Steve April 16, 2021
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“I can’t breathe.” Those were the last words — called out repeatedly — by George Floyd, whose death in the custody of police officers last spring was captured on video and witnessed by millions. Derek Chauvin, an officer in that video, can clearly be seen kneeling on Floyd’s neck for over nine minutes. His murder trial this month has reopened never-quite-healed wounds; it has also recycled old and misleading stereotypes about drug abuse and addiction.

His murder trial this month has reopened never-quite-healed wounds; it has also recycled old and misleading stereotypes about drug abuse and addiction.

In the year since Floyd died, many details about his life have been shared publicly that he cannot respond to. Chauvin’s defense has focused on some of these aspects, even though Floyd is not on trial. The defense, which rested its case Thursday, has spent a considerable amount of time discussing Floyd’s drug use. Defense attorney Eric Nelson has repeatedly mentioned drugs, going so far as to suggest Floyd’s death may have been due to an overdose. This scenario has been disputed by Dr. Andrew Baker, the medical examiner who examined Floyd’s body.

As an emergency physician and medical toxicologist (a specialist in how drugs, medications and overdoses affect the human body) who has further specialized in the treatment of addiction and drug use, I spend a significant amount of my time studying, witnessing and treating drug use in humans. I have unfortunately seen many more overdoses — from fentanyl in particular — than I could possibly count. However, I also frequently see misinformation about drugs and drug use, particularly fentanyl, and the people who use them.

There remain competing theories — posited by a veritable parade of medical experts — about what exactly caused Floyd’s death. But what’s very clear to me is that George Floyd did not die from an overdose.

First, while both fentanyl and methamphetamine were detected on autopsy, the levels detected were not high enough to suggest a fatal overdose. Additionally, postmortem drug levels are notoriously inaccurate and do not reliably reflect pre-death levels, making their interpretation highly subjective. Postmortem fentanyl levels in particular can be extremely inaccurate and falsely elevated.

Second, we know — we can see — that Floyd was awake, talking and desperately trying to breathe right up until he died. Fentanyl, and other opioids, cause the exact opposite effect. Opioids act on the brainstem, the part of the brain that controls breathing, to suppress breathing. Not only do opioids suppress breathing, opioids also suppress respiratory drive; they take away even the desire to breathe. We commonly prescribe opioids to help people who are dying or suffering from serious respiratory problems to stop them from feeling “air hunger.” In other words, opioids like fentanyl actually prevent people from knowing they can’t breathe and from feeling like they can’t breathe.

Opioids like fentanyl actually prevent people from knowing they can’t breathe and from feeling like they can’t breathe.

Another assertion the defense has made was that drugs like fentanyl gave Floyd superhuman strength. This theory is supposed to justify extreme physical response from police, even though video shows us that Floyd was already handcuffed, in a prone position (which, when forcefully restrained, is also known to impair breathing) and in the custody of four adult male police officers.

What the science tells us, and what health care workers see every day, is exactly the opposite. Opioids are so well known for their calming and relieving effects that the word “morphine” comes from the Greek god of sleep, Morpheus. Fentanyl is one of the most commonly used sedating agents in both surgical anesthesia and for patients on ventilators in emergency departments and intensive care units. Many of these myths about drugs have racist roots, and the defense about “superhuman” strength rhetoric in particular has a long history of racism.

Methamphetamine, too, is a well-studied drug that is also used medically. The video and bystander statements are not consistent with a person who had overdosed on methamphetamine, and the autopsy report does not suggest findings of end-organ damage (like a stroke) that typically cause death from methamphetamine overdose. The argument that methamphetamine or other drugs could have worsened an underlying heart condition has also been debunked.

The objective information that has been made available, coupled with facts depicted on video, clearly refute overdose as the cause of Floyd’s death. This is also what the medical examiner — the expert pathologist tasked with determining cause of death — has stated. We should not let breathless myths about drugs distract from actual facts. And we cannot allow the narrative that Floyd’s death was somehow deserved because he, like about half of all Americans, used recreational substances.

George Floyd told us he couldn’t breathe; we would do well to remember his words.

Dr. Ryan Marino

Dr. Ryan Marino is an emergency physician and medical toxicologist. Outside of the hospital he can be found countering misinformation about drugs and the people who use them on social media.

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