The previous relative safety of benzodiazepines has become especially challenged lately with the misuse and abuse of related drugs such as Halcion and Xanax. Notably, these newer ultra-short acting benzodiazepines have a much shorter half-lives. This means that they clear out of the body very fast. Also, they have been considered the sole cause of death in recent forensic cases. Their potential lethality is especially increased when injected, and is the most common form of benzodiazepine-related respiratory failure. While diazepam is effective at a dose of 5 mg, the effective dose of Xanax is merely 250 mcg, with a half-life of 10-20 hours. Thus Xanax works as well as Diazepam at one-twentieth of the dose. Diazepam works in 30 minutes, while Xanax works immediately, and has a half-life of 10-20 hours. That means that 10-20 hours after taking it, half of it has been rendered useless. When injected, benzodiazepines in general are twice as potent. Thus a significantly toxic oral dose of 30 mg of diazepam would be easily achieved by an approximate equivalent of 500 mcg to 750 mcg of intravenously administered Xanax. Diazepam is measured usually by its secondary metabolites in the liver, and the metabolites for Xanax and Diazepam and Valium are all very similar, so often no differentiation is made during testing, which is often only conducted to determine presence, not quantity. If the benzodiazepine in Cobain's blood was indeed a fast-acting one, then it very likely played a major role in making the massive dose of heroin even more deadly.

SOME DEATHS INVOLVING HEROIN & DIAZEPAM
Gottschalk and Cravey, in their large compilation of deaths involving psychotropic drugs, found 129 cases where morphine, predominantly intravenous heroin, was determined to be the primary cause of death. Three of these cases involved diazepam and intravenous heroin or morphine (33). The first and second cases both involved oral diazepam plus intravenous heroin and/or morphine. The first case showed a blood morphine level of only 0.13 mg/L and diazepam at 1.4 mg/L, and the body was discovered approximately nine hours after death. Case 2 showed 0.3 mg/L blood morphine and 6 mg/L diazepam, and was discovered about seven hours after death. Case 3 included the possibility that the diazepam might have been injected with the morphine, and the blood levels were 0.02 mg/L morphine and 0.3 mg/L diazepam, with the body discovered about 24 hours after death. The third case in particular shows an extremely low blood morphine level can be lethal when combined with a low dose of diazepam.

VERY HIGH BLOOD MORPHINE LEVELS ARE RARE
As mentioned previously, the strongest forensic evidence indicating Cobain was murdered is the sheer lack of a parallel case in forensic literature concerning violent suicides and/or overdoses. Overdose reports normally show results similar to those from Logan & Luthi, who described 16 deaths caused by intravenous heroin or morphine in which blood levels were measured, and the highest serum morphine level seen was 0.920 mg/L. (57). Appendix A: Compendium of Intravenous Heroin Related Deaths Where Blood Morphine Levels Were Measured, shows the rarity of occurrence of a blood morphine level equal to or greater than Cobain's. Many thousands of opiate related deaths were reviewed, and for the purposes of this report, over 3000 of these deaths were determined to be specifically related to overdoses among addicts involving the intravenous use of morphine or heroin. Next, this group was further narrowed to eliminate those cases in which blood morphine levels were not available. Cases where the drug was known to be morphine were eliminated, as were cases where the cause of death was determined to be other than overdose. The 1526 cases remaining showed 26 instances where the blood morphine levels were equal to or above Cobain's, an occurrence rate of 1.7%. None of the above cases reportedly involve a gun or violent suicide. Additionally, no case reported overdose sequlelae of a nature which would even imply the possibility of anything other than immediate incapacitation and/or death. Where data was available, it was remarkably clear in presenting images of addicts with tourniquets in place, syringes in hand, and other evidence of abrupt death. Clearly, the level found in Cobain is among the top 2% of the highest blood morphine levels ever discovered, even in severe addicts.

SELF-POISONING & VIOLENT SUICIDE RARE AMONG ADDICTS
The fact that the Cobain case as it supposedly happened has no parallel in the references reviewed concurs with Burston's finding that "self-poisoning with morphine or heroin is very uncommon." (9). He also states the effects of heroin "...is of such short duration and is so intense that it inhibits any type of physical activity, either criminal or non-criminal." (9). Also, no case of violent or traumatic suicide reviewed compared well with the Cobain case. Gatter studied "...1862 postmortem examinations of suicides carried out in north west London over a 20 year period from 1957-1977...," (29) with only 20% (369 cases) committing suicide by physical injury, none of which involved opiates. Maurer and Vogel state plainly "...the general rule that opiates inhibit tendencies toward violence." (59). Similar findings are reported by Nowers, in his study of "...51 consecutive gunshot suicides in the County of Avon, England between 1974 and 1990," where it is apparent that suicide by gunshot is uncommon. "Of the 1,117 cases identified, 51 were gunshot suicides (4.5 per cent)...39 used a shotgun." (65). Again, no case reported blood morphine levels. This is illustrated in Table 5, below.

NONE OF 3586 SUICIDES SHOW PARALLEL TO COBAIN CASE
Additionally, Selway's (83) study of all 96 gunshot suicides in Victoria, Australia during 1988, demonstrates that none of the 64 cases where the blood was analyzed involved narcotics. Only two cases had taken an overdose of any kind, one drinking Paraquat, and the other taking oxazepam, alcohol, and imipramine. Selway's and Nowers' studies collectively deal with 147 suicides in which a gunshot was the cause of death, yet not one single case even distantly resembled the supposed scenario for Cobain's "suicide." The 1862 suicides studied by Gatter included 369 violent deaths, with 51 gunshot suicides as well as a significant degree of drug overdoses, yet again, no parallel exists to Cobain's case. Cooper & Milroy's study involved 536 suicides, 246 of which were violent, 10 of which involved a gun. (15).Thus, in 3586 total suicides, including 208 suicides by gunshot, no case remotely resembles a situation where a gunshot of any kind and a heroin overdose of even minor proportions occurred.

REVIEW OF RARE OVERDOSE CASES IN COBAIN'S RANGE
Remarkably, 8 studies out of 19 reported on at least one of the 26 rare blood morphine levels in Cobain's range. Staubb, et. al., listed 12 cases in particular out of the 52 cases studied which showed total blood morphine levels equal or above Cobain's level. (90). However, it is vital to note that all these cases involved abrupt death immediately following injection, and none of any of the 52 cases studies was reported to have committed suicide with a gun of any kind. Basically, their study showed a remarkable consistency in abrupt reactions, indicating an 85% probability of instant death, and 15% chance of instantaneous collapse into a comatose state. Still, it is worth pointing out that this is the single largest group of cases at or above Cobain's range. Coumbis & Balkrishena (16) show four high level cases, while Gottschalk & Cravey (33) and Hine, et. al. (42) each show 3 such cases. Studies which found only one such level are Richards, et. al. (77), Paterson (70), and Monforte (62). Finally, Nakamura (63), mentioned previously, also found only one very high level case, with 1.8 mg/L, and the manner of death was known to be instantaneous.

WASHINGTON STATE HEROIN OVERDOSES
Regarding Washington State heroin overdose deaths, including Seattle, a 1996 report by Logan & Smirnow in a study of 32 cases of "...deaths involving morphine." (58). The focus of their research basically concerned testing the reliability of postmortem blood samples over time, and the variabilities between morphine levels when collected from different tissues, including different "sites" of blood collection, eg. femoral, iliac, and ventricular sites. Also of specific relevance to the Cobain case is the authors noted "...the pattern of opiate use in this population is almost exclusively one of Mexican black tar heroin." (58). Generally, they conclude that "Although both site dependant differences and time dependant changes have been shown to affect the concentration of some drugs in postmortem samples, neither appears to be the case with morphine." (58). The main point is that the Cobain blood data is generally regarded as reliable, despite the fact that the body was discovered at least three days after death. More importantly, note that only one case of 32 was suicide, with the remainder listed as accidents or probable accidents. The highest total blood morphine level, collected initially from the iliac site, is 0.4 mg/L, shows black tar heroin use among a population of addicts does not appear to necessarily lead to significantly higher blood morphine levels than those found in addict populations where black tar heroin is uncommon.
 

BLACK TAR HEROIN DEATHS IN NEW MEXICO
The high lethality of black tar heroin due to increased purity levels is discussed in Sperry's 1988 paper (90). Most of the 129 deaths involved "...very high (greater than 1 mg/L) concentrations of opiates in the blood..." (89). Sperry also discovered the highest level of purity in black tar heroin ever reported, 93 % in some rare cases. No case involved "...the so-called acute idiosyncratic reaction...," further supporting the findings that acute heroin overdoses are dose-related primarily. While it is obvious that many adulterants can increase lethality, it would be completely mistaken to think that pure heroin lacks toxicity as a result of it's purity or the lack of toxic adulterants. None of the cases studied by Sperry showed evidence of other drugs, and no case was reported to involve a gun or trauma. While it is unfortunate that Sperry does not provide a detailed list of blood morphine levels and other data, it is important to note that even in a population of addicts overdosing on black tar heroin, levels over 1 mg/L are considered "...very high..." (89) This contrasts with Cobain's level, which registers 50% higher. Due to lack of specific blood data, Sperry's report is excluded from Appendix A.

PREPONDERANCE OF EVIDENCE
Further confirmation of these findings is seen ubiquitously throughout the scientific literature, creating a preponderance of evidence. Gottschalk & Cravey's study of 128 heroin-related deaths showed only 3 cases in Cobain's range. (33). Only one of the 128 deaths involved secondary self-inflicted trauma of any kind, in which one person committed suicide by hanging. Notably, despite evidence of intravenous heroin and/or morphine use, and despite the fact that morphine levels in other tissues confirmed death by overdose, there was no morphine detectable in the blood at all, which helps explain how the individual had time to hang himself. The individual in question tested positive for several drugs, as is common in cases of self-poisoning, and this accounts for the lethality of the otherwise low dose of opiates. Specifically, oral methadone was also consumed, thus there would be a moderately delayed reaction before the combined effects of the drugs took effect and killed the victim before he died from the hanging itself. None of the 128 deaths involved a gun of any kind.

DECONSTRUCTING THE MYTH OF THE SUICIDAL HEROIN ADDICT
Paterson (70) discusses 189 cases of fatal self-poisoning in North and West London between 1975 and 1984. These cases involved only one drug each, and each case was determined to be the direct result of an overdose of that specific drug, with no other contributing causes. The study further confirms that the myth of the suicidal heroin addict is indeed a myth, with only seven cases involving morphine, i.e. less than 0.04% of the cases studied. The average, or "mean," blood morphine level was high, at 1 mg/L, with a range of 0.19 mg/L to 1.9 mg/L, indicating at least one case in which the concentration was at or above Cobain's range (probably only one, which would raise the mean beyond normally seen mean levels). No other details are provided concerning the route of administration, i.e. whether or not the morphine or heroin were administered orally or intravenously. Intravenous administration is a significant possibility, and since Paterson's study includes at least one case in seven in Cobain's range, the data is used in this study to determine the specific probability and/or possibility of an individual attaining such a high blood level. Note that if the data is interpreted as 1 case in 189, then the chances of an individual attaining such a blood morphine level via self-poisoning, during a nine year period, is less than 0.0054%, i.e. extremely remote.

BENEFIT OF THE DOUBT GOES TO THE VICTIM
The idea that a person could intentionally kill someone is hard to truly accept, and it is even harder to imagine someone staging a murder to look like a suicide. It seems normal to ask "does this really happen?" Yes it does happen...staged deaths are unfortunately not rare. Furthermore, criminology textbooks clearly state that when someone who is drugged supposedly commits suicide, the "...fair supposition..." is murder. Also, when an adult goes "missing," the chances of suicide are very slim. Read a sampling for yourself from O'Hara's, Charles E., Fundamentals of Criminal Investigation (66): "...V. Beck examined forty suicides, whose skulls were smashed... Naturally in such cases the muzzle of the barrel must be placed directly under the chin or in the mouth. It is not therefore impossible that a murder may be committed in this way, and all the more likely as it lends itself easily to the suspicion of suicide; it is a fair supposition that a person asleep, stupefied, or bound, may thus be killed

2,000 TO 1 ODDS AGAINST SUICIDE AMONG MISSING PERSONS
Table 6, above, demonstrates O'Hara's findings regarding the rarity of suicide among missing persons. It must be noted that this data does not specifically regard heroin addicts, and reflects the findings of one criminologist, yet it provides a general indication as to the rarity of suicide among missing persons. He describes how the myth of a suicidal missing person perpetuates homicides staged to look like suicides; "To the layman the suicide theory is one of the first to suggest itself in a disappearance case. Statistically, however, it can be shown that the odds are greatly against the suicide solution. Approximately one out of 2,000 missing persons cases develops into a suicide case...A voluntary disappearance is motivated by a desire to escape from some personal, domestic, or business conflict...A disappointment in love seldom results in a self-inflicted death...In the disappearance of approximately 100,000 people annually in this country, it is to be expected that personal violence should play a significant part in some of the cases. Murder, the unspoken fear of the relatives and the police, must always lie in the back of the investigator's mind as a possible explanation. The suspicions of a shrewd investigator have not infrequently uncovered an unsuspected homicide. The two most popular motives for this type of homicide are money and love." Thus it is made clear that the police and relatives routinely view the possibility of murder with a certain degree of horror, while the investigator must remain suspicious to a degree which others may find ghoulish and/or paranoid, but which is nonetheless the call of duty.

CASE PARALLELS MANY HOMICIDE PATTERNS
A review of Lester's book on murder statistics shows the conflicting nature of much of the research into the possible relationships between homicide and suicide, yet establishes very clearly that "Narcotics were more likely to be present in the homicides." (54). Victims of murder are usually men, and for both sexes, the most vulnerable age group is between 25 and 34 years of age. Both sexes were "...killed most often at home. Both were killed more often with guns..." Regarding the statistical possibility of spouse murder, Levin & Fox state that "...though only 15% of all homicides are committed by females, more than 40% of all poisonings are committed by them." (55). Lester reports on Wolfgang's 1956 Philadelphia study which concluded that "Wives killing husbands constituted 41% of female murderers...Men killed by women were most often killed by their wives." Furthermore, again consistent with Cobain case, "...spouse murders were more often violent and brutal than other murders...85% of spouse murders took place in the home." (54). Another study showed "...murderers more often attacked people they knew." A 1972 study in New York City by Baden found "...215 homicides, 19 suicides, and 46 accidents among narcotic addicts. Narcotics homicides (versus other homicides versus other addict deaths) were more often male..." (54).

SIMULATED SUICIDES A MAJOR CONCERN
Similarly, O'Hara remarks on the common phenomenon of "Simulated Suicides: These are usually planned by persons wishing to defraud insurance companies or to arrange for a change of spouse...A search for motives should include an inquiry into insurance policies...," as well as a concept especially relevant to this case, the "Incapacitating Sequence: Certain combinations of wounds suggest a physical impossibility. To draw a conclusion of suicide, the wounds should be physically not improbable...". Additionally, he makes the point "Murder: The conclusion that a particular homicide is a murder is often made by the exclusion of accident and suicide." (66). The above quotes show how a charge of murder can result from disproving the possibility of an accident or suicide. Motives aside, the main issue here is described above as an "incapacitating sequence." Indeed, the simple fact that Cobain was drugged at all is considered a major indication of murder. Truthfully, Cobain's death should have been treated as murder from the start; as the victim he should have received the benefit of the doubt.

HOMICIDAL "HOT SHOTS" NOT UNCOMMON
Froede and Stahl, in their paper "Fatal Narcotism in Military Personnel," reviewed 1.3 million U.S. military autopsies between 1918 and 1970, and found 174 cases due to "fatal narcotism." (26). Such deaths have been an ongoing problem for the U.S. military, especially since the expanded military presence of U.S. personnel in Asia since WW II. Interestingly, there were only two deaths involving a gun shot wound, both of which were determined to be accidents while under the influence. These 2 cases did not involve lethal levels, and were thus excluded from Appendix A. Only 14 cases, i.e. 8 %, were determined to be suicide. Thus, despite the overwhelming prevalence of guns in the military, a factor well known to increase the likelihood of a gunshot related suicide, no such case occurred. Additionally, 6 cases, i.e. 3.5 %, were determined to be the result of an intentional homicidal administration of a lethal dose of heroin, a "hot shot." Thus if a similar figure existed for civilian cases, i.e. a 3.5% occurrence of homicidal hot shots amongst heroin deaths, then it appears clear that the Cobain case, statistically speaking, is much more likely to be the result of such a "hot shot" than any other scenario put forth.

OVERTURNED CASES
Levin & Fox (55) report on a series of staged deaths perpetrated by Doreathea Puentes, who allegedly poisoned up to nine people. The first victim was thought to have committed suicide by an overdose of codeine, a verdict which changed when other deaths were correlated with Puentes. As mentioned elsewhere in this essay, other cases have been re-opened an resolved more successfully, eg. the James case (20) in section two, the Winek case (97) in section seven, and the " postmortem credit card use" case (8) in section six.

NO LEGIBLE FINGERPRINTS ON WEAPON
There is an officially acknowledged lack of legible fingerprints on the shotgun. The weapon was handled by two or more people several times before Cobain's death, so it is possible someone wiped the gun clean to intentionally avoid detection. Another well known fact is that Cobain's credit card was used several times after death. Postmortem credit card use has, in and of itself, has been the sole precedent in reopening and solving at least one homicide case staged to appear like a suicide according to Burgess (8). The missing persons report was filed by the widow, who told the SPD that Cobain had escaped a rehabilitation centre, purchased a shotgun, and was suicidal. Truthfully, the purchase occurred before Cobain entered the rehabilitation centre. The report seemingly predisposed the SPD to the idea that they were investigating a definite suicide, not a possible homicide. Despite SPD claims that the case was investigated as a possible homicide from the beginning, the SPD reports on the incident clearly state that the first officer on the scene viewed the case as a suicide. Furthermore, Cobain's behaviour following his departure from the rehabilitation centre included signing autographs at the Seattle airport, hardly the behaviour of a "missing person." Also, misleading accounts of details in the case have mistakenly claimed the room in which Cobain was found was barricaded.

POSSIBLE NOTE ADDITIONS AND MOTIVE
Additionally, the note found at the scene of Cobain's death was determined by the SPD handwriting expert to be a suicide note written by Cobain, yet significant disagreement among handwriting experts points to the definite possibility that the most crucial "suicidal" lines, i.e. the last four lines, were written by a separate person. The note reads like a retirement letter, written to Cobain's "fans," explaining his resignation from the music industry. This retirement included a refusal to perform for a major tour, thus forgoing an estimated $7 to $9.5 million dollars. The estimated revenue from Cobain's music is millions of dollars, clearly enough to be a motive for homicide. The widow continues to deny several reports claiming she and Cobain were about to be divorced and that she was involved in an extra-marital affair.

CORONER DR. HARTSHORNE IN CONFLICT OF INTEREST
The coroner, Dr. Nikolas Hartshorne, was interviewed by a newspaper reporter for the Vancouver Province in April 1996, and he insists Cobain died from a self-inflicted shotgun wound. The doctor's credibility has been questioned due to a conflict of interest, because he knew Cobain and the widow personally. Previous investigative reports indicated this conflict of interest, but the newspaper interview clearly confirms the problem. This was the first time it was ever declared, for example, that not only had Hartshorne booked Seattle "punk" bands frequently, he actually booked Cobain's band, Nirvana. Additional to the conflict of interest issues is the simple fact that even the best coroners make mistakes. The most common cause of mistakes made by coroners is basic human error. Gruver & Freis (1957), studied 1,106 autopsies, who concluded that "...lack of mental alertness or awareness on the part of the physician in attendance seemed to be a most common cause for diagnostic errors. More often than not, the correct diagnosis could have been made if the responsible physician had been less mentally stagnant about the problem."(41).

DIAGNOSTIC DISCREPANCIES IN AUTOPSIES
When a diagnostic discrepancy occurs in an autopsy, it is twice as likely to be due to something missed than something found, or, as Hill & Anderson say, "...significant underdiagnosis occurs more often than overdiagnosis by a factor of almost 2:1."(41). This fact conforms with the Cobain case, where the massive level of blood morphine was mistakenly deemed irrelevant and thus "underdiagnosed." Table 8, above, summarizes a study including over 6,000 autopsies, and provides statistics which show that it is far more likely that the Cobain case involved a serious "major" diagnostic discrepancy (a likelihood of at least 11.7% to 33.8%) than any other scenario put forth officially. Burgess wrote, in Understanding the Autopsy, that "There are many jurisdictions in this country where you would not have to be half-smart to get away with murder, quite literally...the fact remains that, in all too many places, the investigation of possible murder is undertaken only after pressure is brought by relatives or other interested parties, and when such investigation is instituted, it is done so incompetently that murder after murder goes unsolved and unpunished." (8).

"The question whether a fatal injury was homicidal, suicidal, or accidental is as common in real life as it is in detective fiction. ...It is natural for a murderer to try to escape detection by making his crime look like suicide or accident, and such attempts have doubtless been going on for a long time. One cannot say how long, for one never hears about them when they succeed. However, records of failures take us quite far back." Smith, Sir Sydney(87).

HOMICIDE AN OBVIOUS ASSUMPTION
Wecht, in the forward to an article by Winek (97), stated that "One of the most useful and relatively new areas of toxicology has to do with the significance and practical importance of drug and chemical blood levels. Identification and more importantly, quantitation, of blood levels is essential in many civil and criminal actions involving drugs. Without such information, the cases become matters of pure speculation and are predicated on circumstantial evidence (which may or may not prove to be correct ultimately)."(97). Winek's article, "Drug and chemical blood levels," mentions the following amazing case: "A lethal level of a drug or chemical found in an individual's blood does not by itself establish the cause of death. For example, a known narcotic addict was shot to death. Analyses of various body tissues (brain, bile, blood, etc.) revealed levels of morphine that have been found in other deaths attributed to overdose with heroin or morphine. However, in this case the cause of death was due to the bullet wounds!" (97). The indication is that a morphine overdose simultaneous with a gun shot wound is an overwhelmingly rare phenomenon at most, and that in the only such incident reported, the most obvious conclusion was homicide.

CASE SHOULD BE RE-OPENED & VERDICT CHANGED
Table 9, above, summarizes several probability statements regarding this case. A large dose of two drugs administered by intravenous injection thus appears to be a definite possibility. Specifically, Cobain was probably given an injection of no less 225 mg of some type of heroin and a benzodiazepine. The suggestion that Cobain's tolerance to heroin was so high that he could have withstood the dose described above is clearly mistaken. The addition of a benzodiazepine of any kind, especially in combination with Cobain's low body weight, points to complete incapacitation at best, and strongly, if not conclusively indicates Cobain was dead before the gunshot wound. The official statement that Cobain ingested triple the lethal dose of heroin is probably an underestimate, yet it must not be understated that triple the lethal dose of intravenous heroin is three times more than the amount which kills even the most severe addict. Dead men don't pull triggers.