly afterward. The reasons for the delays weren’t clear.

Tiger said authorities examined laptop computers belonging to Smith and her lawyer-turned-companion, Howard K. Stern, and found nothing unusual related to her death. Tiger also said nothing came up during an exhaustive review of tapes from hotel security cameras and from interviews with numerous witnesses.

Smith felt ill shortly after arriving in Fort Lauderdale from the Bahamas on Feb. 5, and she eventually developed a fever of 105 degrees but refused to go to a hospital, Perper said. He said Smith had a blood infection that could have been caused by a contaminated needle, but it was brought under control by antibiotics and an ice bath.

“Her temperature never went again above 100 and, except for an episode of vomiting, she felt relatively well expect for feeling very weak,” he said.

“Miss Smith had a long history of prescription drug use and over-self medicating. She may have drank a little too much chloral hydrate to alleviate symptoms which were secondary to infection,” the medical examiner’s report said. The report, while ruling Smith’s death accidental, notes that her idol, Marilyn Monroe, died of chloral hydrate and barbiturates.

The weeks after Smith’s death were filled with public courtroom drama and private whispers about what might have killed her. She had been distraught over her son’s death in the months before she died and under stress from a longrunning court fight over her late husband’s fortune.

The report listed several reasons Smith’s death was believed to be accidental. It said that suicide victims typically take far more of a lethal drug than the chloral hydrate found in Smith’s body, and that Smith had “a long history of prescription drug use and over-self medicating.” It also cited her religious upbringing and the recent birth of her baby girl.

Smith arrived at the Hard Rock on Feb. 5 and planned to leave four days later aboard a new yacht that Stern, her companion, was arranging to buy.

She was seldom seen outside her room during her stay and was said to be suffering from a stomach flu before she died.

Because her death was so sudden, and because her 20-year-old son Daniel died under suspicious circumstances five months earlier, there had been speculation about possible criminal activity surrounding the deaths.

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