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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.
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Appendix A - Appendix
B - References 1 / 2
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