STRICKEN, STRUNG OUT FOR DAYS BEFORE OD ACCIDENT: DOC
Anna Nicole Smith “accidentally” overdosed on at least nine prescription painkillers - including a powerful sleeping syrup she’d gulp from the bottle to dull immense pain from a 105-degree fever and the horribly infected abscess on her butt caused by multiple drug injections, officials revealed yesterday.
Smith, who died in her sleep Feb. 8, lived a wretched, final few days at the Seminole Hard Rock Hotel and Casino in Hollywood, Fla., as her feverish sweat produced “a ‘pungent’ odor” and she often lay crumpled in a dry bathtub with half-empty pill bottles on the floor.
The stunning autopsy report, by Broward County Medical Examiner Joshua Perper, details how Smith’s downward spiral appears to have occurred over just three days - and ended in her finally eerily dying just like her idol, Marilyn Monroe: in her sleep from a toxic drug cocktail that included chloral hydrate.
Before hopping on a plane from the Bahamas to Florida on Feb. 5, “Anna Nicole felt fairly well . . . She had an injection into the left buttock of either human-growth hormone, vitamin B12 or immunoglobulin,” the report said.
These “repeated intramuscular injections” were “self-treatment for longevity and weight control,” the report said.
But while “upbeat” on the flight, she started to “complain . . . of buttock pain” that continued in the limo to the hotel and began “feeling cold and shivering.”
That night, her fever spiked to 105 degrees.
“Anna was told to have 911 called for transport to the hospital, but she categorically refused,” the report said. “She was given an ice bath, and her temperature dropped to 97 degrees.”
She also gulped down Tamiflu, Ciprofloxacin and chloral hydrate to sleep.
Meanwhile, diet Slimfast and soda cans, not to mention half-eaten packs of nicotine gum, piled up around her, the report said.
The next day, she “did not urinate and had a ‘pungent’ odor and temperature of 100 degrees. She was at times depressed, but she was able to watch television and appeared overall OK,” the report said.
“She was given a bath and various fluids, including Pedialyte, camomile tea and Fiji water.”
She then ingested more chloral hydrate and pestered her handlers for Soma, Klonopin and Topamax, although it’s unclear whether she received and took them, the report said.
On Feb. 7, Anna awoke and stayed in bed watching TV at around 11 a.m. She was feeling better and ate a “breakfast/lunch (omelette of egg white and spinach),” the coroner’s report said.
But things deteriorated quickly again.
“In the afternoon, she was observed naked and sitting confused in a dry bathtub. She subsequently took a bath. In the evening, she ordered two crab cakes and shrimp for dinner” before returning to the bathtub.
At around 1 p.m. the next day, the wife of her boat captain found her in bed and summoned a caretaker because “she didn’t like the way Anna Nicole look[ed],” the report said.
“She saw Anna’s face slumped downward on her chest, her mouth open and without breathing sounds.”
After frantic attempts to revive Smith, her caretakers finally called paramedics at around 1:40 p.m. and whisked her to Hollywood Memorial Hospital.
Smith, 39, was pronounced dead six minutes after she arrived, at 2:49 p.m.
Officials said Smith’s fever could be linked to the infected abscess on her left butt cheek, and that, also suffering from a stomach flu and general depression, she downed the toxic combo of drugs.
In her system were deadly levels of the sleeping medication chloral hydrate - which friends said she would swig straight from the bottle - and several Valium-like medications, the report said.
Smith’s system also showed traces of methadone, a powerful drug most commonly used by heroin addicts. The Playmate’s 20-year-old son, Daniel Smith, also had methadone in his system when he died mysteriously in the Bahamas in September.
But methadone - which Smith took “within several days of death” - played no role in her demise, Perper said.
Perper and Seminole tribal Police Chief Charlie Tiger stressed they found no signs of foul play. But Perper said Smith would still be alive today had she gone to the hospital earlier that week.
“If she would have gone to the hospital, she wouldn’t have died because she wouldn’t have had the opportunity to take the excessive amount of chloral hydrate,” 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,” his report stated.
She was originally prescribed chloral hydrate because she couldn’t sleep after Daniel’s death, officials said.
“She was having nightmares. She was having hallucinations,” said Lilly Ann Sanchez, the lawyer for Smith’s last boyfriend, Howard K. Stern.
The former Playmate of the Year, who stood 5-foot-11, died weighing 178 pounds, and was described in the report as “well-developed, well-nourished.”
The report took note of her “long and clean” fingernails - as well as her “multiple blond hair extensions,” which made her hair 19 inches at its longest when she died.
Smith regularly injected medication into her bottom, and pathologists found a “deep-seated,” puss-filled 3-by-2 1/2-by-2-centimeter abscess on her left buttock.
The medical examiners also found “needle tracks on the arms.”
But despite all her unhealthy practices, it was the sleep medication that finally did her in, Perper said. The medical sleuth ruled out homicide because there was no evidence that Smith was beaten or forced to take her sleeping pills.
“There was no oral trauma to suggest force-feeding,” according to the report. “Chloral hydrate has an unpleasant, harsh taste, which would be easily detectable if it was slipped into a drink.
“There were no other significant injuries.”
The medical examiner said he carefully looked at the possibility of suicide, and pointed out Smith’s intense depression after Daniel’s death.
But Perper ultimately ruled against suicide, citing Smith’s constant, steady use of prescription drugs.
Suicide attempts are usually carried out in a single, major ingestion of drugs to guarantee death, and Smith left a half-full bottle of chloral hydrate behind in her hotel.
“By many accounts, her mood had been improving . . . and she did not seem depressed in the days leading up to death,” the report stated.
Yesterday, Stern and his lawyers washed their hands of any responsibility and shifted blame to photographers who would follow Smith.
“She did not want the media frenzy that follows her . . . She refused to go to the hospital because she wanted to avoid media,” lawyer Sanchez said.
“Anna called the shots in Anna’s life, and everyone close to her knows that.”
**These are some of the drugs found in Anna Nicole Smith’s body: **
* Chloral hydrate: A drug typically used in hospitals for pre- and postsurgery patients struggling to sleep or in great pain
* Diphendydramine: Over-the-counter Benadryl cures itching, sneezing and other allergy-related symptoms.
* Clonazepam: Prescription Klonopin is used to treat seizures and panic- and anxiety-related disorders.
* Diazepam: Prescription Valium is used as a sedative for panic- and anxiety-related disorders.
* Nordiazepam: Metabolized Valium
* Temazepam: Prescription Restoril is a sleep aide commonly used in hospitals.
* Oxazepam: Prescription Serax is used as a sedative for panic- and anxiety-related disorders.
* Lorazepam: Prescription Ativan is used as a sedative for panic- and anxiety-related disorders.