Smith Died of Accidental OD ; Coroner Says 9 Drugs Made Illness Worse

Mar 27, 02:20 PM

Current Headlines: By MATT SEDENSKY, THE ASSOCIATED PRESS

DANIA BEACH, Fla. Anna Nicole Smith accidentally overdosed on at least nine prescription drugs including a powerful sleep syrup she was known to swig right out of the bottle after a miserable last few days in which she endured stomach flu, a 105-degree fever, pungent sweating and an infection on her buttocks from repeated injections.

In a detailed autopsy report released Monday, a medical examiner pointed out that the former Playboy playmate refused to go to a hospital three days before her Feb. 8 death. She chose to ride out her illness in a hotel suite littered with pill bottles, soda cans, SlimFast, nicotine gum and an open box of Tamiflu tablets.

Broward County Medical Examiner Dr. Joshua Perper found that in the days leading up to her death, the 39-year-old Smith had been taking large amounts of the seldom-prescribed sedative chloral hydrate, which also contributed to the 1962 overdose death of Smith's idol Marilyn Monroe.

Police found no apparent signs of foul play, and the medical examiner also ruled Smith's death probably was not a suicide because people who take their own lives typically use much more lethal drugs than chloral hydrate.

Rather, he said, Smith might have been simply unaware that the sedative could be fatal in combination with multiple other prescriptions she was taking in normal doses for anxiety, depression and insomnia.

Contributing factors included her weakened condition from a stomach flu and fever brought on by a pus-filled infection on her buttocks from repeated injection of other drugs.

"She may have taken the dosages she was accustomed to but succumbed because she was already weakened," Perper said in his report. "Miss Smith has a long history of prescription drug abuse and [of being] self-medicated in the past."

The recommended dose of chloral hydrate is one to two teaspoons prior to bed. Smith often took two tablespoons, and she sometimes drank directly from the bottle, the report said.

A statement issued by lawyers for Howard K. Stern, Smith's companion who was with her before her death, said that Stern and Smith's physician urged her to get emergency treatment but she refused because "she did not want the media frenzy that follows her."

"She refused to go to the hospital because she wanted to avoid media," attorney Lilly Ann Sanchez said in a news release. "Anna called the shots in Anna's life, and everyone close to her knows that."

The autopsy report left some unanswered questions, such as why it took so long for emergency personnel to be summoned when Smith was discovered unresponsive Feb. 8 in her room at the Seminole Hard Rock Hotel and Casino.

The report found that a private nurse had asked a bodyguard to call 911 around 1 p.m. and had started CPR. The Seminole EMS was called about 1:40 p.m. by a bodyguard and arrived six minutes later. The ambulance reached the hospital at 2:43 p.m., and Smith was pronounced dead shortly thereafter.

Perper said Smith could have been saved had she been hospitalized earlier in the week simply because her drug intake could have been controlled.

But Perper said the lag in calling 911 on the day of Smith's death probably didn't matter.

"The earlier you come to a hospital the more you have a chance, but there's not a guarantee," he said. "Those are not things with a mathematic precision, but within a reasonable degree of medical certainty, I don't think she had really a realistic chance."

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(SIDEBAR)

A deadly combination

The following drugs, listed by their brand and generic names. were found in Anna Nicole Smith's body during the autopsy:

* Ativan (loraze-pam): anti-anxiety medication.

* Cipro (ciproflox-acin): antibiotic.

* Klonopin (clonazepam): anti-seizure medicine also used to treat anxiety.

* Methadone: strong painkiller, often used to suppress withdrawal from heroin.

* Noctec (chloral hydrate): sedative and sleeping medication.

* Robaxin (meth-ocarbamol): muscle relaxant.

* Soma (meprobamate): muscle relaxant.

* Topamax (topiramate): anti-seizure medication also used to treat migraines.

* Tylenol (acetaminophen): pain reliever.

* Valium (diazepam): anti-anxiety medication, also used as a sedative and to treat seizures.

In addition, she had also taken these around the time of her death:

* Benadryl (di-phenhydramine): antihistamine.

* Human growth hormone: touted as a muscle-building, weight- reducing agent.

* Nicorette (nicotine polacrilex): used to quit smoking.

* Tamiflu (oseltamivir phosphate): anti-viral medicine.

* Vitamin B12: helps formation of red blood cells.

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