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How much is too much Fentanyl?

Published by marco on

Updated by marco on

The article The Movie Follows the Script by James Howard Kunstler (ClusterFuck Nation) included the following about George Floyd’s intoxication level.

“The trouble is what’s not in the indelible picture: Mr. Floyd’s prodigious ingestion of the world’s hardest narcotic, fentanyl, at a level likely to cause death, plus methedrine, plus THC, on top of a 90-percent blockage of a coronary artery, and other cardiopathies, and Covid-19, all according to the official medical examiner.”

I’d already read this claim a few times and had heard both that the medical-examiner’s report should be dismissed as not relevant as well as considered to be very relevant. So I dug it up here: HHennepin County Medical Examiner’s Office Autopsy Report for George Floyd. The case title is “Cardiopulmonary Arrest Complicating Law Enforcement Subdual, Restraint, And Neck Compression”.

The parts that leap out to me (not a doctor) are, “Arteriosclerotic heart disease, multifocal, severe” but also “No life-threatening injuries identified”, which I take to mean that they’d identifies his injuries as internal, not external.

The report does state that Floyd was “positive for 2019-nCoV RNA by PCR” and had “Fentanyl 11 ng/mL” in his system, as well as a metabolite of Fentanyl, “Norfentanyl 5.6 ng/mL” (indicating that part of whatever he’d taken had been processed). I, of course, had to quickly look up Norfentanyl to discover that it was a metabolite (“an intermediate or end product of metabolism”, according to Wikipedia).

On top of that, there were also “Methamphetamine 19 ng/mL” as well as “11-Hydroxy Delta-9 THC 1.2 ng/mL”, which is, according to 11-Hydroxytetrahydrocannabinol, a metabolite of cannabis. “Cotinine” (metabolite of nicotine) and “Caffeine” were also present. No ethanol, though.

As far as I know (not a doctor), though, these are just trace amounts. 11ng/mL doesn’t sound like very much, to be honest. Not when you’re still allowed to drive in many countries with .5% (or .005) BAC (Blood Alcohol Content). Compared to that, .000011 (or .0011%) seems vanishingly small.

On the other hand, Fentanyl is considered to be anywhere from 50-100x stronger than morphine and morphine is much stronger than ethanol. There’s a decent chance that .0011% is a pretty high dose.

To try to figure out what a big does of Fentanyl was, I looked up “Fentanyl 11 ng/mL” and found the report Morbidity and Mortality Weekly Report on June 23rd, 2016 (CDC), which describes other Fentanyl overdose victims as follows,

“The Connecticut Medical Examiner’s Office performed postmortem toxicology screens on specimens obtained from two patients who died en
route to the hospital (patients E and I). Serum samples from the hospitalized patients analyzed at UCSF demonstrated fentanyl levels of 0.5–9.5 ng/mL
(Table 2) (therapeutic range for analgesia = 0.6–3.0 ng/mL) (4); postmortem levels in the first two patients who died were 11 ng/mL (patient E) and 13 ng/mL (patient I). Norfentanyl, a major metabolite of fentanyl, was detected in the serum of nine patients; norfentanyl was not detected in postmortem testing of patients E and I, presumably because death occurred before metabolism of fentanyl to norfentanyl.”

With this research, it seems that the levels of Fentanyl found in George Floyd’s bloodstream led to overdoses in other patients. At the very least, he seems to have taken 3.6x-18.6x (11 / .6 − 11 / 3.0) what is considered an analgesic dose. That’s not even considering that he also had half again as much of the metabolite, suggesting (to me, not a doctor) that his body had already processed part of whatever he’d taken.

Can you imagine what a does of Fentanyl that big feels like? I must have gotten something wrong in my analysis because…how was George Floyd even still walking? Either he’d built up a resistance (can you do that?) or he was absolutely not a danger to anyone, other than to maybe falling on top of them. I can’t believe he’d be a threat as he was probably barely in control of his limbs.

Although some are proposing that this heroic dose of Fentanyl was the reason he died, it seems more likely that this undermines Chauvin’s claim that Floyd was dangerous and that he had to subdue him for “public safety”.

As for whether Chauvin should have been charged and convicted of murder, Minnesota law defines third-degree murder (Wikipedia) as:

“[…] without intent to effect the death of any person, caus[ing] the death of another by perpetrating an act eminently dangerous to others and evincing a depraved mind, without regard for human life”

…which sounds pretty much like what Chauvin did.