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What The Toxicology Report Says About Elliott Smith's Mysterious Death.

One aspect of Elliott Smith’s story that hasn’t been examined enough is the role that prescription drugs supposedly played in his death.


During the Q&A after Gil Reyes’ documentary it was said Elliott quit at least 10 psychiatric medications, cold turkey, within a few days of his suicide….


In the 2004 Spin article, Jennifer Chiba declared to Liam Gowing:

In mid-September, the effects of going cold turkey were apparent. “I came home from seeing Lost in Translation and he was lying in the bed with his arm bleeding,” says Chiba. “He had seven old cigarette burns on his arm. It was evidence of his pain from that heroin and crack period that was just a little too real, so he’d taken a knife to it. It was on a Friday, so we went to the doctor on Monday and found out that he’d abruptly stopped taking one of his medications [Strattera]. It’s so dangerous. It throws you so off balance. You can’t just go off that. So from then on, I got a pill organizer with the days of the week, and I would administer the meds.


The problem is that these declarations do not fit with the toxicology report findings. This is what was found in his blood:


Amphetamine (Adderall): 0.30 µg/ml

Atomoxetine (Strattera): present

Mirtazapine (Remeron): < 0.10 µg/ml

Buprenorphine (Buprenex): Done

Clonazepam: < 4 ng/ml

Gabapentin < 2.0 ng/ml


All the other drugs tested (alcohol and a long list of illegal drugs) were found negative.


I am not an expert but the doctors said at the time he had normal doses of these prescription drugs, and the Strattera mentioned by Chiba in 2004 was present when he died. Strattera, like Aderall, is used to treat ADHD in adults and most sites say it can be discontinued without being tapered anyway. But still that was not the case as he had Strattera in his system at the time of his death.


Mirtazapine (Remeron) is used to treat depression and data I found on line indicate that therapeutic levels should be between 0.039 and 0.18 µg/ml, so Elliott’s level (around 0.10 µg/ml) was totally in the range.


Buprenorphine is used to treat opioid addiction, to control chronic pain (he was still suffering from his beating by the police).

Clonazepam and Gabapentin are used to treat seizures but also anxiety, panic and sleep disorders (probably what he was suffering from).


And if you look for how long amphetamines (Adderall) for example stay in your system, it is not very long! Amphetamines have a plasma life of 4-6 hours, so after 48 hours about 0,02 % of the original dose is left in the body, meaning that after 72 hours the level is completely below detectable concentrations, so he had taken his meds very recently.


Who knows, he may have tried to quit his meds at one point, but what Elliott did years and months before does not matter; what is important is that he had taken his meds at prescribed levels when he died and thus we cannot blame any withdrawal symptoms.


And the most ridiculous part of the story is that, at other occasions, people have blamed an excess of prescription drugs as the cause of his suicide! As Gil Reyes said in an interview: ‘According to friends, it was a combination of prescription drugs, illegal street drugs and alcohol over a period of years. There’s much talk about how Elliott’s doctors could have done a better job monitoring his condition.’


I have to repeat it: he had a normal dose of prescribed meds the day he died, hadn’t drunk any alcohol nor taken any street drugs,… no cold turkey, no overdose and all other stories you may have read or heard are lies.


  1. Carla on September 19, 2017 at 7:58 am

    hey I read ur post a bunch of times and as somebody who was on all that shit legal or not, and still is taking gabapentin (prescribed) right now. u r completely right with everything u say. I take the gabapentin for backspain, but when getting off of drugs on my own it helped me tremendous with the withdrawals and that is a known fact. though u will have restless legs for the first 5 days or so, some probably even longer. once u start that crap it makes u tired and hungry as fuck but it’ll pass after a week or so. adderall my choice of drugs, I took for years because my partner had a prescription (pretty much speed with a better name) so Elliott pretty much should not have had any problems being tired what so ever :). my partner one time had a psychotic episode on those, but he is known to abuse all kinds of shit and he would pop those like candy. I am talking 6-8 20mg pills within a day, sometimes more. But I remember that episode to this day, he went nuts that night and scared the living hell out of me, I thought he mightl kill me or himself. he has a long history of depression as well. but Elliott’s levels are nothing that even come close to what he took back then. and the stuff for withdrawals (called subuxone now a days) u can’t abuse, even if u tried too. after 32mg it’ll just stop building up in ur body so u can’t od on that shit. tried that as well for almost 2 years. just got clean recently and I feel like a million bucks. though I know why Elliott kept the Booze almost till the end. thats what gets me through the day, because my body still feels the toll of years and years of abuse.
    If u ever wanna chat about that whole Chiba mess write me. it gave me a lot of sleepless nights. because I dont understand how the cops NEVER investigated her.

  2. Gabriel H. on November 9, 2017 at 12:09 pm

    My apologies up front for this lengthy comment. But, what I want to impart here cannot be summed up in a pithy remark.

    Here’s another coroner’s take (off-record) on the details of the ES’s autopsy and toxicology reports and why this researcher also believes his equivocal case will probably remain in limbo. BUT – more importantly, I am also writing in support of Alyson and the effort to shed light on what happened to Elliott Smith.

    Over the years I have read comments online and in the media that bring up Elliott’s addictions as if they were a precursor to his “suicide”. It is an idea that has permeated many an article and post about the man as well. Of course, it is hard not to look at some of those YouTube videos and not think about how he might have felt about himself. But, in the medicolegal realm, ES’s addiction does not directly apply in determining the man’s manner of death. At least, that is the opinion of another coroner with whom I have discussed this case. Unless the medications in his system directly caused his death, ES’s history of previous substance abuse would not have influenced her own professional assessment of his death as evidence of a suicidal bent.

    The coroner explained her thinking this way: Elliott was a musician by trade, and in her view, substance abuse is pretty commonplace in the profession (accessibility being one factor), so there is nothing to be gained by weighing that detail into the assessment. Correlation does not predict causality. Perhaps others should consider using the same logic when contemplating this case.

    The coroner did, however, state that self-inflicted injury by sharp force is statistically associated with alcohol/drug consumption and/or psychosis at the time of injury…and it is the TIME OF INJURY that counts. Therefore, the fact that there were no illicit substances in Elliott’s system at the time of injury is significant. However, as mentioned (and described by Carla in an earlier comment), some people can/do have psychotic reactions to anti-depressants; so that small percentage is weighed into the undetermined equation. BUT – since Elliott’s levels were not exorbitant (and, if upon further investigation into his medical past no recorded history of iatrogenic adverse effects were revealed), that particular hypothesis would not sway the coroner’s opinion. (And, yes — the actual presence of the medications also contradicts the only witness’s statements in the media regarding Elliott’s use of the anti-depressants, as Alyson has observed in her past posts.)

    Another very important detail… the parameters of Elliott’s injuries. And, here I will reiterate information Alyson has stressed in the past in other posts. Though opinions were sought independently from different pathologists who focus on epidemiological and criminological research (it is their area of expertise), they share similar interpretations.

    Described on the report as being oblique (from an upper right to a lower left point/slanting toward the right shoulder), the direction of ES’s wounds lends credence to the possibility of homicide. Simply put – statistically speaking, a longitudinal/vertical axis is more prevalent in cases of homicide and a horizontal axis more common in suicides. If one examines ES’s autopsy report and accompanying illustration, the wounds are closer to the vertical. Forensic data gathered (and adapted) over years of epidemiological/criminological research provides a helpful model (through the application of multivariate analysis) for pathologists who are tasked with determining the manner of death in equivocal sharp force injury cases such as Elliott’s. And – yes – there was also injury to cartilage noted in Elliott’s report – also statistically more common in cases of homicide. Statistics matter when determining a manner of death in cases when there are few clues to the circumstances involved… and/or only one witness who happened to handle the object which caused the injuries.

    Addressing the observation regarding the fatal injuries as being “consistent with self-inflection”… keep in mind that what at once reads like confirmation of suicide based on a professional assessment of the wounds actually only means (in layman’s terms) that the decedent could readily access the area of injury – in this case the anterior aspect of the trunk – the chest area. Plain and simple – he could reach his own chest. That’s it. If he had been stabbed in the back (literally, not figuratively), there would have been no question that it was a homicide… because a knife in the posterior aspect of the trunk in forensic metrics = homicide. There are plenty of homicides that have occurred (many domestic violence situations) where the victim sustained wounds due to a surprise frontal attack. In fact, one study found that female assailants favored stabbing (over the use of a gun) as a means of committing homicide; inflicted fewer wounds than male counterparts; and – evidently – often aimed for the chest.

    Still – with all of this, the coroner also pointed out that – medicolegally speaking – beyond the only witness’s account (which may or may not be truthful), the toxicology reports also provide the only strong evidence pointing to suicide. From a forensic pathologist’s/coroner’s perspective, the presence of anti-depressants confirms a history of depression – especially, if (in fact ) the medications were prescribed by a licensed doctor. Depression (as most of us know) is statistically linked to suicide. HOWEVER – since those medications are also used to treat neurological symptoms associated with other diseases (such as the symptoms ES might have experienced during his recovery), his use of the medications would have to be examined more thoroughly. (AND, I’ll add that, in one study, less than half of the suicides in a comparative study had anti-depressants in their systems before they killed themselves.)

    One other detail that would NOT sway this particular coroner’s opinion toward suicide being the manner of death: the post-it “suicide note” found by the only witness. Since current data suggests that suicides DO NOT always leave notes/explanations behind – with an equivocal case such as Elliott’s – the possibility of a staged scene cannot be dismissed without further investigation. In the coroner’s opinion, anyone working in the forensics field should allow for this possibility. [And, by the way, the man’s lyrics would not affect a coroner’s opinion (no matter how depressing some listeners might find ES’s lyrics). Why? Because they have nothing to do with the facts surrounding ES’s death. In reality, the man’s lyrics should not even be included as criteria in the psychological “autopsy”. Who on the LA Coroner’s payroll would take the time to apply literary analysis to ES’s work? Intention and artistic expression should not be conflated.]

    Underscoring why LAPD or any law enforcement agency might not rush in to make an arrest even if they possibly had/have a hunch about an only witness being responsible for a death (and, sure, they did view the circumstances surrounding Elliott’s death with suspicion) … I was told by an integral LAPD source that – NUMBER ONE – no CRIME had/has been established. Law enforcement agencies rarely act without the backing of the medicolegal ruling of an coroner who conducts the autopsy. [Why risk losing a perpetrator to a legal snafu by bumbling protocol?]

    No crime has been established… the determination has not been resolved. Then again – even with an unresolved manner of death, the LAPD opened a case; and they have purposely sealed evidence that they will not release. I know this because all avenues to obtaining certain reports have been blocked. For example, I contacted the LA Fire Department years ago and almost (and almost is not good enough) had help to secure certain reports. That was until the LAFD officers were told that LAPD considered the case an open investigation and the reports were off limits – with or without the permission of someone with legal standing. In fact, I was told a subpoena would be necessary to interview those EMS responders who transported ES to LAC+USC on 10/21/2003. The LAPD has sealed the evidence they have in their possession. They are holding their cards pretty closely. [See The Reporters Committee For Freedom of the Press – Rules For Active Investigations: “Specified facts from investigatory or security records, without disclosure of the records themselves, must be disclosed unless disclosure would endanger the successful completion of an investigation, or related investigation, or endanger a person involved in the investigation. Cal. Gov’t Code §§ 6254(f)(1), (f)(2) and (f)(3).”] Considering California’s (and Colorado’s) standards are much more open than most states when it comes to accessing ongoing police investigations, this could be read as somewhat of a silent statement…especially with no crime having been established.

    Hypothetically speaking, even if the only witness DID stab Elliott, LAPD just did/do not have the material evidence they need to successfully clear this case. This is a “she said, he can’t say” equation.` It is true that a confession would probably be/ is the only thing that could actually clear this case.

    You have to understand some of the legal reasons behind the stalemate. It isn’t that there is no reason for suspicion, but, even with it, there would not be a way to proceed without the legal building blocks required to build enough of a case against her to clear this. There are cases where determinations are changed and arrests are made when new information comes to light. But, there are more cases that remain in limbo due to lack of significant evidence – no matter how compelling an intuitive hunch or. In the legal world, homicide has to be proven in a court of law beyond a reasonable doubt. That means dealing with a jury who may or may not expect impeccable evidence that is not circumstantial. LAPD doesn’t have the solid evidence that will unequivocally disprove Chiba’s original story (and, yes – her details are somewhat convoluted when a comparison is made to what she has said in the press). She was the only witness. The LA District Attorney would have to be convinced that a prosecutor stands a chance at a conviction beyond a reasonable doubt. They only have one chance in court.

    At this juncture, no one can even say – medicolegally – that a crime occurred…NOR THAT A SUICIDE OCCURRED.

    I also had a phone conversation with Captain David Campbell a couple of years ago (retired from the LA Coroner’s office – he very graciously called me after I had tracked him down through a very indirect source). He immediately brought up (with no prompting) that this case – the LA Coroner’s case, that is – was inconclusive and only closed pending further evidence. In other words – straight from the source – the LA Coroner’s office – there was no more evidence supporting suicide as the manner of death than of evidence of homicide in this case. No matter how it has been framed by the majority of the media (and, I ask you to consider that the only witness has been involved with many of the media offerings “detailing” ES’s death… of course, she was the ONLY witness). Captain Campbell also explained to me that he was not involved with any of the investigative process in Elliott’s case – including the psychological autopsy – but, worked instead in the capacity of media spokesperson. He was privy only to the information he was given to disseminate to the press. So anything he had to add about ES’s case (even when quoted in Liam Gowing’s 2004 SPIN article in a piece often seen as a definitive portrait of “self-destruction”) would be speculative.

    Which leads me to this — post-14th anniversary of Elliott Smith’s death:

    Anyone with any knowledge of what happened on October 21, 2003 – be it through rumor, hearsay or direct information that might offer clarity to the circumstances surrounding Elliott’s death (or Elliott’s and Jennifer’s personal or business relationship) please do not hesitate to contact the LAPD — or, Alyson Camus for that matter. Sometimes answers come from what appear to be the most innocuous and inconspicuous sources. And, sometimes the most unlikely inquisitors with seemingly impossible aspirations provide the inspiration in a stalled investigation. Cold case resolutions require a persistent voice and somebody to keep pushing for answers. The LAPD cannot be that force without new, relevant information.

    Even though the idea of someone such as Alyson involving herself in this investigation might strike many as obtrusive, there are actually more “citizen” investigators helping to resolve cold cases than one might expect.

    I have it on good authority that the LAPD doesn’t consider Alyson Camus to be a conspiracy theorist. But, LAPD also knows the odds of ever clearing or resolving a case such as this…and, sure, they’d rather move on and try to keep up with what they can more readily clear.

    That said, there is always the possibility that someone might be able to provide more information about what happened. One never knows who might be able to provide a detail that might open an avenue of investigation, either way. It is easy to lose sight of the fact that this is a real inquiry since it has been minimized by so much erroneous information, confusion and bias — not to mention legal and social pitfalls. Even Elliott’s semi-celebrity status has proven to be more of a hinderance than a help in researching his case. Those asking questions are readily classified as zealous “fans” in the media, regardless of the reasons behind the inquiries.

    If you were a friend and/or close to ES working situation – business or personal – please understand that this is sincere research. If you feel you have anything to add – anything at all that could better flesh out the narrative detailing Elliott Smith’s last 24 hours fourteen years ago — please consider contacting Alyson. Don’t be put off by the fact that she isn’t a professional investigator. She is collecting information that might confirm either manner of death that will ultimately be presented to the proper authorities. She is the public face of this effort, but she is not alone in this pursuit of information.

    Anyone who knew “Elliott” Smith when he was alive knew that he was a huge proponent of the search for truth in all matters; no matter the outcome. No one who chooses to study philosophy can escape the inevitable confusion that comes with asking impossible questions about life… and death. ES applied his existential observations and impressions to his stories. Ironically – and, sadly – his fate has influenced perceptions about the one thing that gave him exclusive freedom in which to contemplate his universe – his artistic legacy. His loss is a tragedy. But, the ensuing misperceptions are a travesty. That is why we choose to look more closely at this case. Justice is warranted in many forms.

    I also want everyone to know that the majority of the professionals contacted regarding this case have taken our efforts much more seriously than the multitude of fans who have not taken the time to examine why there is a dichotomy in thinking about this case. Considering how much erroneous information is out there in the media about ES’s death (and life), it is inevitable that distorted narratives are accepted as truth.

    All that said: I want people to know that our view of this case is based on what is known and not known about the circumstances surrounding ES’s death; not on a misperceived vendetta against Jennifer Chiba. I know Alyson. She wants to see the inconsistencies explained… looking more closely at the only witness is part of the investigative process.

    There are 2 sides to this story.

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