Daniel Smith’s death was accidentally fatal

Sometimes we become so obsessed by the fact of celebrity that we forget to look beyond the immediate headlines to see the sad reality beyond. Such is the case of the family of Anna Nicole Smith. Having lived a life of some notoriety, she died in her hotel room just over a year ago with a cocktail of eleven prescription medications in her system. Yet it is the earlier death of her son, Daniel Smith, that still lives in the headlines. So much tragedy in a single family!

Some ten days ago, the Bahamian court responsible for the inquest into Daniel’s death finally ruled that he was not a victim of homicide. He had been found dead in September 2006 with a mixture of Zoloft, another antidepressant Lexapro and methadone in his system just a few days after his mother had given birth to a daughter, Dannielynn. At a time when he should have been joyful, he was taking Zoloft. Since he only twenty years old, this use of Zoloft and Lexapro raises an interesting spectre which places the inquest in a rather more provocative light.

Having made the interim decision that Daniel was not a murder victim, the jury returned to its task of deciding whether the death should be ruled misadventure, an accident, as a result of non-dependent drug use or to leave an open verdict. One significant word is missing from this list which we shall return to in a moment.

This jury has had the benefit of a wide range of evidence from his stepfather, his mother’s attorney and his own friends. The court also learned that he had been treated for valium addiction. Their final ruling was that Daniel’s death was caused by the non-dependent use of drugs. The necessary implication of this finding was that he was neither addicted to Zoloft and the other two medications, nor did he understand the risk of death by mixing that particular combination in those quantities. After a four-month hearing (which is unusually long in the Bahamas), this would seem to be the end of the matter. The reason for the excessive care devoted to this case (in local terms) was the level of international interest in the cause of death. This verdict should satisfy that curiosity even though it was delivered on April Fool’s Day. But there is still one inevitable question mark because of the presence of Zoloft and Lexapro.

The Food and Drug Administration requires all Selective Serotonin Reuptake Inhibitors (SSRIs) including Zoloft and Lexapro to carry a black box warning. There is clear statistical evidence that Zoloft and Lexapro may increase the risk of suicide in anyone under the age of 25 years. Now, there is no need to second guess the finding of the inquest jury. Daniel did not jump from a tall building or obviously set out to injure himself. Nevertheless, to someone who was apparently addicted to at least one anxiety-relieving medication, using a combination of antidepressants as a means of suicide might seem ironically appropriate.

Further, a finding of non-dependent use seems unlikely. Someone like Daniel would not be using methadone for physical pain relief. The other principal use for methadone is to manage withdrawal symptoms by people dependent on opioids. Given the unpleasantness of the withdrawal symptoms from Zoloft and the other SSRIs, its presence is easily explained. But juries are always entitled to take a forgiving view. Here is someone whose life was already broken from a family whose very existence is fragile. Perhaps this verdict is the kindest thing anyone can say about such a situation.