Hi Dr Bernard here. In my opinion, the things listed
in George Floyd’s toxicology report by Hennepin County, absolutely do not absolve the officers. The reason I bring the toxicology report up
right now in 2020, is because the report will get brought up in the trial of the officers. And, after digging deeper into the report,
it confirms what the video shows- that George Floyd died at the hands of the now former
officers. This is an educational video about not just
the toxicology report, but also the things that are listed on it. On Memorial Day May 25th 2020 George Floyd bought a pack of cigarettes from
Cup Foods. East 38th and Chicago Avenue. Minneapolis. It was just before 8pm. The employees of the store went to George’s
vehicle after he made the purchase and asked him to return the cigarettes because they
believed the $20 bill he used to pay for it was counterfeit. He refused. They called the police. On the 911 call, they reported that George
was “awfully drunk” and “not in control of himself.” That’s not out of the ordinary on a Memorial
Day weekend. On arrival of the police, George was in a
vehicle with another person. The police approached and confronted them. An observer sitting behind the car, recorded
the encounter. It ended with George in handcuffs. He was placed against a wall, sitting down. He was then helped up, and brought to a police
car, where on camera, he stumbles. Police get him back up. More police arrive. As they struggle to get him into the police
car, outside observers record 4 officers huddled over George. This culminated to the knee on neck image. 8 minutes 46 seconds, as George plead to the
officer “I can’t breathe,” as his face becomes purple, and he falls unresponsive. This was in addition to a pressing down on
George’s back, and multiple pleas from the observers for the officers to let off. On arrival of the ambulance, video records
show an unresponsive George Floyd being put onto a stretcher. An hour later, George Floyd was pronounced
dead in the emergency room. An autopsy was done by Hennepin County the
next day. It’s good that the family requested a second
independent autopsy. But the second autopsy didn’t get a second
toxicology report. I’m not sure if they could do a repeat one
because original samples can degrade over time. There’s also some misunderstanding circulating
around about this report. The medical examiner said straight
up, Homicide. He died at the hands of the officer. So lets start from the top. The title reads: Cardiopulmonary arrest complicating law enforcement
subdual, restraint, and neck compression. Cardio means heart, pulmonary means lung. Arrest meaning that the system of the heart
and lungs has stopped functioning. Cardiopulmonary arrest is not a heart attack. Keep that distinction in mind. Heart attacks are called myocardial infarction
which means “heart muscle dead tissue from blockage of blood supply.” Cardiopulmonary arrest could be that the heart
actually stops beating, or it could be something like the heart shakes in place and doesn’t
actually pump blood anywhere, because something is wrong. In George Floyd's case, something was wrong. How did his Cardiopulmonary arrest happen? Well, nothing traumatic on his neck and his
back. But "trauma" here, means something of a high impact,
blunt force or something like a cut. But we have video evidence of what happened. Nothing hit him in a way that would cause
a bruise there. He wasn’t squeezed by hands as to cause
contusions. The officers laid weight on him. They didn’t slam it on him, so yeah, you’re
not going to see bruises. Once the pressure is off, you might not see
any marks. And again, it wasn’t just his neck, there
was someone also pressing down on his back. And not back of his legs. Back of his chest. They didn’t find a bruise from what happened,
they have someone who’s not alive anymore. Both reports also say George Floyd had atherosclerosis. This means that blood vessels that provide
blood to his heart were narrowed. A heart attack is when these blood vessels
that supply oxygen to the heart, get clogged and blocked. This means oxygen can’t get to the heart
muscle. Muscles need a lot of energy so they can contract. Oxygen helps help fuel that energy, and it
provides a way to clear out waste products when that energy is burned. Circulating blood clears it all out. Without oxygen and without blood flow, muscle
tissue can’t function. It will die. That’s a heart attack. The report says some of Floyd’s heart arteries
were narrowed by 75% up to 90%. The category for this is severe. But he didn’t die from a heart attack. He died from cardiopulmonary arrest. Again, 2 different things. George Floyd tested positive for coronavirus. Once on April 3rd 2020. And again post-mortem. But, it looks like he was asymptomatic. COVID can cause someone to stop breathing,
but he didn’t have signs of being sick from COVID. You can have the virus and not be sick, so
it doesnt look like that’s what caused the cardiopulmonary arrest either. So now we get to the toxicology part. The report says they got the samples for testing
about 30 minutes before time of death. And what do the results say? Theres 9 compounds that are listed. This doesn’t mean that George Floyd took
9 different drugs. Some of these are metabolites. That is, you take something, and it gets broken
down. So in reality, there’s 5 unique drugs on
this list. Lets knock out the easy stuff. Caffeine? I had a cup of coffee this morning, I have
caffeine in my blood. Cotinine is a metabolite of nicotine. The man just bought a pack of cigarettes. Cigarettes have nicotine. THC is from pot, along with breakdown products. So then, fentanyl. What is fentanyl? It’s a synthetic opioid. If you’ve heard about the American opioid
epidemic, fentanyl is a big contributor. An opioid interacts with the same structures
in the body as morphine, which is from opium. Fentanyl is 50-100 times more potent than
morphine, meaning you only need 1/100th of the same dose, to get the same effect. I know the autopsy says 80-200 times. The reality is, measuring opioid equivalence
is hard, and depending on what endpoint you’re going to base it off, the number is different. And what effect do you get from an opioid? They’re pain relievers, but at higher doses
they cause the rush euphoria. Just to give you a sense or proportion, heroin
is 2 times more potent than morphine, because these groups let it cross into the brain easier. So fentanyl can be 50 times more potent than
heroin. All of this means you take a smaller dose,
for the same effect. The more potent a medicine, the higher chance
it is to accidentally overdose. This is why bad things happen when heroin
is cut with fentanyl, because if the user doesn’t know it’s been mixed, that’s
an accidental overdose. Going down the list, norfentanyl is not an
additional drug. It’s a metabolite of fentanyl, so it’s
a breakdown product. It’s not active. Same with 4-ANPP. Your body breaks drugs down so it can get
rid of them. Drugs don’t stay in the body forever. And the presence of norfentanyl is really
important. We’ll get to this later. And then methamphetamine. Anyone who’s older than 25 right now, may
have heard of term speedball. This usually means cocaine and heroin together,
but it can be any stimulant, also known as an upper, combined with a sedative, called
a downer. Cocaine is usually the upper. It’s a stimulant. Heroin is usually the downer. Famous people who accidentally died from overdose
in the 70s through the 90s, often died from speedballs. And how does that work? Well, this brings us to what an opioid overdose
does. Being a sedative, or downer, means that opioids
cause respiratory depression. It means in large doses, it affects the parts
of the brain that control breathing rate. Large enough dose, means you stop breathing
altogether. You stop breathing and heart stops beating,
then it’s cardiopulmonary arrest. Do you see how this will get brought up in
the court case against the former officers? Did George Floyd take enough of a dose to stop breathing? I dont think so, because we see him responsive
on camera. If you’ve seen an opioid overdose, those
people are chin to chest, nodding off, and that wasn’t George as we saw it on video. The way opioids distribute in the body usually
peaks fairly quickly, and we have him on camera for some time beforehand. Speedballs in America aren’t as common as
30 years ago. More common now is the combo of fentanyl and
methamphetamine. They’re called goofballs but there’s probably
other names for it now. Goof is because meth causes more cognitive
changes than cocaine, despite them both being stimulants. So why is this more popular now? Well, heroin is made from morphine. To get morphine, you have to grow plants. You don’t need to do any of that with fentanyl. It’s lab made. That lab is quicker and you don’t have to
take time to grow anything. Cheaper, quicker to make, and 50 times more
potent. The numbers show that fentanyl is more common
now than 10 years ago, whether users like it or not. And meth really never went away. We all heard about it in the mid 2000’s
about it being cooked up in some farmhouse in the midwest. These underground cooks would use the cold
medicine Sudafed, which has pseudoephedrine, to help make it. But once states started monitoring all pseudoephedrine
sold at pharmacies, it kinda phased out production in the midwest. Now it gets shipped in. So what does this have to do with George Floyd? One of the points that’s been coming out
about his autopsy is the 11 nanogram per milliliter level in his blood. Nanogram per milliliter is a concentration
unit, so for any volume of blood that’s pulled, find the mass of fentanyl in it. There’s people saying this level is potentially
lethal. And they’re right, but remember opioid overdose
causes one to stop breathing. For the other drugs, nothing appears to be
extraordinarily high. How did George Floyd’s Cardiopulmonary arrest
happen? It’s because he couldn’t breathe. So some might try to frame it that the fentanyl
alone caused him to stop breathing, independent of having a knee and someone’s bodyweight
pushing down on his neck and back. But no, that’s not right. Again, the fentanyl ALONE didn’t cause him
to stop breathing. And here’s why. George Floyd was a big guy. The report says he was 6 feet, 4 inches tall,
but other sources say 6 feet 6 inches. He was 223 pounds. Either way, he wasn’t obese by body mass
index, and he was close to his ideal body weight, which is calculated from his height. So he likely didn’t have a lot of excess
fat tissue on him. This brings us to an idea called Lipophilicity. Lipo meaning fat and phlilc meaning affinity
for. Fentanyl is lipophilic, meaning it dissolves
in fat. What does that mean? Within 5 minutes of entering the bloodstream,
80% of the fentanyl dose leaves the blood and enters the organs. After this, the fentanyl will distribute from
the organs, into fat tissue, where it slowly releases back into the blood. If George Floyd wasn’t obese, then he might
not have as much fat tissue holding on to the fentanyl. This could mean he’d have a higher level
in his blood compared to someone who has more fat tissue. One study that looks back at 500 fatal fentanyl
overdoses in 2016 New Hampshire shows fentanyl levels in the blood had a range from 0.75
to 113 ng / mL with an average of 10. That’s a wide range. Other studies have shown a higher average
of around 18 ng / mL. Keep in mind that’s the average. I saw some people confuse mean, which is the
average, with median. They’re different values. And also, you’re going to see ranges. This is retrospective data. It’s looking back in time. You cant control for all variables, all other
things equal. So it’s subject to selection bias. You’re not wrong if you say the level is
elevated and within range of some of these studies, but you’re also not looking at
the video evidence— that George Floyd wasn’t nodding off on fentanyl. Someof these studies didn’t divide up the
data to account for, body weight, obesity which would affect how fentanyl is distributed
in the body. Remember, it’s lipophilic They didn’t
account for male or female(*some did account for this but a reported mean in Results section of these studies are all-comers), men have more water in their body as a percentage than women. Elderly generally have higher bodyfat percent
than the young on average. Did the study divide the data based on kidney
function, which decreases as you get older. Kidneys are important for urinating out the
breakdown products of drugs. Liver function can also get worse if you have
prior disease. Patients who have opioid use disorder are
at risk of hepatitis because of things like needle sharing might happen. And the liver is what breaks down fentanyl. So without controlling for these, you may
get a wide range of levels IN the study, and BETWEEN studies. Where did they pull the sample? And when did they pull the sample? If it was a long time after the overdose,
and the person had a lot of fat tissue on them, these are details that may change the
measurements from one person to another. So this brings us back to the original description. On the 911 call, the store owners reported
that George was “awfully drunk” and “not in control of himself.” He wasn’t unconscious. He wasn’t nodding off on video, he didn’t
have his chin to his chest and turn cold like one would from an opioid overdose. In medicine, you have to look at the patient
after you read a lab number. 11 nanogram per milliliter is in the average
reported in some these studies. It may be high, but maybe not for George Floyd. Again, he’s not knocked unconscious in the
early parts of the video record before hes on the ground. Hard to see, but it doesn't look like he's asphyxiated before
he’s on the ground. He can respond to commands. He can stand up. He can talk and plead to the officer that
he can’t breathe so he’s oriented and knows hes on the ground in that case. So yes, assuming the Hennepin County report
is verifiable, George Floyd did have fentanyl in his blood. It was around the average level reported in
retrospective overdose data. But observing him, he was responsive. He could follow commands. He was oriented. Had nothing additional happened to him after
8pm on Monday May 25th, the total amount of fentanyl in his body wouldn’t have increased
on its own. The levels would only go down, because the
body is breaking it down. Norfentanyl's presence makes that known. The report says the measurement was taken
just after 9pm, which is more than an hour after the encounter started. Without an increase in fentanyl levels from
taking another dose, which he couldn’t have after the encounter started, it’s very unlikely
he would have have died from fentanyl. And speaking of norfentanyl, there’s one
more reason is why its presence is important. Fentanyl can cause something called Wooden
Chest Syndrome. Sometimes it’s called chest wall rigidity. It’s important that people know about this
because it’s one of the reasons why opioid epidemic is so terrible. Opioids cause respiratory depression. But fentanyl is unique in that it doesn’t
just cause respiratory depression, it also tightens the respiratory muscles. It can compromise the airway by tensing up
the muscles, and it can do this at any dose. We know this, because they use fentanyl in
the operating room. And sometimes fentanyl will cause someone
to stop breathing. Because the muscles are so tight and tense,
doctors have trouble ventilating the patient. They try to push pressure through the chest,
but the muscles are so rigid, air has trouble going in and the person suffocates. How does wooden chest happen? Well if it’s affecting the muscles, then
it might be acting on the nerves, which send signals to the muscles. In the synapse where nerves connect to the
muscles, chemicals are used send signals. In this case, the chemical we’re focused
on is called norepinephrine. When the signal is done, that synapse needs
to clear itself so that signals aren’t sent nonstop. This means those chemicals need to be pumped
back in, or broken down. It looks like fentanyl stops the synapse from
getting cleared. This means that signals are sent non-stop,
continuously stimulating the nerve, and not letting the respiratory muscles relax. But, do you know what else causes the release
of this norepinephrine? Methamphetamine. That’s exactly how meth works. Meaning, taking both fentanyl AND methamphetamine
together, could increase the chances that someone can not only stop breathing, but they
couldn’t even be ventilated even if they wanted to be, which is why “goofball”
needs it’s own distinction as specifically fentanyl and meth, separate from the generic
“speedball.” But it’s important because Wooden Chest
didn’t happen to George Floyd. And here’s why. When wooden chest happens, it looks like it
appears so quickly after dosing, that many times, the body didn’t even have time to
break down fentanyl before the person dies. Remember fentanyl leaves the blood quickly
to go into the organs, then the fat and muscle. The nerves are made of around 60% fat, so
easy target for fentanyl. This means if wooden chest happened to him,
he might not have had norfentanyl in his blood. But he did and that means that Wooden Chest
likely didn’t happen. SO why couldn’t George Floyd breathe? It’s not because of Wooden Chest. The fentanyl alone in my opinion, didn’t
do it either. The fentanyl and methamphetamine combo negated
some effects of each another, as they’re opposites. But they elevated the toxicity of each other. The lab numbers are in range, but remember,
look at the patient. The man was responsive, and oriented. He was not nodding off. Putting him in a compromising position on
the floor. Pressing bodyweight down on his back and neck,
while he’s stressed due to a confrontational situation, which would increase his need for
oxygen, were the cause of death. So again, I bring this up because I see some
misunderstanding online about the report. I had to step back and look deeper myself
because the pivot of heroin to fentanyl has happened so quickly in the United States over
the last 5 years. I put the references in the description below,
but please keep in mind if you want to read them, they sit inside a clinical and scientific
conversation that needs some background context to understand. And clinical context, like looking at the
patient after reading a lab number is not something you “look up” online, as obvious
as doing it sounds. It’s one of the first things that students
miss. All of this is going to get brought up in
the charges against the officer, so we have to make sure the record is clear. There might be more information to come out
later, I dont know. But the video from May 25th 2020, speaks for
itself. George Floyd shouldn’t have been put in
that position to begin with and for that long, regardless of whatever can be found in his
blood by lab test. None of this should have happened and I hope
we never have to see anything like this ever again. And I think we should all work together to
make sure that something like this never happens again. Take care of yourself. Thank you so much for watching. Be kind to one another. And be well.
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Bernard isn't usually the type of thing to touch Breadtube circles, but I am very happy to see him here. Very informative and enjoyable Youtuber. And one of his best videos.