Jeff Kravitz/FilmMagicWhitney Houston drowned on Feb. 11, having ingested cocaine recently enough to have it be a contributing factor in her death.
But what does that mean? Did she overdose? Hit her head? Simply fall asleep? Did years of cocaine use cause the heart disease that was also detected during autopsy?
How exactly did Houston, who was only 48, die in her bathtub at the Beverly Hilton?
Los Angeles County Assistant Chief Coroner Ed Winter, who determined cause of death to be accidental drowning combined with cocaine use and atherosclerotic heart disease, tells E! News that his team actually has not been able to pinpoint exactly how Houston died as far as sequence of events—but there are some likely possibilities.
"It means she could have passed out and drowned," Winter says. "Also, continued use of drugs resulted in heart disease, and that could have led to a heart attack."
"At this time," he adds, "I don't know how bad her heart was. That will be in the final report. We know she drowned, she had heart disease, and the cocaine was considered a contributing cause to her death." They will be reexamining Houston's heart for other indicators of deterioration in the coming days.
As for the traces of pills found in her system, chief coroner investigator Craig Harvey told reporters during a press conference that it was "clear Houston was taking Xanax, but the levels were such they were a therapeutic level...normal for someone following the rules of a prescribed medication."
"The Benadryl may have created a combined effect," Harvey said, "but the toxicology said all levels were therapeutic or sub-therapeutic and not contributory to her death."
They found a "moderate" amount of cocaine—an "acute dose, not too much before she collapsed," he said, but noted that there was evidence of "chronic usage."
"Drug use creates problems," Harvey explained. "If you have one condition and you're using cocaine, you'll exacerbate it. It causes the heart to beat faster, the arteries to constrict, which can create a problem and set you up for a cardiac event."
"It exacerbates heat disease," he said. "Probably in the long run, [all of the substances] didn't help."
The coroner's office said earlier today that the final report should be available for release within two weeks.
Meanwhile, at least one medical expert doesn't buy the notion that the marijuana, Xanax and other sedatives found in her system were not considered contributing factors in Houston's death.
"I don't know how you can say that a bunch of sedating drugs, even in small amounts, couldn't contribute to somebody either passing out or becoming sedated to the point where you wouldn't necessarily struggle to recover the way most people would," Dr. David Baron, chief of staff at Santa Monica-UCLA Medical Center and Ortopaedic Hospital, tells E! News.
"If we were falling asleep and slipped under the water, our emergency systems in our brain would wake us up," Baron said. "When people are sedated, the brain doesn't have the normal alarm systems working properly to make you struggle and fight for life. So I really don't get why [the coroner's office] said they were not contributing causes; I don't know how they can know that unless they were in such minute amounts."
Which is a possibility—the official report hasn't been released yet.
As for the cocaine, Baron said, if she ingested a "large amount...she could have easily had a cardiac event like a heart attack and an irregular heartbeat. There is no way after someone dies to know if they had an arrhythmia, they are always the mystery of sudden death where you weren't there to witness it."
"We are probably never going to know the exact sequence of events that took place," Baron concluded. "But the question about whether the drug use caused her to drown or not I think is unquestionable. It either compromised her heart, made it weak, caused an arrhythmia and resulted in blood vessels constricting."
—Additional reporting by Baker Machado