Anna Nicole Smith died as the result of an accidental overdose caused by combining a powerful sleeping drug with a number of prescription medications, officials said Monday.
A blood infection and flu symptoms were listed as contributory causes.
The verdict was revealed by Broward County Medical Examiner Joshua Perper and Seminole Police Chief Charlie Tiger Monday at a press conference in Florida, after weeks of speculation about what caused the former Playboy Playmate's death on Feb. 8.
"We are convinced that this case is an accidental overdose, with no other criminal elements present," Tiger said.
According to Perper, Smith was on at least nine prescription medications at the time of her death, including antidepressants, antianxiety medications and painkillers, as well as the sleeping medication chloral hydrate.
Though the medications found in Smith's system were within "therapeutic levels," Perper said the chloral hydrate "tipped the balance," making the combination lethal.
"It was only when we had the chloral hydrate that we were able to put the picture together and realize that the chloral hydrate, in combination with the other therapeutic levels [of medications] resulted, unfortunately, in her death," Perper said.
The results were consistent with Perper's earlier statements that he found no illegal drugs in Smith's system, nor any signs that her death was the result of foul play.
The chloral hydrate was prescribed by Smith's friend and psychiatrist, Dr. Kristine Eroshevich, a lawyer for Howard K. Stern said Monday.
Though the powerful medication is prescribed relatively rarely, Eroshevich gave Smith a prescription upon visiting her in the Bahamas shortly after the death of her 20-year-old son, Daniel, attorney Lilly Ann Sanchez said.
"[Smith] was inconsolable. She was having nightmares. She was having hallucinations. She was unable to sleep," Sanchez said.
Eroshevich was aware that conventional sleep meds such as Ambien were not effective on Smith, so went with "an older tried and true medication," Sanchez said.
"The chloral hydrate indeed was effective and as expected it gave Anna the relief that she needed in those agonizing months after Daniel's death and allowed her to sleep," she said.
That the chloral hydrate would eventually cause Smith's death was simply a tragic accident, Sanchez said.
"Anna died of an accidental overdose of her sleeping aid chloral hydrate. It's horrible. It's painful. It's tragic, but it is an accident," Sanchez said.
The attorney lashed out at the media for insinuating that sinister behavior on Stern's part could have factored into Smith's demise.
"At no time was there any indication of wrongdoing whatsoever," she said. "There is no criminal negligence in this case."
She said that the findings were no consolation to Stern.
"Howard does not feel vindicated. He doesn't feel relief. He does not feel peace. He has lost the most important person in the world to him and nothing can change that," she said.
Perper said earlier this month that he was prepared to reveal the cause of Smith's death, but that the Seminole Police Department had turned over two new pieces of evidence in the case that needed to be considered in the investigation.
That evidence was two computers belonging to Smith and Stern, Tiger said Monday, stating that neither computer turned up anything suspicious.
Perper said that information on the computers was helpful in ascertaining Smith's positive state of mind at the time of her death, indicating that her death was not a suicide.
The medical examiner said he was also able to rule out homicide in the case.
Based on information from Stern and others who were with Smith in the days leading up to her death, Perper put together a painstaking reconstruction of the events that transpired before she was discovered unresponsive in her hotel room on the afternoon of Thursday, Feb. 8.
He stated that Smith had a fever of 105 degrees when she arrived at the Seminole Hard Rock Hotel & Casino on Monday, Feb. 5, but "firmly refused" to go to the hospital, against the advice of her companions.
The fever was believed to have been the result of an infection caused by an injection of a "longevity drug" into Smith's left buttock sometime before the trip, Perper said. The needle used to administer the drug apparently punctured an existing abscess, leading to the infection.
Eroshevich, who was traveling with Smith and Stern prescribed antibiotics and Smith was placed in a tub of ice, which brought her temperature down to 97 degrees, Perper said.
She was then given chloral hydrate and slept through the night.
Aside from feeling weak and occasionally vomiting, Smith felt "relatively well" over the next couple of days, Perper said, with her temperature staying below 100 degrees.
On Wednesday, she felt well enough to eat both breakfast and dinner, before again taking chloral hydrate and sleeping through the night, he said.
The next morning, on what would be the last day of her life, Smith woke up and asked Stern to help her to the bathroom, Perper said, relating Stern's recollection of events.
Smith then went back to bed and Stern showered and departed the hotel without checking on her again, leaving her in the care of her bodyguard's wife, Perper said. He never saw her alive again.
Had Smith gone to the hospital for treatment, Perper said he believed her death could have been avoided.
"If she had gone to the hospital, then yes, I think she would have had a chance of surviving," Perper said.
After a lengthy court battle regarding where Smith's remains should be buried, she was laid to rest Mar. 2 in the Bahamas, next to her 20-year-old son, Daniel, who died there in September, three days after the birth of his sister, Dannielynn.
Because Smith died so suddenly and within months of her 20-year-old son Daniel's suspicious death in the Bahamas, there was rampant speculation about possible foul play in both deaths.
With questions surrounding Smith's death answered at last, an inquest into her son's death is due to proceed in the Bahamas on Tuesday.
Meanwhile, the wait is on for the results in the paternity case to determine who really fathered Dannielynn—Stern, as her birth certificate claims; Smith's ex-lover, Larry Birkhead, who has long contended he is the true father; or long-shot contender Prince Frederic Von Anhalt.
(For a guide to all the major players, check out our Anna Nicole cheat sheet. Also, review Anna Nicole's life in pictures.)