How Cocaine Killed Leonard Bias

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"Leonard Bias died of cocaine intoxication. This interrupted normal electrical control of his heartbeat, which resulted in sudden onset of seizures and cardiac arrest. The toxicological study we did in addition to the cocaine analysis showed no alcohol or other drugs in his body at the time of his death."

With that unequivocal statement, the Maryland medical examiner, Dr. John Smialek, last week ended some of the widespread speculation about the shocking death of the University of Maryland basketball star. Bias, 22, who had just been drafted by the Boston Celtics, had been in perfect health. He did not, as rumored, have the genetic disorder Marfan's syndrome. Nor did he suffer from any previously undetected defect in his heart or circulatory system. Bias had simply taken some cocaine--perhaps for the first time--and, as a direct result, died.

The impact of his death was apparently not lost on America's 5 million or so regular cocaine users. Even as Bias was being eulogized in services at the university chapel and applauded by 11,000 people who gathered to honor him at the Cole Field House, where he had performed so spectacularly on the court, cocaine hot lines around the country were clogged by anxious callers. Their questions were echoed across the U.S.: Could the nation's "recreational drug" of choice really be lethal, even on first use? How could a taste of cocaine kill a world-class athlete who had no known physical weaknesses?

The autopsy established that Bias had a large, strong heart and was in excellent shape. His mucous membranes were clear, indicating that he was probably not a veteran snorter of cocaine. Dr. Smialek reported that Bias had no more than "an average level of sensitivity" to the drug and avoided attributing the 6.5 mg-per-liter concentration of cocaine in the athlete's bloodstream to an "overdose." "This particular concentration might not kill another individual," the medical examiner said. "On the other hand, another individual could die at a lower level."

Medical authorities were divided in their explanations of fatal reactions to cocaine. "The most likely explanation," said Dr. Lester Grinspoon, a cocaine expert at Harvard Medical School, "is that this man was extremely sensitive to cocaine, as some people are sensitive to almost any drug. It's not clear how rare this is, but it's not common." Mitchell Rosenthal, director of New York City's Phoenix House, a drug rehabilitation group, disagreed. He thinks that cocaine may frequently cause death by cardiac arrest. "Over the past three years," he said, "the evidence has been coming out of medical examiners' offices and emergency rooms, but the message has been blunted by the sexy qualities of the drug, by the fact that so many people mix drugs and alcohol."

Some of that evidence has been provided by Cardiologist Jeffrey Isner of the New England Medical Center in Boston, who suspects that heart damage from cocaine occurs more often than most specialists believe, partly because doctors seldom ask heart patients if they have used drugs. "There are still superb cardiologists," says Isner, "who are surprised to find out that cocaine can cause a lethal cardiac event." In a paper published last October in Circulation, the journal of the American Heart Association, Isner reported on seven people, ages 20 to 37, who used cocaine shortly before suffering apparent heart attacks. Six of the subjects, including one of two who died, had no evidence of heart disease before taking cocaine.

The drug can act in a number of ways to cause death. It can interfere with the electrical system of the heart or brain, causing the heart to go into ventricular fibrillation, a purposeless twitching that quickly results in death. In addition, cocaine may bring on a cardiac event by temporarily constricting arteries.

While doctors pondered how cocaine killed Bias, Maryland authorities were investigating how he obtained the drug. At week's end they were interested in questioning Brian Tribble, an acquaintance who lives well and drives a Mercedes. Reports circulated that Tribble was seen with Bias in various places around Washington in the early morning before the athlete's death and accompanied him back to his dormitory at 5 a.m., about an hour before he was stricken. Arthur Marshall, state's attorney for Prince Georges County, vowed to develop a manslaughter case if the dealer who sold the fatal cocaine can be identified. Said he: "Just remember the Belushi case."

Bias' death turned the spotlight on the status of athletes at the University of Maryland. Bias had compiled a dismal academic record at the school, particularly in the past year, and was still 21 credits short of graduating, instead of nine, as he recently claimed. The university and Basketball Coach "Lefty" Driesell quickly found themselves the targets of charges that athletes, particularly black athletes, are routinely exploited at big-time sports schools. Wendy Whittemore, academic counselor to the basketball team, took the occasion to resign, saying that she thought education was not a top priority for Coach Driesell. Marshall claimed that the coach had urged members of the team to be careful in talking to authorities about drugs and Bias' death. Driesell denied the charge and asked his longtime attorney, Edward Bennett Williams, to represent him during grand-jury hearings this week.

Although beleaguered, Coach Driesell managed at a press conference to deliver the week's most important message about substances like cocaine. "These are not recreational drugs," he said. "They're killers."