Claims of Drug Overdose in the Death of George Floyd

[Akton]

The autopsy report now gives us the exact amount of fentanyl and norfentanyl (apparently a metabolite of fentanyl) that they found in Floyd's system. There is a claim being made frequently now that Floyd had as much as 4 times the lethal dose of fentanyl in his system and so he would have died anyways even if he wasn't compressed:

Source: https://twitter.com/paulsperry_/status/1268579743399542785


Some of this jives with some interesting bits of information in the original criminal complaint against the cop who compressed his neck, which said that apparently he already was saying he was having trouble breathing before they began compressing his body:

While standing outside the car, Mr. Floyd began saying and repeating that he could not breathe. The defendant went to the passenger side and tried to get Mr. Floyd into the car from that side and Lane and Kueng assisted.

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Apparently before this he also was complaining about feeling "claustrophobic":

Mr. Floyd stiffened up, fell to the ground, and told the officers he was claustrophobic.

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Link to the murder complaint:

https://www.startribune.com/read-th...auvin-in-the-death-of-george-floyd/570870791/

This is all being taken by some to mean that Floyd was basically already dying when he was subdued and therefore the officers are not responsible. Leaving aside the question of whether the officers would be legally responsible for his death in the case that he was entering into a medical emergency in their custody, I'm interested in trying to answer the question of whether or not the facts support the claim that he could have died from some sort of fentanyl overdose anyways due to already being intoxicated with a lethal dose

The full examiners report is here:

https://www.hennepin.us/-/media/hen...-safety/documents/Autopsy_2020-3700_Floyd.pdf

It says that his blood concentration of fentanyl was 11 ng/mL and the concentration of the metabolite norfentanyl was 5.6 ng/mL.

Fentanyl 11 ng/mL 0.10 001 - Hospital Blood LC-MS/MS
Norfentanyl 5.6 ng/mL 0.20 001 - Hospital Blood LC-MS/MS

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I don't know enough about toxicology to know if we should think of those two numbers summed together or not.

Further down in the report there is a line that I believe is the origin of the idea that this is 4 times a lethal dose, where it says

in fatalities from fentanyl, blood concentrations are variable and have been reported as low as 3 ng/mL

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This only gives a lower bound though and 3ng/mL might be a rare outlier.

I found one study that directly bore on this question:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576505/

It basically measures the blood fentanyl concentration of people who died "accidental" deaths (from overdose) and those who died natural deaths while taking fentanyl (as a prescription or otherwise).

The majority (95 %) of the 37 accidental deaths involving fentanyl were multi-drug intoxications. The substance abuse deaths had a mean fentanyl blood concentration (26.4 ng/ml or μg/L) that was over twice that of the natural group (11.8 ng/ml).

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This number for the "natural" group is also higher than that which Floyd supposedly had, indicating that he used the drug but had not taken an overdose-sized quantity.

However, the variation seems to be extremely high here. Table 4 of this study looks at other studies that had gathered relevant data and you can see on there that some people apparently had died "naturally" with blood concentrations as high as 81 ng/mL and there appears to be an extremely high amount of overlap between the values observed in those that died of overdose and those that died naturally, indicating that it is very hard to tell the cause of death from the blood concentration.

The degree of postmortem change in the peripheral blood similarly has wide variation from pre- to postmortem [25, 30]. Theoretically, prolonged agonal states (e.g., survival for hours with a hypoxic–ischemic encephalopathy) may result in lower postmortem concentrations due to ongoing metabolism prior to death. Since the length of this survival interval may not be known, or if known to be prolonged, a relatively low postmortem concentration should not dismiss intoxication as a possible cause of death if other autopsy finding and circumstances support this conclusion.

Based purely on the blood concentration, these factors may make it difficult to determine whether fentanyl caused the death or is an incidental finding. In 2000, a study in Los Angeles of 25 deaths with transdermal patches concluded that postmortem blood concentrations following therapeutic administration can range up to 7 ng/ml (see Table 4) [15]. The concentrations of the deaths certified as natural ranged from 1.8 to 81 ng/ml while the accidental intoxications ranged from 3.5 to 139 ng/ml.

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In the end, I don't feel like I can use the data to decide one way or another if this claim (that Floyd had taken a lethal dose of fentanyl and died from fentanyl overdose) is credible. I must admit the evidence does seem somewhat compatible with the claim but also I lack a lot of the specialized knowledge to make sense of this and the evidence is also more or less consistent with the claim being false. Does anyone else have more knowledge/expertise/intelligence they can apply to this question?

 

[gp99]

Sadly the fentanyl/meth epidemic is not at the forefront of these protests and discussions on racial injustice because it is far more deadly and oppressive to all races than the law enforcement community. These drugs are absolutely destroying many communities. In my experience of 8 years as an ER/ICU Nurse I have learned the following:

1. The lethal amount of fentanyl will vary widely based on frequency of use. The lethal concentration for someone wearing a continuous release fentanyl patch or taking fentanyl for pain every day will be higher than for someone just using fentanyl intermittently. For people who have never or rarely used fentanyl, the mortality rate is high.

2. Illegally manufactured fentanyl is highly concentrated, much more so than commercially manufactured fentanyl. I dont know if this is the reason why the ranges vary so widely in those studies. The wide ranges could also indicate that the extremely high levels are the result of an attempt at suicide whereas the lower levels are from a more controlled but lethal recreational use.

3. There is certainly some type of synergistic effect from the combination of meth/fentanyl use although this is difficult to quantify. Given the time it would be interesting to research how this impacts blood concentrations.

4. Fentanyl metabolizes very quickly in the body i.e. it has a much shorter half-life than other opioids like oxycodone, morphine, and dilaudid, for example. This causes much quicker and pronounced effects and much quicker lethal side-effects (depressed respirations). It may also be the reason for the wide ranging concentrations. It comes and goes very quickly in the body.

5. Meth use causes very erratic and dangerous behavior in people, both to themselves and others. People have little inhibition and exhibit "super human" type strength. My educated guess is that the officers may have been restraining him with 3 officers because he became a danger to himself and others and was out of control. Minus the use of the knee, we have had to hold down many people with multiple staff to prevent people from harming themselves and others. Its ironic that they may have been trying to help him. I wouldnt be surprised if that turns out to be the case, but I could be wrong. With the extensive data and mortality related to fentanyl abuse, it is going to be difficult for a jury to determine whether the death was solely caused by the actions of the officers and not caused solely or partly from the drugs.

 

[occams rusty scissor]

In the end, I don't feel like I can use the data to decide one way or another if this claim (that Floyd had taken a lethal dose of fentanyl and died from fentanyl overdose) is credible.

Irrespective of the drugs, the fact that he was placed face down while handcuffed is the main issue. One of the "restraint 101" discussions in the Academy is that once someone is restrained and cuffed, they should be turned on their side at the earliest opportunity to avoid the potential for positional asphyxia.

The reason is that being face down with your hands behind your back places excessive strain on the respiratory muscles and causes them to tire whilst the chest is being compressed. Coupled with any physical stress during the arrest (i.e. running, climbing, resisting/fighting) a load of drugs or alcohol on board AND the weight of another person further compressing the chest it's a recipe for disaster.

 

[occams rusty scissor]

Meth use causes very erratic and dangerous behavior in people, both to themselves and others. People have little inhibition and exhibit "super human" type strength. My educated guess is that the officers may have been restraining him with 3 officers because he became a danger to himself and others and was out of control. Minus the use of the knee, we have had to hold down many people with multiple staff to prevent people from harming themselves and others. Its ironic that they may have been trying to help him. I wouldnt be surprised if that turns out to be the case, but I could be wrong

Edit:
...sorry, just read this after my post. Wasn't meaning to disregard your experience.
Dealing with/restraining meth addicts is not an easy task for sure. From what I understand Floyd wasn't resisting at the time of him being restrained on the ground, which is what I was replying to.

I couldn't say for sure that he wouldn't have died anyway if it was an overdose, but the restraint "technique" used was definitely not helping, and would be hard to justify vs turning him on his side.

 

[Akton]

Edit:
...sorry, just read this after my post. Wasn't meaning to disregard your experience.
Dealing with/restraining meth addicts is not an easy task for sure. From what I understand Floyd wasn't resisting at the time of him being restrained on the ground, which is what I was replying to.

I couldn't say for sure that he wouldn't have died anyway if it was an overdose, but the restraint "technique" used was definitely not helping, and would be hard to justify vs turning him on his side.

I focus on fentanyl because the amount of meth in his system was rather small

Methamphetamine, a stimulant often called “speed,” was found at a low level, Goldberger said.

Source: https://knsiradio.com/news/local-news/expert-drug-toxicity-had-no-bearing-george-floyds-cause-death

According to the cop's story he was resisting, in that he was refusing to get in the car and was "intentionally" falling on the ground, but I do not believe he was resisting in a way that indicated he was becoming violently erratic.

Irrespective of the drugs, the fact that he was placed face down while handcuffed is the main issue. One of the "restraint 101" discussions in the Academy is that once someone is restrained and cuffed, they should be turned on their side at the earliest opportunity to avoid the potential for positional asphyxia.

The reason is that being face down with your hands behind your back places excessive strain on the respiratory muscles and causes them to tire whilst the chest is being compressed. Coupled with any physical stress during the arrest (i.e. running, climbing, resisting/fighting) a load of drugs or alcohol on board AND the weight of another person further compressing the chest it's a recipe for disaster.

And yes, I agree that even if he was dying of an overdose the officer's actions were negligent in a possibly criminal way, that's why I said I wanted to put aside the legal question of whether the cop acted correctly.

 

[Mendel]

According to the cop's story he was resisting, in that he was refusing to get in the car and was "intentionally" falling on the ground, but I do not believe he was resisting in a way that indicated he was becoming violently erratic.

We have surveillance footage of the events leading up to the arrest:
Source: https://www.youtube.com/watch?v=VDd5GlrgvsE&t=2m30s

The camera is mounted outside the Dragon Wok restaurant. Cup Foods is visible on the opposite side of the street. George Floyd is initially sitting inside the car parked at the curb at the top right. After two other persons are taken from the car, at 2:30 George Floyd is removed, appears to stumble (?) and is taken to the sidewalk, where he is sat down against the building with his hands already tied.

Later, the officers take him across the street to the police car where he eventually dies (not captured in this footage).

Any resistance would have needed to occur outside Cup Foods as the police were trying to put George Floyd into their vehicle. In the minutes leading up to that, Floyd appears compliant enough.

P.S.:
The Washington Post used a longer version of this footage to construct their timeline, but the events that happened at the cruiser parked outside Cup Foods are obviously just those few pixels in the corner that don't show much of the
interactions, as there's also a Park Police cruiser parked across the sidewalk blocking the view.
https://www.washingtonpost.com/nation/2020/05/30/video-timeline-george-floyd-death/?arc404=true
Source: https://m.youtube.com/watch?v=FMGUAHBFmjk&t=30s

 

[deirdre]

Any resistance would have needed to occur outside Cup Foods as the police were trying to put George Floyd into their vehicle

that's what @Akton said. the police reported he was complaining of claustrophobia. which to me would indicate a general panic attack.

The video shared by King lines up with the criminal complaint filed against Chauvin, detailing what happened at 8:18 p.m., when the video is time-stamped.

At 8:14, "Mr. Floyd stiffened up, fell to the ground, and told the officers he was claustrophobic," the complaint said.

"The officers made several attempts to get Mr. Floyd in the backseat of squad 320 from the driver’s side. Mr. Floyd did not voluntarily get in the car and struggled with the officers by intentionally falling down, saying he was not going in the car, and refusing to stand still," it said.

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https://www.nbcnews.com/news/us-new...rs-appear-struggle-george-floyd-back-n1220856

 

[Akton]

Another piece of evidence that might point to overdose is that he supposedly was seen with foam around the edges of his mouth, which can potentially be a symptom of opioid overdose

When Lane asked Floyd if "was on anything," Lane noted that there was "foam at the edges" of Floyd's mouth.

Source: https://abcnews.go.com/US/george-fl...s-america-approaching-10000/story?id=71038665

Without the full body cam footage I don't know if it's possible to verify this claim by the arresting officers. I do not see any foam around his mouth in the video though I'm not necessarily sure what I'm supposed to be looking for or what that might look like.

My sense is that if he was having a severe enough overdose that he was foaming at the mouth he would be seizing up more dramatically and be having much more trouble talking and thinking than he apparently does in the video, as foaming at the mouth seems to be associated with seizures and/or being totally non-responsive.

This source: https://www.medicalnewstoday.com/articles/321756#causes

Says that foaming at the mouth in the context of a drug overdose occurs in the context of seizures or fluid filling the lungs, one of which does not appear on the video and the other would appear on the autopsy.

This article goes over what some of the characteristics of a fentanyl overdose are: https://www.livescience.com/58682-fentanyl-overdose-characteristics.html

Floyd fits some of them:

The researchers asked the respondents to describe what happened during a suspected fentanyl overdose. The most common characteristic, described in 20 percent of the cases, was that the person's lips immediately turned blue, followed by gurgling sounds with breathing (16 percent of the cases), stiffening of the body or seizure-like activity (13 percent), foaming at the mouth (6 percent) and confusion or strange behavior before the person became unresponsive (6 percent), according to the report.

If we accept he was "foaming at the mouth" than he fits that symptom, and the criminal complaint did mention him "stiffening up", though we don't see any seizure-like contractions of the muscles in the video while he's on the ground. There aren't really any gurgling sounds (the way he shouts is maybe sort of gurgle-y but that's a speculative leap) and no blue lips, which is the most common symptom (such a thing may be very hard to see on the video, though wouldn't a medical examiner notice it?).

More importantly though fentanyl overdose is supposedly a very sudden thing:

One of the major characteristics that the respondents described was the speed of a fentanyl overdose: Seventy-five percent of the respondents said that the symptoms occurred within seconds to minutes.


When a person overdoses on heroin, he or she may take the drug and then proceed to carry on a conversation for a few moments, one respondent said. Then suddenly, that person stops talking and "you look over and realize that they're overdosing," the respondent said.


But with fentanyl, the same respondent said that the effect is immediate: "I would say you notice it [a fentanyl overdose] as soon as they are done [injecting the fentanyl]. They don't even have time to pull the needle out [of their body] and they're on the ground."

This is what initially made me suspicious of the "4 times a lethal dose" claim. If he actually injected or otherwise imbibed such a massively lethal dose my sense is that he would under no circumstances be able to go to the store to buy cigarettes and as far as I know no fentanyl patches that would have given him a slow release over time were found on his body.

Some other sources mention pinpoint pupils as a symptom and this seems to be a symptom of opioid overdose more generally. I don't see pinpoint pupils in the video but I don't know enough about forensic examination to know whether the eyes would stay contracted like that for a medical examiner to see.

Signs of fentanyl overdose include:

• Slowed breathing
• Confusion or cloudiness
• Drowsiness or loss of consciousness
• Blue lips
• Small pupils
• Cold fingers

Source: https://www.banyantreatmentcenter.com/2019/05/09/what-to-do-when-a-fentanyl-overdose-occurs/

 

[Rend]

Unfortunately I had some experience with addiction a lifetime ago. It is really hard to say exactly what is a lethal dose. It varies from person to person in general (body weight and other factors), but tolerance is the biggest factor. A person new to drugs or one who has been away from drug abuse for a while can die easily from dosages that a hardcore currently abusing addict would laugh at. This is a great danger for relapsing addicts, because they often try to do the same amount they were doing when they quit. If I had to guess, I would suspect most overdose deaths are from relapsing addicts or new users... as people deep in addiction often don't have the money to overcome the incredible tolerance they have built up in order to overdose. However, fentanyl is a whole different animal because it is dosed in micrograms instead of milligrams which is really hard to stay safe with. Also, it should be noted speed balling (mixing upper and downer) increases overdose risk considerably.

 

[Akton]

Unfortunately I had some experience with addiction a lifetime ago. It is really hard to say exactly what is a lethal dose. It varies from person to person in general (body weight and other factors), but tolerance is the biggest factor. A person new to drugs or one who has been away from drug abuse for a while can die easily from dosages that a hardcore currently abusing addict would laugh at. This is a great danger for relapsing addicts, because they often try to do the same amount they were doing when they quit. If I had to guess, I would suspect most overdose deaths are from relapsing addicts or new users... as people deep in addiction often don't have the money to overcome the incredible tolerance they have built up in order to overdose. However, fentanyl is a whole different animal because it is dosed in micrograms instead of milligrams which is really hard to stay safe with. Also, it should be noted speed balling (mixing upper and downer) increases overdose risk considerably.

Yes, for this reason I suppose the blood concentration is not really useful in making this determination and we have to look at other contextual factors

 

[Agent K]

that's what @Akton said. the police reported he was complaining of claustrophobia. which to me would indicate a general panic attack.

Akton also pointed out that the police reported, "While standing outside the car, Mr. Floyd began saying and repeating that he could not breathe."
We'll see if this is confirmed by their body cameras.

 

[Mendel]

The full examiners report is here:

https://www.hennepin.us/-/media/hen...-safety/documents/Autopsy_2020-3700_Floyd.pdf

There is no evidence of a Fentanyl patch. There is evidence of only two needle punctures, listed under the "medical intervention" heading, that reflect Floyd's treatment by the EMT crew.

I wonder how the Fentanyl is supposed to have entered George Floyd's body.
If I thought the Minneapolis police department was corrupt, I'd wonder if it was George Floyd's blood that was sent to the toxicology lab, knowing that Fentanyl can cause breathing problems, and knowing the nature of his death.

If I interpret the Dragon Wok video correctly, the police took Floyd from the driver's seat and handcuffed him immediately. The WaPo timeline says that this happened at 8:10pm, and that Floyd was pinned down at 8:20pm.

I wonder when George Floyd is supposed to have taken the Fentanyl. If he died of an overdose, the time between the latest opportunity of him taking the drug and onset of symptoms seems too long.

 

[Akton]

There is no evidence of a Fentanyl patch. There is evidence of only two needle punctures, listed under the "medical intervention" heading, that reflect Floyd's treatment by the EMT crew.

I wonder how the Fentanyl is supposed to have entered George Floyd's body.
If I thought the Minneapolis police department was corrupt, I'd wonder if it was George Floyd's blood that was sent to the toxicology lab, knowing that Fentanyl can cause breathing problems, and knowing the nature of his death.

If I interpret the Dragon Wok video correctly, the police took Floyd from the driver's seat and handcuffed him immediately. The WaPo timeline says that this happened at 8:10pm, and that Floyd was pinned down at 8:20pm.

I wonder when George Floyd is supposed to have taken the Fentanyl. If he died of an overdose, the time between the latest opportunity of him taking the drug and onset of symptoms seems too long.

This is for me the biggest problem with the fentanyl theory. I don't see where he could have taken fentanyl recently enough to have caused an overdose death right at the moment he was 6 minutes into being pinned. I believe he was somewhat heavily intoxicated on fentanyl and this was probably the cause of much of his strange behavior during the incident that people remarked upon, as well as probably making him more vulnerable to being killed, but I as of yet don't see how a fentanyl overdose could have been the primary cause of death. There are still unanswered questions I have though, like why he might have been complaining of trouble breathing before being restrained. This could be explained by a panic attack or something like that. We will need to see the full body cam footage before getting a sense of what they really mean by that (as well as the foam around the mouth, which my intuition tells me that could have just been something like drooling).

Edit: Though apparently there is one other formulation of fentanyl that could possibly give a sort of delayed release, that is, pills that could be swallowed or sucked on.

Source: https://www.uofmhealth.org/health-library/d00233o1

The autopsy doesn't say anything was found in his mouth and doesn't mention anything like this in his stomach, though it theoretically could have dissolved. I don't know enough about the pharmacodynamics of oral fentanyl use and whether a lethal dose from an ingested pill (or blob of gel maybe?) taken an hour or so ago could have slowly built up to an overdose death at the exact moment we saw on camera, though it is initially plausible. It would be hard to distinguish empirically though from simply taking a non-lethal dose and then happening to be killed by other means while under the influence of it.

 

[occams rusty scissor]

There is no evidence of a Fentanyl patch. There is evidence of only two needle punctures

There's more than those two methods for taking fentanyl.

I wonder how the Fentanyl is supposed to have entered George Floyd's body

Prior to search/arrest, it's common for suspects holding drugs to take a huge hit all at once by swallowing the drugs they're holding. Sometimes it's an attempt to overdose to get to hospital and/or have their charges viewed in a different light when in court. Just a thought.

If I thought the Minneapolis police department was corrupt, I'd wonder if it was George Floyd's blood that was sent to the toxicology lab,

Are you aware of the blood collection procedures when it comes to evidence, and who handles this evidence prior to it being tested? You do know that it's not cops that just arbitrarily walk up to a body and draw a vial of blood, right?

I'd suggest that without this knowledge, the statement about it not being Floyd's blood is fanciful at best and just speculative conspiracy theory.

the time between the latest opportunity of him taking the drug and onset of symptoms seems too long.

According to what though? You just said you don't know by what means it was taken, so speculating about how long it would take for him to be affected by it, therefore it's unreasonable to suggest that the onset is "too long".

 

[Mendel]

without this knowledge, the statement about it not being Floyd's blood is fanciful at best and just speculative conspiracy theory.

I agree, and I hope my phrasing made that clear.

My idea of how speedy this would act is based on the third quote in Akton's post #8.

Article:

Pharmacokinetics

Absorption

The absorption pharmacokinetics of fentanyl from the oral transmucosal dosage form is a combination of an initial rapid absorption from the buccal mucosa and a more prolonged absorption of swallowed fentanyl from the GI tract. Both the blood fentanyl profile and the bioavailability of fentanyl will vary depending on the fraction of the dose that is absorbed through the oral mucosa and the fraction swallowed.

Absolute bioavailability, as determined by area under the concentration-time curve, of 15 mcg/kg in 12 adult males was 50% compared to intravenous fentanyl.

Normally, approximately 25% of the total dose of ACTIQ is rapidly absorbed from the buccal mucosa and becomes systemically available. The remaining 75% of the total dose is swallowed with the saliva and then is slowly absorbed from the GI tract. About 1/3 of this amount (25% of the total dose) escapes hepatic and intestinal first-pass elimination and becomes systemically available. Thus, the generally observed 50% bioavailability of ACTIQ is divided equally between rapid transmucosal and slower GI absorption. Therefore, a unit dose of ACTIQ, if chewed and swallowed, might result in lower peak concentrations and lower bioavailability than when consumed as directed.

Elimination

The total plasma clearance of fentanyl was 0.5 L/hr/kg (range 0.3 – 0.7 L/hr/kg). The terminal elimination half-life after ACTIQ administration is about 7 hours.

Metabolism

Fentanyl is metabolized in the liver and in the intestinal mucosa to norfentanyl by cytochrome P450 3A4 isoform. Norfentanyl was not found to be pharmacologically active in animal studies [see DRUG INTERACTIONS].

Excretion

Fentanyl is primarily (more than 90%) eliminated by biotransformation to N-dealkylated and hydroxylated inactive metabolites. Less than 7% of the dose is excreted unchanged in the urine, and only about 1% is excreted unchanged in the feces. The metabolites are mainly excreted in the urine, while fecal excretion is less important.

Source: https://www.rxlist.com/actiq-drug.htm

The toxicology reports Fentanyl 11 ng/mL and Norfentanyl 5.6 ng/mL (see post #1).

Article:

The DEA reports that pills containing fentanyl or its analogues are manufactured in Canada or Mexico and smuggled across the border, but they're also made domestically when Americans buy powdered fentanyl and pill presses (often from China) to distribute it themselves.

Source: https://www.safemedicines.org/policymakers-media/fentanyl-pills-ravaging-american-communities

If George Floyd had swallowed Fentanyl, would that be discoverable in the stomach contents? Would it make a difference if it was pills or a powder?

Where is the large amount of norfentanyl coming from?
Does it allow drawing conclusions as to when the Fentanyl entered the system?

 

[Mendel]

Youtube just threw a video my way that has a physician explain the toxicology of Fentanyl and Fentanyl/Meth cocktails ("Goofballs"). Dr Bernard ("chubbyemu") regularly publishes videos giving medical backgrounds to unusual cases, and often deaths with toxic causes. He uses toxicology knowledge and the Dragon Wok video footage of George Floyd to conclude that he did not die of a Fentanyl overdose, although he does not explicitly consider a delayed release from ingested Fentanyl.
Source: https://www.youtube.com/watch?v=xRoqSyIi-98

Article:

If you’ve seen an opioid overdose, those people are chin to chest, nodding off, and that wasn’t George as we saw it on video. The way opioids distribute in the body usually peaks fairly quickly, and we have him on camera for some time beforehand.

Speedballs in America aren’t as common as 30 years ago. More common now is the combo of fentanyl and methamphetamine. They’re called goofballs but there’s probably other names for it now. [..]

Spoiler: about toxicity ranges in studies

George Floyd was a big guy. The report says he was 6 feet, 4 inches tall, but other sources say 6 feet 6 inches. He was 223 pounds. Either way, he wasn’t obese by body mass index, and he was close to his ideal body weight, which is calculated from his height. So he likely didn’t have a lot of excess fat tissue on him.
This brings us to an idea called Lipophilicity. Lipo meaning fat and phlilc meaning affinity for. Fentanyl is lipophilic, meaning it dissolves in fat. What does that mean?
Within 5 minutes of entering the bloodstream, 80% of the fentanyl dose leaves the blood and enters the organs. After this, the fentanyl will distribute from the organs, into fat tissue, where it slowly releases back into the blood. If George Floyd wasn’t obese, then he might not have as much fat tissue holding on to the fentanyl. This could mean he’d have a higher level in his blood compared to someone who has more fat tissue.
One study that looks back at 500 fatal fentanyl overdoses in 2016 New Hampshire shows fentanyl levels in the blood had a range from 0.75 to 113 ng / mL with an average of 10. That’s a wide range.
Other studies have shown a higher average of around 18 ng / mL. Keep in mind that’s the average. I saw some people confuse mean, which is the average, with median. They’re different values. And also, you’re going to see ranges.
This is retrospective data. It’s looking back in time. You cant control for all variables, all other things equal. So it’s subject to selection bias.
You’re not wrong if you say the level is elevated and within range of some of these studies, but you’re also not looking at the video evidence— that George Floyd wasn’t nodding off on fentanyl.
Some of these studies didn’t divide up the data to account for, body weight, obesity, which would affect how fentanyl is distributed in the body.
Remember, it’s lipophilic They didn’t account for male or female(*some did account for this but a reported mean in Results section of these studies are all-comers), men have more water in their body as a percentage than women.
Elderly generally have higher bodyfat percent than the young on average.
Did the study divide the data based on kidney function, which decreases as you get older. Kidneys are important for urinating out the breakdown products of drugs.
Liver function can also get worse if you have prior disease. Patients who have opioid use disorder are at risk of hepatitis because of things like needle sharing might happen. And the liver is what breaks down fentanyl.
So without controlling for these, you may get a wide range of levels IN the study, and BETWEEN studies.
Where did they pull the sample? And when did they pull the sample? If it was a long time after the overdose, and the person had a lot of fat tissue on them, these are details that may change the measurements from one person to another.

So this brings us back to the original description.
On the 911 call, the store owners reported that George was “awfully drunk” and “not in control of himself.” He wasn’t unconscious. He wasn’t nodding off on video, he didn’t have his chin to his chest and turn cold like one would from an opioid overdose.
In medicine, you have to look at the patient after you read a lab number. 11 nanogram per milliliter is in the average reported in some these studies. It may be high, but maybe not for George Floyd.
Again, he’s not knocked unconscious in the early parts of the video record before hes on the ground. Hard to see, but it doesn't look like he's asphyxiated before he’s on the ground. He can respond to commands. He can stand up. He can talk and plead to the officer that he can’t breathe so he’s oriented and knows hes on the ground in that case.
So yes, assuming the Hennepin County report is verifiable, George Floyd did have fentanyl in his blood. It was around the average level reported in retrospective overdose data.
But observing him, he was responsive. He could follow commands. He was oriented.
Had nothing additional happened to him after 8pm on Monday May 25th, the total amount of fentanyl in his body wouldn’t have increased on its own. The levels would only go down, because the body is breaking it down. Norfentanyl's presence makes that known.
The report says the measurement was taken just after 9pm, which is more than an hour after the encounter started. Without an increase in fentanyl levels from taking another dose, which he couldn’t have after the encounter started, it’s very unlikely he would have have died from fentanyl.

And speaking of norfentanyl, there’s one more reason is why its presence is important. Fentanyl can cause something called Wooden Chest Syndrome. Sometimes it’s called chest wall rigidity. It’s important that people know about this because it’s one of the reasons why opioid epidemic is so terrible.
Opioids cause respiratory depression. But fentanyl is unique in that it doesn’t just cause respiratory depression, it also tightens the respiratory muscles. It can compromise the airway by tensing up the muscles, and it can do this at any dose. We know this, because they use fentanyl in the operating room. And sometimes fentanyl will cause someone to stop breathing. Because the muscles are so tight and tense, doctors have trouble ventilating the patient. They try to push pressure through the chest, but the muscles are so rigid, air has trouble going in and the person suffocates.

How does wooden chest happen?
Well if it’s affecting the muscles, then it might be acting on the nerves, which send signals to the muscles. In the synapse where nerves connect to the muscles, chemicals are used send signals. In this case, the chemical we’re focused on is called norepinephrine. When the signal is done, that synapse needs to clear itself so that signals aren’t sent nonstop. This means those chemicals need to be pumped back in, or broken down. It looks like fentanyl stops the synapse from getting cleared. This means that signals are sent non-stop, continuously stimulating the nerve, and not letting the respiratory muscles relax. But, do you know what else causes the release of this norepinephrine? Methamphetamine.
That’s exactly how meth works. Meaning, taking both fentanyl AND methamphetamine together, could increase the chances that someone can not only stop breathing, but they couldn’t even be ventilated even if they wanted to be, which is why “goofball” needs it’s own distinction as specifically fentanyl and meth, separate from the generic “speedball.” But it’s important because Wooden Chest didn’t happen to George Floyd. And here’s why.
When wooden chest happens, it looks like it appears so quickly after dosing, that many times, the body didn’t even have time to break down fentanyl before the person dies. Remember fentanyl leaves the blood quickly to go into the organs, then the fat and muscle. The nerves are made of around 60% fat, so easy target for fentanyl. This means if wooden chest happened to him, he might not have had norfentanyl in his blood. But he did and that means that Wooden Chest likely didn’t happen.

SO why couldn’t George Floyd breathe?
It’s not because of Wooden Chest.
The fentanyl alone in my opinion, didn’t do it either.
The fentanyl and methamphetamine combo negated some effects of each another, as they’re opposites. But they elevated the toxicity of each other.
The lab numbers are in range, but remember, look at the patient. The man was responsive, and oriented. He was not nodding off.
Putting him in a compromising position on the floor. Pressing bodyweight down on his back and neck, while he’s stressed due to a confrontational situation, which would increase his need for oxygen, were the cause of death.

Source: https://downsub.com/?url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DxRoqSyIi-98

There are reference links in the description of the video.

 

[Rend]

There is no evidence of a Fentanyl patch. There is evidence of only two needle punctures, listed under the "medical intervention" heading, that reflect Floyd's treatment by the EMT crew.

I wonder how the Fentanyl is supposed to have entered George Floyd's body.
If I thought the Minneapolis police department was corrupt, I'd wonder if it was George Floyd's blood that was sent to the toxicology lab, knowing that Fentanyl can cause breathing problems, and knowing the nature of his death.

If I interpret the Dragon Wok video correctly, the police took Floyd from the driver's seat and handcuffed him immediately. The WaPo timeline says that this happened at 8:10pm, and that Floyd was pinned down at 8:20pm.

I wonder when George Floyd is supposed to have taken the Fentanyl. If he died of an overdose, the time between the latest opportunity of him taking the drug and onset of symptoms seems too long.

There are many ways to take fentanyl including eating and snorting. I believe I have seen videos where he ditches drugs. Ten minutes is not "too long" of a time for orally taken fentanyl to kick in. Depending on dosage, orally taken opiates typically take anywhere from 10-45 minutes to start taking affect. However, if it is a massive dosage, it could be much faster. Most addicts will graduate to needles, but some stick with snorting / oral use if they have a phobia of needles. Intravenous use of these drugs take effect instantly. Snorting is faster than orally taking it, but still takes on average 5 - 10 minutes. Now if we were to speculate that George Floyd wasn't an active user or addict and just had a bag for sales that he wanted to get rid of by swallowing, the drugs effects could also be slowed by the baggy. And if he wasn't an active user, the amount found in his blood would probably kill him.

Least likely scenario here: Minneapolis Medical Examiner is corrupt.

But this is all speculation. But tl;dr is orally taken fentanyl could definitely fit in the timeline.

 

[Akton]

There are many ways to take fentanyl including eating and snorting. I believe I have seen videos where he ditches drugs. Ten minutes is not "too long" of a time for orally taken fentanyl to kick in. Depending on dosage, orally taken opiates typically take anywhere from 10-45 minutes to start taking affect. However, if it is a massive dosage, it could be much faster. Most addicts will graduate to needles, but some stick with snorting / oral use if they have a phobia of needles. Intravenous use of these drugs take effect instantly. Snorting is faster than orally taking it, but still takes on average 5 - 10 minutes. Now if we were to speculate that George Floyd wasn't an active user or addict and just had a bag for sales that he wanted to get rid of by swallowing, the drugs effects could also be slowed by the baggy. And if he wasn't an active user, the amount found in his blood would probably kill him.

Least likely scenario here: Minneapolis Medical Examiner is corrupt.

But this is all speculation. But tl;dr is orally taken fentanyl could definitely fit in the timeline.

If he swallowed it at some point around when he was taken out of the car (which is when it woud have to be) wouldn’t it show up in his stomach? I have a hard time believing it would have become fully digested in 10 minutes, especially if it was in a bag. Maybe it would be hard to detect in the stomach but I can’t comment on that question authoritatively.

In any case, the video you are referring to of him supposedly dropping a bag of white power almost certainly (to my eye and the eye of others) shows a piece of white paint chipping off the building as he rubs against it to sit down.

edit: the other claimed instance of him dropping a bag of white powder looks like him pushing forward a piece of white trash on the ground with his foot (if you look at the whole area there are little bits of white stuff all over the ground, probably all flakes of white paint from the facade of the building which you can tell is falling apart)

 

[Mendel]

It's kinda hard to talk about video evidence without links and screenshots.
There is something white appearing on the ground as the officer takes Floyd from the car, shown in the video taken by the dashcam in the vehicle parked behind, after 1:50 in this video:
Source: https://m.youtube.com/watch?v=DNX8-PWCi6E&t=1m50s


It could be something that got "ditched", or a piece of litter. It's not clear enough to be evidence of anything. Edit: probably a driver's license, see post #23 below.
After that point, George Floyd had his hands cuffed behind his back, it's hard to see how he could have ditched anything later.

 

[Akton]

I hadn’t seen the thing falling from that second angle. Only the two alleged baggies in the security camera footage which I think can easily be explained. Something does seem to fall there that wasn’t originally on the ground. It looks like it flutters though and moves more like a piece of paper than a bag containing powder

Edit: Actually it looks more like it bounces. This is speculation but it looks like it might be a cigarette? He had just bought some. The "bounce" motion seems uncharacteristic of a bag of powder as well. It's a weird object because from some angles it's white and from some it's not visible, which to me indicates something shiny. I can't really tell what it is, but it doesn't look like a bag of powder to me in any case. It does sort of look like he dropped it though, but it's hard to tell.

 

[Mendel]

But tl;dr is orally taken fentanyl could definitely fit in the timeline.

The problem is, I don't understand how the symptoms would fit.

The medical information I quoted in post #16 rules out Wooden Chest syndrome because of the presence of a large amount of norfentanyl in the system, and I am reading that opinion to say that WCS acts too fast for that amount of norfentanyl to be metabolised before death.

And breath depression would show him being sleepy, which he wasn't on the video, and seems to not have been later since he was resisting the officers, and protesting.

So I would really like to see how the symptoms we're seeing, and the fentanyl metabolites in the toxicology report, fit with an oral overdose of fentanyl. Because the medical opinion I've quoted says they don't.

I would really like to see evidence or expert medical opinion that supports the "oral overdose" story.

 

[Akton]

The problem is, I don't understand how the symptoms would fit.

The medical information I quoted in post #16 rules out Wooden Chest syndrome because of the presence of a large amount of norfentanyl in the system, and I am reading that opinion to say that WCS acts too fast for that amount of norfentanyl to be metabolised before death.

I would really like to see evidence or expert medical opinion that supports the "oral overdose" story.

Right, the metabolites indicate that he had taken it probably a bit earlier in the day than just right then, far back enough that he was probably past the peak of his intoxication given how fast fentanyl would seem to peak.

 

[deirdre]

It's not clear enough to be evidence of anything.

it's a credit card or some such
timestamp 9:30

https://www.fox9.com/news/minneapolis-park-police-releases-body-camera-video-in-george-floyd-death


possibly driver's license.

 

[Agent K]

Speaking of fentanyl, can the police administer a sedative to someone who resists arrest?

Why did three cops hold Floyd down, anyway? The complaint against Chauvin only says he "pulled Mr. Floyd out of the passenger side of the squad car at 8:19:38 p.m. and Mr. Floyd went to the ground face down and still handcuffed. Kueng held Mr. Floyd’s back and Lane held his legs. The defendant placed his left knee in the area of Mr. Floyd’s head and neck."
Why'd they do that? And what were they waiting for, an ambulance?

 

[Mendel]

Speaking of fentanyl, can the police administer a sedative to someone who resists arrest?

No, but the EMTs can. There is a 2018 report on this:

Article:

Police officers in Minneapolis pushed emergency medical personnel to inject people in custody — including some who posed no physical threat — with the powerful sedative ketamine.

That's according to an alarming report published Thursday by the city's police oversight commission. It found that during police calls last year, paramedics administered 62 injections of the drug ketamine, up from just two in 2010. One person was injected on four separate occasions.

The report, which was leaked in draft form to the Star Tribune last month, concerns situations in which police officers interacted with the medical staff of a local public hospital, Hennepin County Medical Center, to deal with people in their custody.

Hennepin staff are authorized to use ketamine on people who are "profoundly agitated," present a risk of physical violence to themselves or others, and can't be safely restrained otherwise. But the report found that, sometimes at the behest of police, medical staff frequently used ketamine on people who did not fit this description.

Investigators looked at all police reports since 2010 mentioning the word "ketamine." By reviewing footage from police body cameras, they determined that police assisted in the injection of ketamine, usually by restraining people, 76 times since 2016. Officers didn't inject the sedative themselves, but the bodycam footage showed eight instances of police urging medical staffers to administer the drug.

Source: https://www.buzzfeednews.com/article/azeenghorayshi/ketamine-police-minneapolis-report

 

[Akton]

Speaking of fentanyl, can the police administer a sedative to someone who resists arrest?

Why did three cops hold Floyd down, anyway? The complaint against Chauvin only says he "pulled Mr. Floyd out of the passenger side of the squad car at 8:19:38 p.m. and Mr. Floyd went to the ground face down and still handcuffed. Kueng held Mr. Floyd’s back and Lane held his legs. The defendant placed his left knee in the area of Mr. Floyd’s head and neck."
Why'd they do that? And what were they waiting for, an ambulance?

The report makes it sound like they put him on the ground because they couldn’t get him fully into the car, but I don’t know why such an extreme restraint was necessary, especially given that they had reason to believe he might be having medical problems already.

The question of whether they were already waiting for an ambulance is interesting. The ambulance does seem to arrive rather quickly and I don’t really know what else they would have been standing around waiting for. On the other hand I don’t know of any sources that actually can confirm this. In any case, if they were waiting for an ambulance the restraint seems doubly inappropriate, but that’s beyond the scope of the this thread.

Edit: Nevermind, it looks like it’s pretty well established that they were waiting for an ambulance.

According to the incident report, Floyd then “physically resisted arrest.” Police say it was only after they cuffed him that they realized he was “suffering a medical distress” that prompted them to call an ambulance. Police say he died shortly upon arriving at the Hennepin County Medical Center.

source: https://www.google.com/amp/s/www.th...-down-by-minneapolis-police-officer-dies.html

Note that this quote says he “died shortly upon arriving at the Hennepin county medical center”. It’s more accurate to say he died on the scene and was pronounced dead at the medical center (and that’s what the criminal complaint says), but I’ve seen people use the fact that this language was used to justify saying the knee on the neck had nothing to do with his death because he died after the knee was taken off in the medical center.

 

[occams rusty scissor]

can the police administer a sedative to someone who resists arrest?

Not so much for resisting. "Chemical restraint" is used usually for medical assistance and only ever administered by paramedics, and at their discretion.

That's according to an alarming report published Thursday by the city's police oversight commission. It found that during police calls last year, paramedics administered 62 injections of the drug ketamine, up from just two in 2010. One person was injected on four separate occasions.

In what context? This is very cherry picked. The rest of the article (which you conveniently neglected) explains it a bit better:

Hospital leaders say the report is misleading. "Though well-intentioned, the 'Ketamine' draft report from the City of Minneapolis is a reckless use of anecdotes, partial snapshots of interactions with police, and incomplete information and statistics to draw uninformed and incorrect conclusions," Jeffrey Ho, chief medical director of Hennepin EMS, and Jon Cole, chief medical director of the Minnesota Poison Control System, wrote in a formal response to the draft report.

They also claimed that the report "will prevent the saving of lives by promoting the concept of allowing people to exhaust themselves to death."

Content from external source

Maybe utilise ALL of the facts at hand, not just the convenient ones...

Why did three cops hold Floyd down, anyway?

It does look extreme to the uninitiated. In Floyd's case I'd suggest it wasnt necessary (esp not the compression to the neck). With a resisting person, handcuffed or not, it can prove difficult for a single officer to restrain them one-on-one utilising the approved methods. Also, if one officer goes to ground with an arrest, the partner will be compelled to assist in restraining the legs if it looks to be an ongoing struggle, most academies teach this (again, using approved methods).

In any case, restraining the hips(knee/weight over the pelvis) is much more effective and safer in this instance, and never leave them for prolonged periods face down.

 

[Mendel]

Maybe utilise ALL of the facts at hand, not just the convenient ones...

I decided against including that because it contains no fact.
The quote basically confirms that the "anecdotes" and interactions did happen, and the article does not provide actual statistics that disprove the point (e.g. that the hospital used the same amount of sedation in previous years utilizing different drugs before they commenced the ketamine study -- the quote suggests that this might be the case, but there aren't any actual facts or statistics).

The point that I supported with my excerpt was that police can't sedate perps, but medical staff can. Your excerpt does not call that into question.

 

[occams rusty scissor]

The point that I supported with my excerpt was that police can't sedate perps, but medical staff can.

What facts exactly? That medical staff can sedate people in a hospital is a pretty widely known "fact", it's not a revelation.

You're being disingenuous about your intentions with "facts" that are convenient to your anti-police narrative, and then don't own up about it.

 

[deirdre]

The quote basically confirms that the "anecdotes" and interactions did happen

what? the buzzfeed article with loaded [fake news] language and spin (and yes i can give you specific examples comparing the article to the actual DRAFT report which is linked in the buzzfeed article ) doesn't confirm squat.

you could just quote from the actual draft report. which would be confirmation of instances on body cams or in police reports of EMS providing sedation and police officers not providing sedation.
(anecdotes arent anecdotes if they actually happened).


Bold added by me for ease of viewing

page 3
While reviewing video, OPCR analysts observed multiple instances of the injection of an unknown
substance by Emergency Medical Services (EMS) professionals to police detainees.

....page 11
Of incidents that could be analyzed using body camera recordings or in police reports26, MPD officers
assisted EMS while they injected individuals with ketamine in 85% of cases (n=90). At no point did OPCR
analysts observe MPD officers injecting or possessing ketamine.e. Typically, MPD assisted by holding the
individual down or assisting in restraining the individual while EMS administered the injection.
......page 11
There are lingering questions regarding how much risk MPD, thus the City, is assuming by
assisting in the injection of sedatives, regardless of whether MPD participates in decision-making

Content from external source

and the article does not provide actual statistics that disprove the point (e.g. that the hospital used the same amount of sedation in previous years utilizing different drugs before they commenced the ketamine study -- the quote suggests that this might be the case, but there aren't any actual facts or statistics).

did you edit your quote and forgot you edited it? because where do any of the quotes suggest such a thing?

 

[Mendel]

you could just quote from the actual draft report.

Yes, but I didn't anticipate you questioning the source on that. I think it was the highest-ranked google hit that wasnt paywalled?
Thank you for confirming.

 

[Agent K]

Akton also pointed out that the police reported, "While standing outside the car, Mr. Floyd began saying and repeating that he could not breathe."
We'll see if this is confirmed by their body cameras.

Confirmed.

Article:

Transcript of officer's body camera shows George Floyd told officers 'I can't breathe' before being restrained
As the officers are trying to get Floyd into their squad car, he repeatedly tells them he is claustrophobic and asks them to crack a window.
"Y‘all I'm going to die in here! I'm going to die, man!...and I just had COVID-19 man, I don’t want to go back to that,” Floyd says.
Lane tells Floyd he will roll the windows down and turn the air conditioning on.
Floyd tells the officers several times that he cannot breathe and says he wants to lay on the ground. Prior to getting Floyd to the ground, he says he cannot breathe multiple times.

Source: https://www.fox9.com/news/transcript-of-officers-body-camera-shows-george-floyd-told-officers-i-cant-breathe-before-being-restrained

 

[Old Fart]

With regards to the "I can't breath" comments Floyd made, has the possibility of an anxiety attack been considered? An anxiety attack could be easily triggered by claustrophobia and the threat of confinement.

 

[Agent K]

Article:

Medical examiner: George Floyd may have had 'fatal level' of fentanyl in his system

"[Baker] said that if Mr. Floyd had been found dead in his home (or anywhere else) and there were no other contributing factors he would conclude that it was an overdose death," the memorandum stated.
Baker's final determination listed Floyd's death as a homicide because of the actions of the officers who restrained Floyd by kneeling on his neck. The Office of the Armed Forces Medical Examiner similarly determined that Floyd's death was a homicide "caused by the police subdual and restraint in the setting of severe hypertensive atherosclerotic cardiovascular disease, and methamphetamine and fentanyl intoxication."

Source: https://www.washingtonexaminer.com/news/medical-examiner-george-floyd-may-have-had-a-fatal-level-of-fentanyl-in-his-system

 

[DavidB66]

I recently read a book written by an experienced forensic pathologist in the UK (Dr Richard Shepherd, Unnatural Causes). He mentioned that several times in his career he had dealt with cases where a black (African or Afro-Caribbean) person had died while being restrained by police or prison officers. He pointed out that many people of African ethnic origin were carriers of the sickle-cell gene, often without knowing it. While carriers, with a single copy of the gene, did not usually suffer major ill-effects, he believed that when oxygen was restricted they were more likely than non-carriers to die. He said that this was not sufficiently recognised, at least at that time (probably the 1990s), and he had made attempts to improve training in methods of restraint. The main discussion is in Chapter 20 of the book.

I see from press reports that George Floyd was a sickle-cell carrier, among other medical conditions, but this does not seem to have been identified as a major factor in his death. This medical research article from 2007 implies (in the Abstract) that it may still be an under-recognised problem:

https://pubmed.ncbi.nlm.nih.gov/16914356/

The Abstract states:

We report a case of vaso-occlusive sickle cell crisis in a young schizophrenic man with undiagnosed sickle cell trait who was restrained. Prior to being restrained he had locked himself in his apartment for two days without food or water. He was subsequently restrained, and transferred to hospital while handcuffed to the stretcher. He died suddenly during restraint. At autopsy, there was acute vaso-occlusive sickle cell crisis associated with hypernatremic dehydration. There were no injuries present. We conclude that the death was due to vaso-occlusive sickle cell crisis secondary to dehydration. It is important for the forensic pathologist to remember that death may occur suddenly during restraint from an unexpected mechanism other than excited delirium leading to cardiac arrhythmia or restraint asphyxia.

 

[Dave Green]

If Floyd had breathing difficulty and/or an anxiety attack then, regardless of the levels of fentanyl etc in his blood, the manner of his detention is all the more heinous.