The tape was admitted as evidence in the Los Angeles drug conspiracy case against her boyfriend Stern, and two doctors who are accused of supplying drugs to the nude model until her untimely death. However, the judge won't allow the tape to be played in court.
The 2006 video shows the former Playboy model in full clown makeup, speaking with slurred speech, to Stern at a birthday celebration for Riley Shelley, a friend's daughter, at Smith's Bahamas home.
"I didn't lose my mind," Smith says, staring blankly into the camera.
Prosecutors have charged Stern and two of Smith's doctors with conspiring to keep Smith in a prescription drug stupor for the two years leading up to her death from an accidental overdose in 2007.
In the video, which was released by the LA Superior Court, 9-year-old Riley voices concern for Smith's health, and says that Smith might have "brain trouble." She also asks Stern to take Smith to the hospital at one point.
Meanwhile, Stern asks Smith, who is wearing an orange sarong, "Is this a mushroom trip?" and notes, "This footage is worth money."
The Playboy model is eight-months pregnant in the video, and in one exchange with Riley, seems to mistake symptoms of her pregnancy, saying she is just feeling "a little gas."
Smith also appears to completely forget she is pregnant, and pointing to a baby doll on the floor says, "My baby's over there sleeping."
Throughout the video 9-year-old Riley is the only one heard expressing concern for Smith, and right before the end of the tape says, "Howard help. Howard, seriously help. Cut off the tape."
Superior Court Judge Robert J. Perry said Friday he is not sure if the video of Smith with a painted clown-face showed she was under the influence of drugs.
The judge ruled at a preliminary hearing that there is sufficient evidence to try Stern, along with Dr. Sandeep Kapoor and psychiatrist Dr. Khristine Erosevich, on charges of conspiring to give Smith controlled substances and supplying drugs to an addict.
Smith died of an accidental drug overdose from at least nine medications in 2007.