DANIA BEACH, Fla. - Playboy Playmate Anna Nicole Smith died of an accidental overdose of a sleeping medication and at least eight other prescription drugs, and she had recently had a bacterial infection from injecting drugs into her buttocks, authorities said Monday.
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Broward County Medical Examiner Joshua Perper said Smith died of "combined drug intoxication" with the sleeping medication chloral hydrate as the major factor. She had been taking a lengthy list of medications, including methadone for pain and valium, he said.
A bacterial infection from injecting medication in her buttocks and a viral infection contributed to her death, the autopsy report said.
Chloral hydrate is a sedative used to treat insomnia and alcohol withdrawal, relieve anxiety and ease post-surgery pain. Perper said Smith had been on several antidepressant and antianxiety drugs and had recently taken longevity medications, B12 and growth hormone. The detailed autopsy showed no evidence of disease.
"We found nothing to indicate any foul play," said Chief Charlie Tiger of the Seminole police department.
Smith, 39, was found Feb. 8 in her room at the Seminole Hard Rock Hotel and Casino in Hollywood, which is on one of the tribe's reservations.
Dr. Chip Walls, a forensic toxicologist for the Miller School of Medicine at the University of Miami, said chloral hydrate is rarely prescribed and is known to be fatal if combined with certain other drugs — including the sedative Lorazepam, which the autopsy showed she was taking.
"It's very toxic if you mix it with any other central nervous system depressant drugs," Walls said. "You could get profound sedation leading up to coma and respiratory arrest."
Tiger said authorities examined laptop computers belonging to Smith and her lawyer-turned-companion, Howard K. Stern, and found nothing unusual related to her death. Tiger also said nothing came up during an exhaustive review of tapes from hotel security cameras and from interviews with numerous witnesses.
Perper said Smith felt ill shortly after arriving in Fort Lauderdale from the Bahamas on Feb. 5 and that she eventually developed a fever of 105 degrees. Perper said Smith had a blood infection that could have been caused by a contaminated needle, but it was brought under control by antibiotics and an ice bath.
"Her temperature never went again above 100 and, except for an episode of vomiting, she felt relatively well expect for feeling very weak," he said.
The weeks after Smith's death were filled with public courtroom drama and private whispers about what might have killed her. Officials delayed releasing the autopsy results because of additional evidence, not publicly released.
Perper's initial examination had revealed no serious injuries to her body. Perper said then that prescription drugs, but no illegal drugs, were found in Smith's hotel room, though he wouldn't identify them.
Smith had arrived at the Hard Rock on Feb. 5 and planned to leave four days later aboard a new yacht that her companion Howard K. Stern was arranging to buy. She was seldom seen outside her room during her stay: She was said to be suffering from a stomach flu before she died.
Because her death was so sudden, and because her 20-year-old son Daniel died under suspicious circumstances five months earlier, there has been speculation about possible criminal activity surrounding the deaths. The Seminole Police Department investigated the case because the casino is on tribal land.
An inquest into Daniel's death is scheduled to start Tuesday in the Bahamas, where he died.
Smith grew up in Texas and went from topless dancer to Playboy Playmate of the Year, Guess jeans model and bride of 89-year-old oilman J. Howard Marshall II. She took her fight for Marshall's estimated $500 million fortune as far as the Supreme Court, and the ongoing battle could make her infant daughter, Dannielynn, very wealthy. Stern and two other men have claimed to be the baby's father.
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