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RELEVANCE OF BLOOD DATA
The overall importance and relevance of such toxicological data is emphasized eloquently by Prouty, et. al., as "One of the most fundamental questions of postmortem forensic toxicology is...'How much drug did the decedent take?' Historically, to answer this question, toxicologists have relied upon published case reports of fatal intoxication, in which the amount of ingested drug was known or reasonably approximated, and upon reports in the clinical literature that contain information concerning drug concentrations after single or chronic dosing. In recent years, pharmakokinetic equations have been increasingly used in an effort to estimate more precisely the total amount of a drug in the body and, subsequently, estimate the dose of the drug required to produce a measured blood concentration." (76). The use of blood morphine levels to establish criminal intent dates back over 100 years. Nakamura points out that "As early as 1893...Thorwald describes a celebrated court proceeding involving a physician who allegedly poisoned his wife with morphine." (63).

BLOOD IS LIKE AN HONEST WITNESS
Analyzing the morphine level of a dead person can help determine the time and the manner of death. Such tests are useful in cases where there is no eyewitness, or, for example, in the Cobain case, where there are officially no witness, but where forensic evidence suggests the presence of a witness, i.e. Cobain was either dead or so severely incapacitated by the massive dose heroin, that someone else had to have pulled the trigger. Nakamura remarks similarly that "Many...witnesses are unavailable because they either flee from the scene upon the death of their companion or they discard the body in a location less discriminating than their own domicile." (63) Thus the very idea of investigating a suspicious death using forensic testing of the morphine levels is a well established phenomenon, due at least partly to the tendency of those associated with the event to flee, discard the body elsewhere, and provide otherwise unreliable information in an attempt to avoid implication of their involvement. With respect to Nakamura's comment regarding "...they discard a body in a location less discriminating than their own domicile," it is noteworthy that Cobain's body was suspiciously enough found in his own domicile, even though he was supposedly a "missing person."

2.) INCAPACITATED OR DEAD BEFORE GUNSHOT:

HEROIN IS VERY FAST ACTING
The following quotes from Krivanek describe the rapid action of this deadly narcotic, especially when taken intravenously, "Heroin 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 pain. 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." (53). Additionally, Platt remarks on the amazing rapid action of intravenous heroin by explaining that "...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 measure. " (75). It would be a mistake to think that even a severe addict could intravenously inject triple the maximum lethal dose of heroin and survive 10 to 20 seconds. First, it must be understood that the injection process itself takes a considerable amount of time such that the lethal effects of the drug often take effect with the needle still in the arm. This specific case supposedly involved the injection, the removal of the needle & tourniquet, the placement of paraphernalia in a box, sitting on the floor, and positioning and firing the shotgun. Secondly, it is important to note that an intravenous heroin overdose is very different from the previously described "usual injection" because an overdose produces much more serious effects much faster than the "usual injection".

SOME DATA ON SPEED OF DEATH
The Lange manual for Poisoning & Drug Overdose states that for opiates, "with higher doses, coma is accompanied by respiratory depression and apnea often results in sudden death." (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: "...we have shown that in 85% of the cases, the death should be attributed to a so-called 'golden 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." (90). Similarly, Garriot & Sturner, describe how "...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 litre, ed.) in the short-term interval group." (28). Notably, as of 1973, Garriott & Sturner did not find any blood morphine level over 0.93 mg per litre, 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 " there are vivid accounts of victims lapsing into a deep coma immediately following a 'fix' with a syringe still afixed in the arm or on the floor underneath the body, and/or with an improvised tourniquet still in place around the arm." (63). Gossell & Bricker report that "for a large overdose, the victim rapidly lapses into coma and is not arousable by verbal or painful stimuli." (32).

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Appendix A - Appendix B - References 1 / 2