Never take life seriously. Nobody gets out alive anyway.

Written, edited & compiled by Mukut K Saha

Its well past midnight.The light is dim, and the writing seems to appear a fraction of a moment after the pen has passed, a fraction of a moment too late, an illusion of the lighting, surely, but an illusion that is like a metaphor of how we only see for ourselves what we are doing once the moment is already gone, and then the writing stops altogether, and perhaps this is a metaphor also, because it is now too dark to see what has been written.

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Shocking deaths in Bollywood

Parveen Babi: This glamorous actress had quite a sad death. She died at the age of 55 on January 20, 2005 in her Juhu residency. As she lived alone, nobody got a hint of what was in store for her. Her door was locked from inside, so the police had to break open the door and that’s when they found her body three days after her death. Its still unclear if it was a natural death or a suicide case.

Divya Bharti: This cute bubbly actress and daughter of Amrish Puri died at the age of 19 on April 5, 1993. It was said that she allegedly committed suicide by jumping off the 5th floor of her building. Fans are still not sure if she was drunk and fell off the building or she was murdered. Though Divya was a part of the industry for barely four years, she managed to leave an unforgettable mark in Bollywood with movies like Deewana opposite Rishi Kapoor and Shah Rukh Khan.

Smita Patil: It was a great loss for Bollywood, the day Smita Patil passed away. She died at a young age of 31 on December 31, 1986. This outstanding dusky and beautiful actress passed away giving birth to her youngest son Pratiek Babbar, who was seen in Jaane Tu Ya Jaane Na as Genelia’s younger brother. Smita was not just an amazing actress but also a newsreader and a photographer.

Madhubala: One of the most beautiful face of Bollywood was Madhubala. This legendary actress too died at an early age of 36 on February 23, 1969. Her performances in films like Mughal-E-Azam, Howra Bridge and Kaala Paani to name a few are remembered till date. The sad part was that she was surrounded by a number of people when she was a big name, but during her last days when she was bedridden, she had no one besides her and she died a lonely death.

Meena Kumari: The renowned tradegy queen of Bollywood passed away on March 31, 1972. She was just 40 years old when she died of cirrhosis of liver caused by excessive drinking. The saddest part was when she died, her superhit film Pakeezah was still running in all the theatres. She didn’t even get a chance to see how much people loved her and appreciated her performance in the film.

Kunal Singh: Actor Kunal Singh, whose claim to fame in Bollywood was the film Dil Hi Dil Mein opposite Sonali Bendre died at a young age. He was also seen in a few regional films. Kunal committed suicide in his Oshiwara residence on February 7, 2008. He hung himself to death. Did he commit suicide as he left no note behind ? He wasn’t really a known celebrity. So, maybe he was frustrated in life for not getting film offers and fame can get to them at times.

Priya Rajvansh: Priya was murdered in the year 2000 in the Ruia Park bungalow in Juhu. When she died newspapers first carried out stories saying ‘Priya committed suicide’ then the police said ‘Priya Rajvansh died of a heart attack’ but later the media was told that Priya died due to excessive consumption of alcohol, as she had been in a state of deep depression after Chetan (her husband’s) death a couple of years ago. But the actual truth came out after a long time. It was finally proved that the actress was actually murdered by Chetan’s three sons for property

Nafisa Joseph: Successful model and actress Nafisa Joseph passed away when her career had just started shaping up. She died at the age of 26 on July 29, 2004. She was also a VJ on MTV and was crowned Miss India in 1997. Nafisa, who was everyone’s darling knocked everyone for a six by hanging herself to death. It’s said that her fiancee had the previous day, called off the wedding following differences of opinion over his earlier marriage and divorce. The only question that can come to one’s mind now is – Why is a woman’s universe still a man ?

Guru Dutt: The legendary actor and director Guru Dutt, who created his identity with the film Pyasa opposite Waheeda Rehman and Mala Sinha passed away at the age of 42 in 1964. He died due to overdose of sleeping pills. He had tried to commit suicide twice before but somehow survived after he was rushed to the hospital. But unfortunately the third time it was his bad luck.

Nargis: Nargis, one of the greatest Indian actresses of all time died on May 3, 1981. She was 40 plus when she lost her battle against pancreatic cancer and just a few weeks later her son Sanjay Dutt’s debut film Rocky was released. Her death was truly shocking for the industry, but even today people remember her outstanding performance in Mother India.

Final exit

Notes of Methodology: Most drugs, taken in large quantity, will induce vomiting. To prevent this, take one or two anti-histamine tablets (travel sickness, allergy, hay fever tablets, etc.) an hour before on a fairly empty stomach.

If your poison of choice is in tablet form, swallow the first 20% as normal. (A larger quantity may induce vomiting or impede absorption.) Take the remainder with food or a strong alcohol, crushed or dissolved as appropriate; this will help the entire dose to hit your system at the same time. Alcohol helps dissolve the drugs, but don’t drink any beforehand! Instead, wash the tablets down with vodka or a similar spirit, and then drink yourself silly while you’re still conscious.

To increase your odds of death, secure a large, airtight plastic bag over your head. Also consider securing a rubber band around your neck. This can bring your odds from “good” to “almost certain,” in case the drugs don’t work as expected.

Friday night is a good time to die, if you live alone–nobody will miss you until Monday morning. Bolt all the doors and windows, and tell your neighbors or friends that you’ll be away. If you’ve got a loyal dog, set it free–you just don’t want to be featured on the nightly news as the chump whose dog dialed 9-1-1 and saved his life.

Be aware that people who regularly use painkillers can develop a tolerance. Increase the dosage accordingly.

Alcohol

Dosage: Variable
Time To Die: About 8 hours
Availability: Wonderfully easy to get
Certain Death?: Unreliable
The Savvy Suicide: Drink it all at the same time, as quickly as possible. Will cause liver and kidney damage if ‘rescued’ before death. Dosage is questionable.
Science Facts: Ingesting spirits as an enema is supposed to be a very quick way of absorbing alcohol; even better, inject it. Dosage varies according to method of ingestion, the individual’s tolerance, and the health of the individual’s liver.
So They Say: “The fatal dose of pure alcohol in an average adult is 300-400 mL (750-1000 mL of 40% alcohol) if consumed in less than one hour. Apart from the effects of overdosage, death after alcohol consumption can occur as a result of choking on vomit while unconscious…Consequences such as liver damage occur after chronic consumption.”

Amobarbital
(amytal, amal, eunoctal, etamyl, stadadorm)
Dosage: 4.5 grams, typically ninety 50mg tablets
Time To Die: Unconsciousness in 5-15 minutes; death in 20-50 minutes
Availability: Prescription only
Certain Death?: Very reliable
The Savvy Suicide: More effective when used with an airtight bag over one’s head and a rubber band around one’s neck. Alcohol accelerates the process and increases reliability.

Aspirin
Dosage: 20-30+ grams
Time To Die: Variable: hours to days
Availability: Easy to get
Certain Death?: Unreliable
The Savvy Suicide: Not recommended. Fatal dose varies wildly, could cause liver & kidney damage instead of death. Too many cause vomiting. Overdose causes strange noises in your ears and projectile vomiting after about 10 hours. Medical help generally effective, so stay out of hospital for a couple of days. May cause bleeding in your stomach and/or upper intestines. To speed up absorption, take with sodium bicarbonate (bicarbonate of soda).

Bleach
(also lye, drain cleaning fluids)
Dosage: One half to one liter
Time To Die: Variable: hours to days
Availability: Easy to get
Certain Death?: Uncertain
The Savvy Suicide: This method depends on your stomach corroding, thereby releasing stomach acids to destroy vital organs. A painful way to go.
So They Say: “I have heard of people throwing themselves through plate glass windows in their death agonies after drinking lye.”

Butabarbital
(secbutobarbitone, butisol, ethnor)
Dosage: 3 grams, typically one hundred 30mg tablets
Time To Die: Unconsciousness in 5-15 minutes; death in 20-50 minutes
Availability: Prescription only
Certain Death?: Very reliable
The Savvy Suicide: More effective when used with an airtight bag over one’s head and a rubber band around one’s neck. Alcohol accelerates the process and increases reliability.

Caffeine
Dosage: 20 grams
Time To Die: Unknown
Availability: Easy to get
Certain Death?: Without much data or secondhand accounts, the lethality of caffeine remains uncertain.
Science Facts: An average cup of coffee contains roughly 200 mg, as does one caffeine pill such as Vivarin.

Carbon Monoxide
Dosage: 5% concentration
Time To Die: Minutes to hours
Availability: Easy to get: car exhaust, for one
Certain Death?: Fairly certain
The Savvy Suicide: Causes brain damage to survivors. Skin becomes fire engine red, making the coroner’s job easy.
Science Facts: The actual cause of death is asphyxiation, since the carbon monoxide binds tighter to hemoglobin than oxygen does (the oxygen gets crowded out, so to speak).
So They Say: “Urban legend tells of one couple who tried to kill themselves by filling their apartment with carbon monoxide. Unfortunately, the heavier-than-air carbon monoxide leaked through the floor and killed the people in the apartment below.”

Chloral Hydrate
(noctec, chloratex, somnox)
Dosage: More than 10 grams, typically more than twenty 500mg tablets
Time To Die: Info not available
Availability: Prescription only
Certain Death?: Not effective by itself
The Savvy Suicide: Mix with alcohol and restrict breathing with a bag and rubber band.

Chlorine gas
Dosage: Unknown
Time To Die: Unknown
Availability: Tricky
Certain Death?: Good
The Savvy Suicide: Used in World War One, known to be a very unpleasant death.

Chloroform
Dosage: Unknown (a soaked rag?)
Time To Die: Several minutes
Availability: Fairly easy to get
Certain Death?: Unknown
The Savvy Suicide: Victim will become unconscious first, so steps must be taken to ensure a continued ingestion. Perhaps taping the soaked rag over one’s mouth?

Cocaine
Dosage: 1 ounce (?)
Time To Die: 2 to 3 hours (?)
Availability: Possibly difficult; very expensive
Certain Death?: Unknown
The Savvy Suicide: Cocaine overdose induces a heart attack. Along the way, expect severe paranoia and breathing problems. It is not uncommon for drug mules to swallow bags or condoms of cocaine, only to have them accidentally burst in transit, killing them quite handily.

Codeine
Dosage: 2.4 grams, typically eight 30mg tablets
Time To Die: Unconsciousness in 5-15 minutes; death in 20-50 minutes
Availability: Prescription only
Certain Death?: Very reliable
The Savvy Suicide: More effective when used with an airtight bag over one’s head and a rubber band around one’s neck. Alcohol accelerates the process and increases reliability. Be warned than tolerance develops with “normal” use.

Cyanide
(HCN, KCN)
Dosage: 50 mg Hydrogen Cyanide gas, 200-300 mg Cyanide salts
Time To Die: Seconds for gas; minutes for the salts on an empty stomach; possibly hours on a full stomach
Availability: Very difficult to secure
Certain Death?: Very certain
The Savvy Suicide: Instead of ingesting cyanide salt orally, drop 500mg into a strong acid. The fumes will be pure Hydrogen Cyanide, capable of killing within seconds.
Science Facts: Hydrocyanic acid is one of the most poisonous substances known; the inhalation of its fumes in high concentration will cause almost immediate death. Hydrogen cyanide acts by preventing the normal process of tissue oxidation and paralyzing the respiratory center in the brain. Most of the accidental cases are due to inhaling the fumes during a fumigating process. In the pure state it kills with great rapidity. Crystalline cyanides, such as potassium or sodium cyanide are equally poisonous, since they interact with the hydrochloric acid in the stomach to liberate hydrocyanic acid. This poison has been used for both homicide and suicide; in recent history, a number of European political figures carried vials of cyanide salt for emergency self-destruction and some used them. Death resulted from amounts of only a fraction of a gram. A concentration of 1 part in 500 of hydrogen cyanide gas is fatal. Allowable working concentration in most of the United States is 20 ppm. Two and one-half grains of liquid acid has killed. The acid acts fatally in about 15 minutes. The cyanide salts kill in several hours. The average dose of solution is 0.1 cc.
The Savvy Suicide: Stomach acids will react with Cyanide salts to form Hydrogen Cyanide, so an empty stomach is a great advantage.

Diazepam
(valium, apozepam, aliseum, ducene)
Dosage: 500 milligrams, typically one hundred 5mg tablets
Time To Die: Info not available
Availability: Prescription only
Certain Death?: Unreliable
The Savvy Suicide: Not effective by itself. Mix with alcohol and restrict breathing with a bag and rubber band.

Flurazepam
(dalmane, dalmadorm, niotal)
Dosage: 3 grams, typically one hundred 30mg tablets
Time To Die: Info not available
Availability: Prescription only
Certain Death?: Not effective by itself
The Savvy Suicide: Mix with alcohol and restrict breathing with a bag and rubber band.

Gasoline
(inhaled/injected)
Dosage: 20 ml (?)
Time To Die: Seconds/minutes
Availability: Very easy to get
Certain Death?: With correct dosage, a reliable method.
So They Say: “You can also use propane or butane on a skin surface. Go stick your hand in a bucket of propane and see how many seconds you last…”

Gluthethimide
(doriden, doridene, glimid)
Dosage: 24 grams, typically forty eight 500mg tablets
Time To Die: Info not available
Availability: Prescription only
Certain Death?: Not effective by itself
The Savvy Suicide: Mix it with alcohol and restrict breathing with a bag and rubber band.

Heroin
Dosage: 120 to 500 mg for non-users
Time To Die: Unknown
Availability: Difficult (and, like cocaine, expensive)
Certain Death?: Unknown
The Savvy Suicide: Combined with alcohol, a lethal dose might be reduced.

Hydrazine
Dosage: As produced by reaction (see below)
Time To Die: Unknown (2 weeks?)
Availability: Easy to get
Certain Death?: Not known
Science Facts: Commonly produced by mixing a bottle of bleach and a bottle of ammonia. A fairly common way for illiterate cleaning people to accidentally kill themselves.
So They Say: “Several years ago at my high school, one of the janitors innocently mixed together half a bottle of bleach with half a bottle of of ammonia in a small closet where the cleaning fluids were kept. He passed out due to the hydrazine gas released in the reaction between the two chemicals. This man was in agony for two weeks in an intensive care unit in a local hospital with the majority of the inside surface of his lungs damaged and untreatable before he got lucky and died.”

Hydromorphone
(dilaudid, pentagone)
Dosage: 100-200 milligrams, typically 50-100 2mg tablets
Time To Die: Unconsciousness in 5-15 minutes; death in 20-50 minutes
Availability: Prescription only
Certain Death?: Not effective by itself
The Savvy Suicide: Mix it with alcohol and restrict breathing with a bag and rubber band.

Insulin
(injected)
Dosage: Unknown
Time To Die: Hours-days
Availability: Prescription only
Certain Death?: Reasonable
The Savvy Suicide: Rumored to be quite a pleasant way to go.

Suicide methods

Gun Shot
A gun shot is thought to be the most common and effective way to commit suicide, and accounts for 53.7% of all suicides in the United States.

The most common target to shoot is through the head to the brain or the heart, at point-blank range. Sometimes an attempt is made to shoot under the chin and through the mouth.

Shooting is not a fail-safe method. When a the gun shot method is unsuccessful, there is the huge chance of permanent damage to the body or brain.

If the gun is aimed at the temporal bone (the lower side of the skull), there is a 50% chance of suffering facial nerve damage if the shot is survived.

Choosing to commit suicide by a gun shot could fail for the following reasons:

Poor aim (the heart and brain are more difficult to hit than many people think, as the bullet can pass through the temples without actually hitting the brain, and the heart is protected by the ribcage)
Flinching can also cause one to miss the vital body parts needed to end ones life
Poor ammunition such as badly manufactured or old bullets can contribute to surviving the gunshot and instead lead to nasty wounding
Drug Overdose
Another very common method of suicide attempts is by consuming large amounts of drugs and alcohol. This is usually attempted by mixing different types of medication together, and ingesting them along with alcohol or illegal drugs to create a deadly combination.

Despite being a common method of attempted suicide, the method itself is not reliable. Naturally, it depends on the type of drugs one chooses, but the overall success rate of taking a fatal overdose is estimated at less than 2%. Success from drug induced suicide is 40 to 1 against. Usually, attempts at taking a fatal overdose use over-the-counter or prescribed medications, and it is the more common method chosen when suicide is assisted (euthanasia). In the UK, data from the Office for National Statistics for 2001showed that of 1,243 drug related suicides, 28.5% were due to paracetamol and its compounds, and 24.5% were by anti-depressants, making these the top two methods. In the US the story is the same.

A common drug used for attempted suicides is sleeping tablets. Decades ago barbiturates were prescribed for sleep, it was possible to overdose on them. Although barbiturates can be highly lethal, they are now rarely prescribed, and extremely difficult to obtain. Barbiturates act as central nervous system depressants with effects from mild sedation to total anesthesia. Seconal (Secobarbital) and Nembutal (Pentobarbital) are the two most effective barbiturates for a swift, painless and swift death. Nembutal is currently the drug of choice for human euthanasia.Barbiturates have now largely been replaced by benzodiazepines treating anxiety and insomnia as they less dangerous in overdose.

Hanging
This method of suicide is thought to be 75% effective, and is the main method of choice in places like prison where there are few other options available.

There are two main methods of hanging:

Short Drop Suspension. Simply the act of using ones body weight to place pressure around the neck, blocking blood flow to the brain and air supply through the windpipe, eventually causing death
Drop Hanging. This is the method of hanging made most popular by historical methods for the capital punishment of convicted criminals. Because this method involves dropping from a height, the force can increase the chances of a fatal neck or spinal break, making the method slightly more effective and potentially faster. However, although considered faster and more effective, the pain is more intense, and it can also cause more severe complications for those who survive
Poisoning
Another common suicide method, poisoning involves consuming a substance not designed for human ingestion. Popular choices are cleaning products, cyanide and industrial fluids. Other harmful substances not made for consumption also classes as poisoning.

Some poisons such as hydrogen cyanide act faster than other methods, although consumption of toxic plants like the belladonna family in high enough quantities can also prove fatal. Poisonous plants are usually a slower method and cause more pain.

One of the popular choices of a poisonous chemical, is bleach – a corrosive product that can eat through metal, remove stains, and kill the majority of bacteria.

Drinking bleach can kill a person if enough is consumed. It begins by erroding the throat, then the stomach, and finally leaks through to other internal organs. This causes unbearable stomach pain, vomiting, and is one of the most painful methods of suicide.

It has been observed that attempted suicides involving bleach have led people to throw themselves through sheets of glass in an attempt to end the pain faster.

As a general rule, successful suicide through poisoning is high, usually because if enough poison has been taken to end ones life, the effects are often irreversible, even if a last minute change of mind occurs.

On occasion, medical workers can reverse the effects of the poison, but the long-term effects are generally very nasty, and may make a persons life seem more miserable than before.

Inhaling Carbon Monoxide
The most popular way of utilizing Carbon Monoxide (CO) inhalation is for a person to enclose themselves within a space with a car. The car’s engine must be running, as this will then fill the space with the poisonous gas CO. People opting to end their life this way should choose an older car, as newer cars are designed to emit much smaller amounts of CO.

Alternatively, one could buy a tank of CO and attach a valve. Generally this takes around 15 minutes, although if there are exposed wires or light filaments in the proximity, an explosion may be caused – carbon monoxide is highly flammable.

People who have survived this method of attempted suicide have usually been left with memory loss, psychosis or blindness.

Suffocation
A pet name for a suffocation device is an exit bag. This usually is made up of a plastic bag with a drawstring, and can often be combined with a gas such as nitrogen or helium. The reason for the gas, is to painlessly cause unconsciousness so the discomfort of suffocating is avoided. The suffocation itself is caused by the high levels of carbon dioxide that are breathed back into the bag.

If a last minute change of mind occurs, there is a very high chance of suffering serious and sometimes permanent brain damage.

A 2007 study involving right-to-die groups suggested this method of suicide as being the least painful and one of the fastest.

Jumping
This involves jumping from great heights such as building roofs, balconies and cliffs. The result is often highly lethal and effective, however failed attempts can lead to permanent disability through shattered bones in various places, and other horrific injuries.

Dropping from a height accounts for only 2% of reported US suicides based on a 2005 research project. Hong Kong however, with its high number of sky scrapers, makes jumping the method of choice for 52.1% of suicides (study results 2006).

The picture below is of a France Telecom employee who became the 24th worker of the company to commit suicide in under two years

Wrist Slitting
Also called Exsanguination, this method is often showcased in films for dramatic effect. The most effective method is not to cut across the wrists, but up the forearm. The result when successful will reduce the blood volume and pressure to a fatal level.

Whilst it is a commonly portrayed method of suicide, it is not effective as hitting the right artery can be harder than it seems. Survivors often have deep scars, damaged tissue and sometimes – for those who are nearly successful and induce a huge level of blood-loss – brain damage.

Electrocution
Another common suicide method, this involves causing arrhythmias of the heart to slow or stop blood flow by invoking a lethal electric shock. This can be achieved by pushing a metal utensil into a plug socket, or dropping a plugged-in appliance into the bathtub whilst in it.

This method can fail, and when it does results in severe burns and nerve damage.

Drowning
Another of the less common methods of suicide, it accounts for less than 2% of US suicides. To successfully drown a person must submerge themselves in liquid (usually water) to prevent the ability to breathe air, resulting in the lack of oxygen to the brain.

Popular choices of places to drown are baths, lakes and oceans.

Before death, the central nervous system begins the involuntary contraction of muscles, creating a jerking and a twitching.

Failure is usually caused by the bodies natural reaction to surface for air. When unsuccessful, the lack of oxygen to the brain can cause permanent brain damage.

Vehicular Impact
There are many forms of this type of suicide, but the general description involves purposefully placing oneself in the path of an oncoming vehicle. This can include trains and fast moving cars.

Suicide by train impact is one of the most fatal, with a 90% death rate, but can carry some of the nastiest after effects if the suicide attempt is unsuccessful. These include limb amputations, permanent disability, chronic pain and brain damage.

It is difficult to judge the percentage of suicides involving car impact, as it is hard to tell which road deaths are accidental and which are deliberate. Success is less than that of train impact, although the effects of unsuccessful attempts can be similar.

Pesticide
Internationally, the consumption of pesticides and weed killers accounts for over 30% of suicides. This makes it one of the most common suicide methods of all.

In Finland the pesticide Parathion was a particular favourite in the 1950′s, although access to the chemical was restricted. It was quickly replaced by other similar chemicals.

Death can be very painful and failure can cause life-long effects on the body’s internal organs.

Freezing
The technical name is Hypothermia, and involves a very cold and very slow death.

The stages of Hypothermia start with mild symptoms graduating through to severe. When freezing to death a person may experience shivering, hallucinations, loss of coordination, a warm sensation, and then death.

Even after a persons organs have shut down, the brain can still be kept alive through clinical stimulation and medical support.1. asphyxiation (dangle on end of rope for 10 minutes)
Time: 5 to 10 minutes
Available: Rope, solid support 10 foot above ground
Certainty: Fairly certain (discovery, rope/support snapping)
Notes: Brain damage likely if rescued. Very painful depending on rope. Most common effective form of suicide in UK. See “Asphyxiation”.

2. breaking neck
Time: Should be instant if it does break. See previous if not
Available: Rope, solid support, 10 foot space below, several above
Certainty: Very certain if the rope/support doesn’t break
Notes: Minimal danger of discovery (depends on location). Painless if you drop far enough (8 foot is optimum). Make sure that the rope is tied securely to something STRONG!! It has to support your weight MULTIPLIED by the deccelleration. Use a hangman’s knot (with the knot at the back of your neck). It doesn’t always work this well though, you might get a bust jaw / lacerations etc and then asphyxiate.

Calle: I got this table of appropriate falling heights from a.s.h. long-time regular MegaZone (megazone@wpi.wpi.edu), who got it from a friend of his named Mark.

Hanging Drop Heights…

Culprits Weight Drop
14 stone (196 lbs) 8ft 0in
13.5 stone (189 lbs) 8ft 2in
13 stone (182 lbs) 8ft 4in
12.5 stone (175 lbs) 8ft 6in
12 stone (168 lbs) 8ft 8in
11.5 stone (161 lbs) 8ft 10in
11 stone (154 lbs) 9ft 0in
10.5 stone (147 lbs) 9ft 2in
10 stone (140 lbs) 9ft 4in
9.5 stone (133 lbs) 9ft 6in
9 stone (126 lbs) 9ft 8in
8.5 stone (119 lbs) 9ft 10in
8 stone (112 lbs) 10ft 0in
Source: Charles Duff, Handbook of Hanging (Boston: Hale, Cushman & Flint 1929)
Notes: This is for person of average build with no unusual physical problems. The Author (James “Hangman” Barry) noted that when executing “persons who had attempted suicide by cutting their throats…to prevent reoping the wounds I have reduced the drop by nearly half.”

Jumping off buildings
Time: Instantanious if you are lucky, minutes/hours otherwise
Available: You need ten stories or higher, and access to the top floor windows/roof. Bring a bolt cutter to get onto the roof
Certainty: 90% for 6 stories, increasing after that
Notes: Difficult to overcome fear of heights, many people can’t do it. Totally painless if high enough, but very frightening. Easily discovered if seen on/near roof/windows. Access fairly easy in a city, otherwise difficult. Risk of spending the rest of your life in a wheelchair. Ever tried killing yourself if you are paralysed from the neck down? Email conversations suggest 10+ stories works ALMOST all of the time. Try to land on concrete. Quote – “9 out of 10 people who fall 6 stories will die”. Note that it may take a while for many of those 90% to die.

Slitting wrists or other (often not effective)
Time: Minutes if major artery cut, eternity otherwise.
Available: You really need a razor sharp knife. Razors are pretty tricky to hold when they are covered with blood.
Certainty: possible if you cut an artery, improbable otherwise
Notes: Painful at first. Danger of discovery. This is a very common suicide ‘gesture’ and hardly ever results in anything other than a scar. A lot of will power required to cut deeply into groin or carotid arteries, which are the only ones likely to kill you. Don’t bother with this method. Cutting your throat is difficult due to the fact that the carotid arteries are protected by your windpipe (feel where your arteries are with your fingertips, & slice from the side). I’ve seen photos of people who have used this method – the depth of the cut required is amazing. If you want to cut your wrists, cut along the blue line (vein) on the underside of your wrist, but cut deeply so that the artery underneath is exposed. Cut this lengthways with a razor or similar. The traditional hot bath does help, since it keeps the blood flowing quickly, slows down clotting, and is nice to lie back and relax in. Position yourself so that your wrists don’t fall inwards against your body, blocking off blood flow.

Calle: A posting to A.S.H. suggests using the kind of equipment they use when you give blood to a blood bank, i.e., a needle in a blood vessel and a piece of tubing. It sounds like it would remove several of the disadvantages of the ordinary slitting-wrists method.

Bullet
Time: Microseconds unless you are unlucky (mins/hours)
Available: Difficult in UK, easier in USA (get a shotgun)
Certainty: Certain
Notes: Painless if worked, otherwise painful & brain damage. Danger of discovery of weapon or ammunition. Not at all common in UK, more common in USA where guns available. Brain damage & other effects if you survive. Death either instantaneous, or prolonged. Lots of will power needed to fire gun (‘hesitation marks’ are bullets/pellets embedded in the wall, when you jerk the gun as you fire). Bullet can miss vital parts in skull, deflect off skull. If you have a choice, use a shotgun rather than a rifle of a pistol, since it is so much more effective. (“shotgun” entry later). Ammunition to use is: .458 Winchester Magnum, or soft-point slugs with .44 Magnum. Also you could use a sabot round, which is a plastic wedge with a smaller thing in it. These rounds are rather overkill, the phrase “elephant gun” has been used about the .458 Winchester, but if you’re going to go, do it with a bang. Note, people usually survive single .22 shots to the temples. The other problem with guns is that is is bloody messy. Your next of kin will really _enjoy_ cleaning up after you, washing the coagulated blood & brains out of corners etc…

Asphyxiation
Time: 5 mins to unconciousness, 10+ mins to brain death
Available: Anywhere there’s a rope and something solid to tie it to
Certainty: Certain, if you don’t get “rescued”
Notes: Panic reaction is very likely (unless inert gasses used). One of the most effective and most used methods of suicide. Probable brain damage if you are “rescued”. NOTE, this can only really be done in two ways: firstly, when you are unconsious (eg, sleeping pills), or secondly, by hanging. Combining with pure inert gasses is a very good suggestion. See “Nitrogen” in the poisons section

Air in veins (basically just a myth)
Time: Couple of minutes claimed
Available: Plenty of air about… Need a hypodermic & syringe
Certainty: only 1 known case.. patient may already have been dead
Notes: The only case I know about, it killed with 40cc of air. Smaller amounts are harmless. The case was the death of Abbie Borroto, who died in 1950 from a 40cc injection in New Hampshire. She died in minutes. This was the 1949 Dr H Sander case. He was found not guilty to murder on the grounds that the patient may already have been dead when he gave the injection. (A doctor and a nurse could find no pulse earlier the same day). The following 2 quotes are from [1]: Prof. Y Kenis says: “… not a suitable method, nor a gentle death… extremely difficult to utilize as a method of suicide. .. possibly with very serious consequences, such as paralysis or permanent brain damage. .. this is only an impression, and I have no real scientific information on the subject.” Dr Pieter V Admiraal .. describes the theoretical air bubble method of suicide as impossible, disagreeable and cruel. “To kill somebody with air you would have to inject at least 100 -> 200 millilitres as quickly as possible in a vein as big as possible close to the heart. You would have to fill the whole heart with air at once. The heart would probably beat on for several minutes, perhaps 5 -> 15 minutes, and during the first minutes the person may be conscious.”

Decapitation
Time: Couple of seconds before conciousness fades
Available: Happen to have a train line nearby? Or a guillotine perhaps?
Certainty: Very certain, unless you pull away just before
Notes: See “jumping in front of trains”. May be difficult to stop pulling your head out of the way – OD on sleeping tablets first

Calle: A news notice from California posted to alt.suicide.holiday tells the story of a man who comitted suicide nearly cut his own head off with a chainsaw. Sounds like a grisly way to do it.

Disembowelment (aka seppuku/hara kiri)
Time: Minutes
Available: Got a nice razor-sharp sword?
Certainty: Fairly certain, assuming that you managed to gut yourself properly before passing out with the agony
Notes: Painful, even the macho Samurai used a ‘second’ to decapitate them at the appropriate point, so don’t expect to do much more than give yourself peritonitis. Trendy for insane martial arts fanatics and gay Japanese poets called Mishima.

Drowning
Time: Minutes (5 mins to die of drowning, 20 to die of hypothermia)
Available: Anywhere there’s deep, (cold) water in a remote spot
Certainty: Good, just make sure you sink & can’t swim
Notes: Put stones in your pockets, tie your legs & hands together, and hop into the lake.. bit of a shock to the fisherman who finds your rotting corpse stuck in his brand new net. Also see entry for “hypothermia/freezing”. However, remember that you can be revived from cold water drowning after several hours, because the cold slows down terminal brain damage. Warmer water doesn’t have the advantage of hypothermia, but is more effective in making sure you *stay* dead.

Electrocution
Time: Seconds / minutes
Available: Anywhere with high-tension, high-current lines & a good earth
Certainty: Somewhat dependant on luck & how much power goes through you
Notes: Don’t bother with 110 or 240 volt mains, its just not enough. Some people do get killed with household electricity, but only after several minutes. Use high tension lines, stand in bare feet on waterlogged ground (better still, put a piece of THICK copper cable into the nearest river). Works best if current path travels through your head, or through the heart. Just burns you badly otherwise. NOTE: people have survived massive high-voltage, high-current shocks with nothing but 3rd degree burns to show for it. Sometimes paralysis, limbs amputated etc.

Explosives
Time: 10 milliseconds, or similar (!)
Available: Difficult to get hold of detonator & good explosives
Certainty: Certain if detonator works properly
Notes: DON’T USE GUNPOWDER or other ‘slow’ explosives (eg, homemade explosives). Use dynamite or ‘Plastique’, strap it to your forehead with the detonator, and BOOM! The main problem is with getting hold of high explosives (I know the recipe for Nitro-Glycerine, but home manufacture is extremely risky, and the product is unstable). If you can get a grenade, use it, it’s probably the best way of doing this one.

Calle: Recipies for creating explosives can be found, together with the appropriate warnings, in the rec.pyrotechnics FAQ.

Freezing to death (hypothermia)
Time: several hours (15 minutes in very cold water)
Available: Got a large chest freezer? Is the outside temp 1000 years time?
Certainty: Good assuming that the technology is developed
Notes: Basically, this involves a ‘replicator’ panel. You program it to replicate yourself, simplifying very slightly, with the exception of the urge to use this technique. After a while, you turn into a mindless zombie, trudging around from the exit of the machine to the entrance, for eternity. Strange philosophical implications.

Calle: If you postulate nanomachines, why not use the deconstructor kind? Take your body apart into its component molecules in less than a minute… A silly method, if you hadn’t guessed.

Scuba-diving (various fatal ‘accidents’)
Time: see notes -most are minutes/hours
Available: scuba diving gear, nobody around
Certainty: see notes
Notes: The first method is to rise 30 metres or so without releasing your breath. Assuming that you can do it, it should cause your lungs to burst. The second is the bends – stay under long enough for the nitrogen to dissolve (30 metres for 30 minutes). go up rapidly without decompression time. This is unreliable, and may cause brain / joint damage. The third way is Carbon Monoxide poisoning – fill your tank with it, and stay away from other divers. You will fall asleep fairly quickly. See CO in poisons section. The final way is oxygen poisoning – however, this means that you have to go very deep with an oxygen-rich mix, and there are problems associated with that. The advantage of these methods is that insurance companies / relatives will assume that it was an accident (‘misadventure’), with the possible exception of the CO poisoning.

The source of this follows: (from the net) “Rising 30m without exhaling will usually result in an over pressured lung, possible subcuteaneous emphazema, collapsed lung, death usually from drowning in your own blood. Rather painful and usually curable if you are rescued, but fair chance of dying if you aren’t.

Building up a high residual nitrogen time (say 30m for 30 min) then coming up without decompressing will get you bent fairly nicely. You don’t feel much, but your joints tend to start stiffening up after half an hour. Death is very uncertain, coming from a stroke. Brain damage, joint damage etc are most likely. Pobably can be recued but some damage certain. Oxygen poisoning, going down 50+m until the partial pressure of the oxygen reaches a toxic level. Difficult to accomplish, very painful to get down that deep, cold pressure etc, possibility of nitrogen narcosis and forgetting what you are doing. Probably get bent, good chance of rescue.

CO poisoning, mix a healthy batch of carbon monoxide in your tank as you dive, you tend to go to sleep under water, when combined with the above methods you have a pretty good winner, don’t forget to forget your BCD.”

Sucking your brains out (silly)
Time: Minutes
Available: You’d need a Puma (TM) robot, & some other bits
Certainty: certain, given proper programming
Notes: You would need an industrial robot to do this properly. Give it a saw attachment, a sucking tube attachment, and program it. Make a head restraint. When you are fixed securely into the restraint, start the robot’s program. It will drill a hole in your head, and stick the tube into the hole. Program it to wiggle the tube back and forth so that it doesn’t miss anything. This might work better if you put a stream of water into the hole as well, so that the sucking attachment doesn’t just suck air all the time. Debugging the program could be amusing.

Microwaves
Time: ?
Available: Source of strong microwave emissions
Certainty: ?
Notes: Cooking yourself. Point is to raise your core body temperature to fatal levels.

Calle: Does anyone have any information on this? All that I know is that standing in front of a Swedish coast surveillance radar (which happens to use exactly the same wavelength as your average microwave oven) is a Bad Thing.

Dehydration
Time: a week or so?
Available: you need to be able to stop medical help.
Certainty: certain if your will-power stands up to it.
Notes: Don’t eat or drink. Remember that food contains a high proportion of water. Avoiding medical help can be difficult. See ‘starving to death’.

Skydiving ‘accident’
Time: pretty damn quick.
Available: need to join a skydiving club. Takes much time and money.
Certainty: Fairly certain. People have fallen from extreme heights and survived. The resulting injuries are not fun.
Notes: Join a skydiving club, continue to practise it for a while to clear off all suspicions and then once pack your parachute in a real mess (preferably knotted up, but not too clearly) and then jump. The para will not open and you will reach a terminal velocity of 220 km/h (160 mph/120 kn). Death is instant in the impact with the Planet Earth.

This has the advantages of being ‘accidental’, and your family/ friends do not have the additional pain and guilt associated with suicides.

Calle: In addition to the above, you need to remove or disable your reserve parachute (which is not easy, I’m told). There are better “accidental” methods than this.

A correspondent who is a skydiver dislikes this entry, since if people use it it will give skydiving an undeservedly bad reputation.

Death by a thousand cuts; modern version (silly)
Time: variable
Available: a heck of a lot of razor-wire.. maybe a high-voltage supply
Certainty: not very good
Notes: This is a modern variant of the Arabic ‘Death of a thousand cuts’. Basically, jump onto a stack of unravelled razor wire, and roll around till you die.. it may help to connect a high- voltage, low current power supply to the wire, so that you have spasms, which should keep you getting cut even when you are unconscious. Also, you should make sure that you can’t roll off the wire.

Crushing
Time: seconds to minutes, depends on car press
Available: a car press.. any good junkyard
Certainty: certain as long as you can’t escape
Notes: This is an elegantly simple one.. get into a car, in a car press, and shortly afterwards be squashed to death as your body is converted into a red pulp. It may be tricky getting the press to trigger, but if you hide in the car someone may come along and activate it. There are other ways of getting crushed, this just happens to be the most effective I can think up on the spur of the moment. Getting yourself run over by a fully loaded articulated lorry is quite good. You should remember that people quite often survive the actual crushing; they die when the weight is taken OFF them.

World War Three
Time: moments if you are near a militarilly significant site
Available: happen to be one of the ‘key-holders’? president maybe?
Certainty: pretty certain
Notes: All you have to do is trigger world war three. Fire an ICBM or three at the Chinese and the Russians… This method has the advantage that you take everyone else with you! Trouble is, the number of people with the requisite access is minimal, and I sort of doubt that any readers of ASH can do this.

Calle: Lots harder since the collapse of the Soviet Union… Silly.

Heatstroke
Time: 4 hours or more
Available: Very hot day; no disturbance from neighbours etc
Certainty: depends on the weather
Notes: Basically, the point is to give yourself extreme heatstroke. You should pass out after a few hours. Use some aluminium foil to direct the sun’s heat onto you, to speed up the process a bit. Try to reduce the chance of being interuppted, take off the phone etc. Obviously, start in the morning! Helps if the outside temperature is >100F.

Acid bath
Time: depends on acid
Available: a lot of a very strong acid
Certainty: fairly good
Notes: [from alt.suicide.holiday]
“summer heat got you down? Try the new and improved neighbourhood acid bath. Most metal working plants and some auto-repair shops will have a nice soothing acid bath. This, of course, is for those of you who enjoy extreme pain and don’t want to make a mess for others to clean up. If you don’t leave a note chances are they will never know what happened, aside from the shop / plant being broken into.”

Fake car bomb
Time: milliseconds
Available: explosive
Certainty: fairly good if enough explosive
Notes: This is a modification of the basic use-explosives method. What you do, is make a homemade car bomb, and drive off happily after chatting with your neighbour about how well your life is going, apart from a few minor death-threats from an Iraqi death-squad.. To confuse the authorities even more, have a note in your pocket listing the telephone numbers of all the eastern foreign embassies in your pocket, together with a little line of random “code numbers” next to each.., and a random but large amount of cash listed against each code number.🙂 Oh yes, and a heavily annotated copy of Jane’s Defence Weekly – Xhosa edition.

Jumping off bridges (slice and dice with piano wire)
Time: 9.87 ms-2; 4 to 10 meters; calculate it yourself!
Available: Rope, pianowire and a high bridge.
Certainty: Fairly certain
Notes: Never been tried. Can also be used with a fairly high building, but then the art-motive will disappear.

Cut the rope and wire in various lengths. Each length must not be longer than the height of the bridge.

Tie one end of the ropes and wires to the bridge Tie the other part of the ropes to different bodyparts like thigh, calves, torso etc. Then tie the pianowires around your joints. (Don’t forget your genitals..)

When you jump various parts of you body are whipped away by the pianowire nooses, and your bits are held up by the ropes swaying in the breeze. If you to this right you should end up with just your torso hanging by it’s neck above the sea, highway, ground.

Do it with friends, and call it art.

Being eaten alive
Time: depends, but probably a couple of minutes
Available: zoo, or live in Africa/wherever
Certainty: not brilliant.. what if they’re not hungry and don’t finish?
Notes: basically, find one or more hungry carnivores… tigers are nice. Also, sharks, lions, any of the big cats..

Being burned up in unprotected re-entry (silly)
Time: probably a few minutes
Available: if you happen to be able to get into orbit
Certainty: about as certain as you can get!
Notes: Just go for a spacewalk in a low earth orbit, and decelerate enough to enter the atmosphere. You’ll get a great view…

Acquired Immune Deficiency Syndrome (AIDS)
Time: Incubation period 1 to 10 years, death within 2 years of diagnosis of AIDS, Can have HIV for years/decades
Dosage: Just one intimate contact with an Infected person of any gender
Available: Available to all for free
Certainty: 99.9% certainty AFTER infected
Notes: [2]:
This is not painfree. This method may cost you alot of money if you allow others to get you medical attention. It may a little difficult to get infected as people who know they have it may not comply with your request. Could be great fun attempting to get infected depending upon your attitude (remember -any gender – you don’t have to limit yourself – you’re going to die, you might as well try it😉. Should be quite devasting to your family & close friends. You also get the satisfaction of leaving behind a virtual unrecognizable-as-you body ! This also gives you the prime opportunity to point your finger at your dentist and say he did it for all the times you have suffered in their chair. Happy dying !

Calle: May not be so certain any more. Ten years may well be long enough for someone to develop a cure. Silly, IMHO.

Auto-decapitation by car (added by Calle)
Time: Real quick
Available: You need access to a car and a rope
Certainty: I wouldn’t trust it
Notes:
Comes from alt.suicide.holiday. Basic idea is to tie one end of the rope around your neck, tie the other end to a real solid object, get into the car and accelerate away as fast as the car can manage. When you reach the end of the rope, your head gets torn off. Be sure to use enough rope and fasten your seat belt.

A posting to a.s.h. in July 1993 says that someone in Washinton State, USA actually used this method to commit suicide, so it can’t be that bad. The posting said that 25 feet of rope were used (about 7.5 meters), which does sound a bit short. Perhaps he had a real awesome car.

Death by painting your body (very silly, and wrong)
Dosage : Less than 1 can of paint depending on your body type
Time : ? Probably less than 8 hours
Availability : Very available ! You have a choice of greasepaint or House paint. You need a type of paint that will not allow your pores to breath in order to be successful at this. You also have a smashing selection of colors you can choose to die in ! Nile Green ? Blood Red ? Basic Black ? Or any combo you desire.. If you couldn’t decide before what to wear to die in, this method will cause you considerable angst.
Certainty : This is a sure method, provided you have a paint that will block your pores from breathing. Don’t forget the bottom of your feet. You must paint every last bit of available skin. If your pores can breathe, you won’t die.
Notes : I read this in some theater journal 5 or so years ago, saying when you you do full body makeup, you must insure that parts of the body are left naked to breathe or the actor will die. Usually for full body makeup, they leave the bottoms of feet, and some patterns on the body, like lines so the actor doesn’t suffocate.

Calle: This is an *extremely* silly one. It was in the “not yet edited” portion of Mike’s file, and I think it is quite straight from an a.s.h. posting. This method does not work. As you can check in most any book on human anatomy, the skin does not breathe. The only places in your body which absorbs oxygen are the lungs and the corneas, and the corneas only feed themselves. You might get ill or even die if you use poisonous paint, though.Notes of Methodology: Most drugs, taken in large quantity, will induce vomiting. To prevent this, take one or two anti-histamine tablets (travel sickness, allergy, hay fever tablets, etc.) an hour before on a fairly empty stomach.

If your poison of choice is in tablet form, swallow the first 20% as normal. (A larger quantity may induce vomiting or impede absorption.) Take the remainder with food or a strong alcohol, crushed or dissolved as appropriate; this will help the entire dose to hit your system at the same time. Alcohol helps dissolve the drugs, but don’t drink any beforehand! Instead, wash the tablets down with vodka or a similar spirit, and then drink yourself silly while you’re still conscious.

To increase your odds of death, secure a large, airtight plastic bag over your head. Also consider securing a rubber band around your neck. This can bring your odds from “good” to “almost certain,” in case the drugs don’t work as expected.

Friday night is a good time to die, if you live alone–nobody will miss you until Monday morning. Bolt all the doors and windows, and tell your neighbors or friends that you’ll be away. If you’ve got a loyal dog, set it free–you just don’t want to be featured on the nightly news as the chump whose dog dialed 9-1-1 and saved his life.

Be aware that people who regularly use painkillers can develop a tolerance. Increase the dosage accordingly.

Alcohol

Dosage: Variable
Time To Die: About 8 hours
Availability: Wonderfully easy to get
Certain Death?: Unreliable
The Savvy Suicide: Drink it all at the same time, as quickly as possible. Will cause liver and kidney damage if ‘rescued’ before death. Dosage is questionable.
Science Facts: Ingesting spirits as an enema is supposed to be a very quick way of absorbing alcohol; even better, inject it. Dosage varies according to method of ingestion, the individual’s tolerance, and the health of the individual’s liver.
So They Say: “The fatal dose of pure alcohol in an average adult is 300-400 mL (750-1000 mL of 40% alcohol) if consumed in less than one hour. Apart from the effects of overdosage, death after alcohol consumption can occur as a result of choking on vomit while unconscious…Consequences such as liver damage occur after chronic consumption.”

Amobarbital
(amytal, amal, eunoctal, etamyl, stadadorm)
Dosage: 4.5 grams, typically ninety 50mg tablets
Time To Die: Unconsciousness in 5-15 minutes; death in 20-50 minutes
Availability: Prescription only
Certain Death?: Very reliable
The Savvy Suicide: More effective when used with an airtight bag over one’s head and a rubber band around one’s neck. Alcohol accelerates the process and increases reliability.

Aspirin
Dosage: 20-30+ grams
Time To Die: Variable: hours to days
Availability: Easy to get
Certain Death?: Unreliable
The Savvy Suicide: Not recommended. Fatal dose varies wildly, could cause liver & kidney damage instead of death. Too many cause vomiting. Overdose causes strange noises in your ears and projectile vomiting after about 10 hours. Medical help generally effective, so stay out of hospital for a couple of days. May cause bleeding in your stomach and/or upper intestines. To speed up absorption, take with sodium bicarbonate (bicarbonate of soda).

Bleach
(also lye, drain cleaning fluids)
Dosage: One half to one liter
Time To Die: Variable: hours to days
Availability: Easy to get
Certain Death?: Uncertain
The Savvy Suicide: This method depends on your stomach corroding, thereby releasing stomach acids to destroy vital organs. A painful way to go.
So They Say: “I have heard of people throwing themselves through plate glass windows in their death agonies after drinking lye.”

Butabarbital
(secbutobarbitone, butisol, ethnor)
Dosage: 3 grams, typically one hundred 30mg tablets
Time To Die: Unconsciousness in 5-15 minutes; death in 20-50 minutes
Availability: Prescription only
Certain Death?: Very reliable
The Savvy Suicide: More effective when used with an airtight bag over one’s head and a rubber band around one’s neck. Alcohol accelerates the process and increases reliability.

Caffeine
Dosage: 20 grams
Time To Die: Unknown
Availability: Easy to get
Certain Death?: Without much data or secondhand accounts, the lethality of caffeine remains uncertain.
Science Facts: An average cup of coffee contains roughly 200 mg, as does one caffeine pill such as Vivarin.

Carbon Monoxide
Dosage: 5% concentration
Time To Die: Minutes to hours
Availability: Easy to get: car exhaust, for one
Certain Death?: Fairly certain
The Savvy Suicide: Causes brain damage to survivors. Skin becomes fire engine red, making the coroner’s job easy.
Science Facts: The actual cause of death is asphyxiation, since the carbon monoxide binds tighter to hemoglobin than oxygen does (the oxygen gets crowded out, so to speak).
So They Say: “Urban legend tells of one couple who tried to kill themselves by filling their apartment with carbon monoxide. Unfortunately, the heavier-than-air carbon monoxide leaked through the floor and killed the people in the apartment below.”

Chloral Hydrate
(noctec, chloratex, somnox)
Dosage: More than 10 grams, typically more than twenty 500mg tablets
Time To Die: Info not available
Availability: Prescription only
Certain Death?: Not effective by itself
The Savvy Suicide: Mix with alcohol and restrict breathing with a bag and rubber band.

Chlorine gas
Dosage: Unknown
Time To Die: Unknown
Availability: Tricky
Certain Death?: Good
The Savvy Suicide: Used in World War One, known to be a very unpleasant death.

Chloroform
Dosage: Unknown (a soaked rag?)
Time To Die: Several minutes
Availability: Fairly easy to get
Certain Death?: Unknown
The Savvy Suicide: Victim will become unconscious first, so steps must be taken to ensure a continued ingestion. Perhaps taping the soaked rag over one’s mouth?

Cocaine
Dosage: 1 ounce (?)
Time To Die: 2 to 3 hours (?)
Availability: Possibly difficult; very expensive
Certain Death?: Unknown
The Savvy Suicide: Cocaine overdose induces a heart attack. Along the way, expect severe paranoia and breathing problems. It is not uncommon for drug mules to swallow bags or condoms of cocaine, only to have them accidentally burst in transit, killing them quite handily.

Codeine
Dosage: 2.4 grams, typically eight 30mg tablets
Time To Die: Unconsciousness in 5-15 minutes; death in 20-50 minutes
Availability: Prescription only
Certain Death?: Very reliable
The Savvy Suicide: More effective when used with an airtight bag over one’s head and a rubber band around one’s neck. Alcohol accelerates the process and increases reliability. Be warned than tolerance develops with “normal” use.

Cyanide
(HCN, KCN)
Dosage: 50 mg Hydrogen Cyanide gas, 200-300 mg Cyanide salts
Time To Die: Seconds for gas; minutes for the salts on an empty stomach; possibly hours on a full stomach
Availability: Very difficult to secure
Certain Death?: Very certain
The Savvy Suicide: Instead of ingesting cyanide salt orally, drop 500mg into a strong acid. The fumes will be pure Hydrogen Cyanide, capable of killing within seconds.
Science Facts: Hydrocyanic acid is one of the most poisonous substances known; the inhalation of its fumes in high concentration will cause almost immediate death. Hydrogen cyanide acts by preventing the normal process of tissue oxidation and paralyzing the respiratory center in the brain. Most of the accidental cases are due to inhaling the fumes during a fumigating process. In the pure state it kills with great rapidity. Crystalline cyanides, such as potassium or sodium cyanide are equally poisonous, since they interact with the hydrochloric acid in the stomach to liberate hydrocyanic acid. This poison has been used for both homicide and suicide; in recent history, a number of European political figures carried vials of cyanide salt for emergency self-destruction and some used them. Death resulted from amounts of only a fraction of a gram. A concentration of 1 part in 500 of hydrogen cyanide gas is fatal. Allowable working concentration in most of the United States is 20 ppm. Two and one-half grains of liquid acid has killed. The acid acts fatally in about 15 minutes. The cyanide salts kill in several hours. The average dose of solution is 0.1 cc.
The Savvy Suicide: Stomach acids will react with Cyanide salts to form Hydrogen Cyanide, so an empty stomach is a great advantage.

Diazepam
(valium, apozepam, aliseum, ducene)
Dosage: 500 milligrams, typically one hundred 5mg tablets
Time To Die: Info not available
Availability: Prescription only
Certain Death?: Unreliable
The Savvy Suicide: Not effective by itself. Mix with alcohol and restrict breathing with a bag and rubber band.

Flurazepam
(dalmane, dalmadorm, niotal)
Dosage: 3 grams, typically one hundred 30mg tablets
Time To Die: Info not available
Availability: Prescription only
Certain Death?: Not effective by itself
The Savvy Suicide: Mix with alcohol and restrict breathing with a bag and rubber band.

Gasoline
(inhaled/injected)
Dosage: 20 ml (?)
Time To Die: Seconds/minutes
Availability: Very easy to get
Certain Death?: With correct dosage, a reliable method.
So They Say: “You can also use propane or butane on a skin surface. Go stick your hand in a bucket of propane and see how many seconds you last…”

Gluthethimide
(doriden, doridene, glimid)
Dosage: 24 grams, typically forty eight 500mg tablets
Time To Die: Info not available
Availability: Prescription only
Certain Death?: Not effective by itself
The Savvy Suicide: Mix it with alcohol and restrict breathing with a bag and rubber band.

Heroin
Dosage: 120 to 500 mg for non-users
Time To Die: Unknown
Availability: Difficult (and, like cocaine, expensive)
Certain Death?: Unknown
The Savvy Suicide: Combined with alcohol, a lethal dose might be reduced.

Hydrazine
Dosage: As produced by reaction (see below)
Time To Die: Unknown (2 weeks?)
Availability: Easy to get
Certain Death?: Not known
Science Facts: Commonly produced by mixing a bottle of bleach and a bottle of ammonia. A fairly common way for illiterate cleaning people to accidentally kill themselves.
So They Say: “Several years ago at my high school, one of the janitors innocently mixed together half a bottle of bleach with half a bottle of of ammonia in a small closet where the cleaning fluids were kept. He passed out due to the hydrazine gas released in the reaction between the two chemicals. This man was in agony for two weeks in an intensive care unit in a local hospital with the majority of the inside surface of his lungs damaged and untreatable before he got lucky and died.”

Hydromorphone
(dilaudid, pentagone)
Dosage: 100-200 milligrams, typically 50-100 2mg tablets
Time To Die: Unconsciousness in 5-15 minutes; death in 20-50 minutes
Availability: Prescription only
Certain Death?: Not effective by itself
The Savvy Suicide: Mix it with alcohol and restrict breathing with a bag and rubber band.

Insulin
(injected)
Dosage: Unknown
Time To Die: Hours-days
Availability: Prescription only
Certain Death?: Reasonable
The Savvy Suicide: Rumored to be This is a theoretically simple method of suicide, where the cause of death is hypoxia (lack of oxygen to the brain and body).

Given many drugs do not, on their own, induce death (especially if the dose is below the minimum lethal dose), the idea is to ingest drugs that will cause unconsciousness, and then for the plastic bag to cause death by hypoxia, as, with no fresh oxygen in the bag, carbon dioxide is inhaled eventually causing death.

Care must be taken to use a bag that will not tear if the body is convulsing, or during semi consciousness.

Nitschke & Stewart1 and Derek Humphry2 recommend the sort of oven bag you roast a turkey in. Thin plastic bags where the plastic will easily stick to the face are not recommended, although Stone3 mentions that wearing a hat with a brim can avoid this problem. The bigger the bag, the slower the asphyxiation. Whatever the bag size though, there does need to be some seal around the neck. It does not need to be tight – an elastic band or a loop of elastic should do the trick.

The major drawback of this method is running out of oxygen in the bag whilst still conscious. Humans, whatever their mental state, have an underlying strong desire to stay alive, so are likely to tear or remove the bag in this situation. A bigger bag may be the answer, although it is always hard to know how long it will take for any given drug dose to render unconsciousness, and whether the oxygen in the proposed bag size will last more or less than that time. In Final Exit Derek Humphry talks about elasticating the bag, then holding the bottom open so breathing is easy until consciousness is lost, when the elastic would gently close the bag around the head.

Stone3 states that a 30 gallon trash bag should have around 30 minutes of air in it, although in his own tests he stated that after only 15 minutes carbon dioxide build up was sufficiently high for his breathing rate to more than triple and be uncomfortable enough to want to remove the bag. On Alt Suicide Holiday4 it is stated that even when people start to become unconscious, they can remove the bag from their head, thus making this method prone to failure.

Another option is to try and place the bag over the head as the drugs are starting to take effect, although this is prone to failing to get the bag over the head in time, or still running out of oxygen. A small tent that has all vents sealed may offer a viable alternative to a bag, and have a fair amount of oxygen to last for a number of hours until the drugs take effect, although in this case it really would be important to ensure that no air can leak into the tent once inside it.

It is probably advisable to do testing with different types of bag/tent before any suicide attempt to get a gauge for how long any given bag/tent can be breathed in before it becomes uncomfortable. Then ensure that whatever drugs are taken will cause unconsciousness in less than that time.

This method does take time for death to occur. The time all depends on how much air is in the bag/tent, and potentially what drugs are being used. Whilst discovery and interruption of the attempt within a relatively short time frame may not cause any permanent damage, discovery later in to the process may result in permanent brain damage. For this reason, it is absolutely essential that there is no chance of being discovered for a period of at least a few of hours.

So whilst this method is potentially lethal, generally painless, and will leave a peaceful looking body, it does have a number of drawbacks to carry it out effectively. Important considerations are a bag with enough oxygen to last until the drugs cause unconsciousness, ideally a bag that is comfortable to breath in whist conscious, drugs that will reliably cause unconsciousness, and to ensure there is no chance of being discovered.

Although this method is mentioned as potentially lethal in Final Exit, and mentioned in many forums, it is not mentioned in Peaceful Pill Handbook, and Alt Suicide Holiday states that posts on their newsgroup consistently report this method as failing, and advise against using it. There are certainly more reliable methods.quite a pleasant way to go.

sleeping pill overdose

Statistically speaking, a sleeping pill overdose is among the most common ways used by women to attempt or to commit suicide. Sleeping pills act by slowing down the body functions, by relaxing the muscles, and chemically lulling a person to sleep. In theory, a sleeping pill overdose would pretty much shut down the entire body, including the nervous system, respiratory system, and the cardiovascular systems — all of which would eventually lead to death. A sleeping pill overdose, thanks to the tranquilizing and anesthetic qualities of those medications, can kill a person without pain or agony, which is also the reason why it is very common in suicide cases — one of which is the death of Marilyn Monroe. However, as police investigators and those who actually survived a suicide attempt can attest, a sleeping pill overdose does not always work.

The fact is, most of the sleeping pills that are potent enough to be used as a means to commit suicide are no longer being prescribed by doctors. Some relatively high dosage pills might still be available in hospitals but these are only used for anesthetic purposed during major surgery. Sleeping pills that are still sold in the market have milder formulas and are no longer as potentially lethal as the sleep-inducing medications available some years back. In other words, the current generation of pills are now chemically and purposefully designed to be safer. One of the main goals is to make sleeping pills less potent and make sleeping pill overdose lose its ?appeal? as a painless means of committing suicide. However, that doesn’t mean that there won’t be significant damage to the body or mind, as those factors are still present despite the lower risks of modern pills.

One more factor to consider would be the specifics involved in the overdose. Some people might have a tolerance for the components of the sleeping pills, thus increasing the chances of survival. Other factors including blood chemistry and the possibility of intervention during the attempted suicide can reduce the probabilities of death. In many cases, alcohol was used supposedly to speed up the effects of the pills. since a sleeping pill overdose does requires time to fully work and deliver its fatal effects.

Modern sleeping pill overdose situations can still cause considerable damage since present-day drugs almost always produces an effect on the central nervous system. Normal doses only pose very minimal risks but side-effects can still be expected after using large quantities of the drug. The most serious side effect would be the complete shutdown of the neural pathways and receptors that control some of the body’s systems. Someone who survives a sleeping pill overdose might find himself completely paralyzed, with little or no control over his bodily functions — left only to live life as a ?vegetable.?

Sleeping pill overdose is also a very significant issue in the realm of psychology. Most people would assume that a person who chooses to end life via a sleeping pill overdose has a very serious psychological problem. In most cases, physical stress or a mental illness can be associated to suicides. Mentally-ill individuals who survived their own suicide attempt using sleeping pills are in danger of suffering memory loss, which can occur due to the lack of oxygen in the brain. Other suicide survivors have exhibited paranoid delusional tendencies or were found to have psychological disorders prior to the suicide attempt.INERSIAS is completely wrong. Here are the FACTS, not my personal belief of a lethal dose. And just because a person falls asleep from taking Xanax is not the same as a dangerous or near-lethal dose. Xanax (alprazolam) is a benzodiazepine class drug indicated for the management of an anxiety disorder, for the treatment of panic disorder with or without agoraphobia, for the short-term relief of symptoms of anxiety, and for anxiety associated with depression.

The best way to figure it out is by looking at the LD50 of Xanax (alprazolam). The LD50 (median lethal dose) is a measurement of acute toxicity of a substance that shows the dose required to kill half the members of a tested population after a specified test duration.

There is not really any data on the LD50 for humans so typically we come up with an estimation by using the LD50 for an animal. In studies using rates the oral LD50 for alprazolam ranged from 331 to 2171 mg/kg. So now lets extrapolate- say we have a person (Mr. Smith) with a weight of 68 kg (150 lbs). The LD50 for Mr. Smith would be 22,508 mg to 147,628 mg of oral alprazolam. Thus conservatively 50% of people would die from taking a dose of 22,508 mg of oral alprazolam and 50% would live.

Even two year studies studying chronic toxicity at up to 30 mg/kg/day of oral alprazolam did NOT result in death. For Mr. Smith that would mean that even taking 2,040 mg oral alprazolam a day for TWO years would not be lethal. FYI the official maximum dose of Xanax is 4 mg/day except for panic disorder which has a maximum dose of 10 mg/day.

Having said that it is certainly true and important that a person who has overdosed on Xanax receive immediate medical attention due to other potential heath risks. But the vast majority of people who end up in the emergency department after taking a large amount of Xanax (be it accidental, a suicide attempt, or substance abuse) have little or no complications. Typically people sleep, they may have anterograde amnesia (which can be severe), they may have a total loss of inhibitions and do dangerous activities and potentially self harm, suicide attempt, and rarely suicide completion, they and may develop acute sleep apnoea when sleeping after taking a large dose of Xanax.

However contrary to common belief Xanax has only minimal effects on heart rare and respiration except at near lethal doses. The reason Xanax and other benzodiazepines are very popular is that they have almost completely replaced barbiturate use. Unlike benzodiazepines barbiturates are very dangerous and a lethal dose occurs at as little as 1 gram and 4 grams almost always result in death.

Unless Xanax is taken in a large dose in a person severely medically compromised OR if a person has used Xanax with other drugs (known as polypharmacy) especially opioids (morphine, oxycodone, hydromorphone), barbiturates (phenobarbital, secobarbital, butalbital, pentobarbital), Miltown (meprobamate), chloral hydrate, or alcohol then the synergistic effect of the multiple drugs is extremely dangerous. When most people die from drugs they typically have used multiple drugs. In France for example methadone addicts commonly use the benzodiazepine temazepam (brand names include Restoril, Normison, and Euhypnos) and the highest incidence of death comes from that group of addicts abusing BOTH methadone and temazepam.

If you are considering harming your self (or you know a person who is) please get help. Call a doctor, go to the emergency department (ED aka ER), or if you or another person is actively suicidal then don’t hesitate to call for an ambulance.

Xanax and other benzodiazepine are some of the safest drugs in an overdose situation but don’t think they are risk-free.

All about HIV

HIV is a virus which is most commonly passed on by sexual contact. HIV attacks cells of the immune system. Untreated, the immune system weakens so that the body cannot defend against various bacteria, viruses and other germs. This is when AIDS (commonly now called late-stage HIV infection) develops. However, early detection and treatment with antiretroviral therapy (ART) means that people living with HIV can lead active, healthy lives, although they may get side-effects from the treatment.

What are HIV and AIDS?

HIV stands for human immunodeficiency virus. This is a virus in the group of viruses called retroviruses. HIV destroys cells in the body called CD4 T cells. CD4 T cells are a type of lymphocyte (a white blood cell). These are important cells involved in protecting the body against various bacteria, viruses and other germs. HIV actually multiplies within CD4 cells. HIV cannot be destroyed by white blood cells, as it keeps on changing its outer coat, so protecting itself.

AIDS stands for acquired immunodeficiency syndrome. This is a term which covers the range of infections and illnesses which can result from a weakened immune system caused by HIV. Because ART has altered the way we think about the condition, the term late-stage HIV is being increasingly used instead of AIDS.

Note: HIV and AIDS are not the same thing and people who get HIV infection do not automatically develop AIDS. AIDS is unlikely to develop in people who have been treated in the early stages of HIV infection. Even in people who do not receive treatment, there is usually a time lag of several years between first being infected with HIV and then developing infections and other AIDS-related problems. This is because it usually takes several years for the number of CD4 T cells to reduce to a level where your immune system is weakened.

People with HIV can pass the virus on to others whether or not they have any symptoms.

How do you become infected with HIV?

Sexual transmission. This is the most common way to pass the virus on. In 2010, it accounted for about 19 in 20 new confirmed cases in the UK. Semen, vaginal secretions and blood from an infected person contain HIV. The virus can enter the body through the lining of the vagina, vulva, penis, rectum or mouth during sex. Having vaginal or anal sex with an infected person is the most common route. Oral sex carries a much lower risk but this can increase if you have a condition which affects the defence barriers of the mouth, such as ulcers, bleeding or damaged gums or a sore throat. You cannot be infected with HIV by coming into contact with the saliva of an infected person (for example, through kissing or coming into contact with spit). HIV is not passed on by coughing or sneezing.
Needle sharing. HIV (and other viruses such as hepatitis B and hepatitis C) can be passed on by people who are dependent on injectable drugs and share needles, syringes and other injecting equipment which is contaminated with infected blood. However, needle-exchange services run by hospital, clinics and drug dependency units and the more ready availability of medicines taken by mouth (such as methadone) have drastically reduced needle-sharing as a source of infection.
Infected blood. In the past, quite a number of cases occurred from infected blood transfusions and other blood products. This is now rare in the UK, as since 1985 all blood products are checked for HIV before being used. It is still a significant problem in developing countries.
Accidental needlestick injuries. There have been no cases of HIV infection from needlestick injuries in a healthcare setting in the UK since 1999. HIV infection from a needlestick injury outside of a healthcare setting has never been recorded anywhere in the world.
From mother to child. HIV can be passed to an unborn child from an HIV-positive mother. However, with appropriate treatment the risk of transmission of HIV from mother to baby can be reduced to less than 1 in 100. This means that, with appropriate treatment, the vast majority of babies born to HIV-positive mothers will not have HIV. Achieving this depends on detecting HIV before pregnancy, or, in early pregnancy, when anti-medicines can be taken by the mother. Having a Caesarean section to deliver the baby reduces the risk even further. HIV can occasionally be passed to babies through breast milk during breast-feeding. If formula milk is available, mothers with HIV are encouraged not to breast-feed.
Note: to become infected with HIV, some infected blood, semen or vaginal secretions would have to get into your body. You can not catch HIV from ordinary contact with someone with HIV, such as hugging, shaking hands or touching, or from sharing food, towels, utensils, swimming pools or telephones.

How common is HIV?

The number of new people diagnosed with HIV in the UK peaked at 8,000 in 2006 and dropped to 6,660 in 2010. The total number of people living with HIV in the UK in 2010 was 91,500. Of these, About 9 in 20 resulted from men having sex with men and about 9 in 20 were due to heterosexual sex. HIV infection is much more common in many other countries in the world.

How does HIV cause problems in the body?

Once HIV is in your body the virus attaches to and gets into the CD4 T cells. The virus then uses the DNA (the genetic code inside the cell) to replicate (make copies of itself). As new virus particles break out of a CD4 T cell, the cell dies. The new virus particles then attach and enter new CD4 T cells and so the process continues. Millions of new virus particles are made in CD4 T cells each day and millions of CD4 T cells die each day.

To counter the virus destruction the body continues to make new CD4 T cells each day. However, over time, the virus usually wins and the the number of CD4 T cells gradually falls (usually over several years). Once the level of CD4 T cells goes below a certain level, your immune system is weakened. If your immune system is severely weakened by HIV infection then you are likely to develop various opportunistic infections. These are infections caused by germs which are commonly around us. You would not normally develop infections from these germs if you have a healthy immune system. A low level of CD4 T cells also increases the risk of developing other conditions which the immune system helps to prevent such as certain cancers.

What are the symptoms of HIV and AIDS?

Primary infection with HIV
When you first become infected with HIV it is known as the primary infection. About 8 in 10 people develop symptoms at this time. The three most common symptoms (sometimes known as the classic triad) are sore throat, fever and a blotchy red rash. Other symptoms can include feeling sick, diarrhoea, swollen glands, headache, tiredness and general aches and pains. The symptoms can last up to three weeks and are often just thought of as flu or a mild viral illness.

After the primary infection
After any primary infection settles, you can remain without any symptoms for several years. Early testing and treatment has revolutionised our concept of HIV infection which is now considered a long-term disease (see ‘What is the prognosis (outlook)?’, below). Even without treatment, there are often no symptoms for a long time (often up to ten years) and many people do not realise that they are even infected. However, the virus continues to multiply, the number of CD4 T cells tends to gradually fall and you can pass on the virus to others. During this time some people with HIV who are otherwise well may develop persistent swollen lymph glands (persistent generalised lymphadenopathy) or night sweats.

In time you may start to develop problems such as recurring mouth ulcers, recurring herpes or shingles infections, or seborrhoeic dermatitis (a skin condition caused by a yeast). Old tuberculosis (TB) infection may reactivate in some cases even before AIDS develops, especially in people in the developing world. Other symptoms of HIV that may occur before AIDS develops include diarrhoea, skin rashes, tiredness and loss of weight.

Symptoms of AIDS
The term AIDS is used to describe the most advanced stages of HIV infection and is being overtaken by the term late-stage HIV. People who are treated early in an HIV infection do not develop this stage. AIDS is a general term which includes various diseases which can result from a very weakened immune system. Typically, a person with AIDS has:

A very low level of CD4 T cells (around 200 cells per cubic millimetre of blood or below), and/or
One or more opportunistic infections such as Pneumocystis jirovecii pneumonia, severe thrush in the vagina or mouth, fungal infections, TB, Mycobacterium avium complex, toxoplasmosis, cytomegalovirus, etc. These infections can cause a range of symptoms including sweats, fever, cough, diarrhoea, weight loss and generally feeling unwell.
In addition, people with AIDS have an increased risk of developing other conditions such as:

Certain cancers. Kaposi’s sarcoma is a cancer which is usually only seen in people with AIDS. There is also an increased risk of developing cancer of the cervix and lymphoma.
An AIDS-related brain illness such as HIV encephalopathy (AIDS dementia).
A severe body wasting syndrome.
Many different symptoms can develop from the above conditions. Children with AIDS can develop the same opportunistic infections and problems as adults. In addition, they may also develop severe common infections of childhood such as severe ear infections or severe tonsillitis.

What tests are done?

Most sexual health clinics offer a rapid blood test for HIV and can give results within thirty minutes. Even if rapid testing is not available, the results are usually back within a week. Modern tests will pick up the infection a month after first being infected (as opposed to three months with the older tests). GPs can also arrange blood tests but the result will go on your health record. It is recommended that all gay and bisexual men should be tested every year, more often if they have anal sex without a condom, multiple partners, have been diagnosed with another sexually-transmitted disease or develop symptoms of primary or late-stage HIV.

Assessing the extent of disease
If you are confirmed to have HIV then your doctor may do a blood test to check the amount of virus in your blood (the viral load) and the number of CD4 T cells in your blood. These tests may be done from time to time to assess how far the disease has progressed (and the response to treatment).

Tests to diagnose AIDS-related conditions
There is no test for AIDS but you may have a range of other tests to detect opportunistic infections or other AIDS-related conditions. These will depend on the type of symptoms that you develop.

What is the treatment for HIV infection?

Although there is still no cure for HIV, treatment is now effective at allowing people with HIV to live their lives as normally as possible. Since the introduction of medicines to treat HIV, the death rates from AIDS has reduced dramatically. With effective treatment, very few people go on to develop AIDS.

It is not uncommon for people with HIV to feel low or even depressed, especially soon after the diagnosis is made. If you have any feelings of depression then you should speak to your doctor.

Treatment to tackle the virus itself
HIV is now a treatable medical condition and most people with the virus remain fit and well on treatment. Since the 1990s a number of medicines have been developed called antiretroviral medicines. Antiretroviral medicines work against HIV infection by slowing down the replication of the virus in the body. Newer medicines are more effective than medicines used in the past. There are several classes of these medicines which include: nucleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs), protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Newer classes of medicines have recently been introduced which are integrase inhibitors, fusion inhibitors and CCR5 antagonists. The medicines in each class work in different ways but all work to stop the HIV from replicating itself. This method of treatment is called antiretroviral therapy (ART). You may still occasionally see this referred to as highly active antiretroviral therapy or HAART.

There is a growing body of evidence that taking ART reduces the risk of passing the HIV infection on to others.

Taking three or more antiretroviral medicines at the same time, each attacking HIV at different points in its cycle of replication, is more effective than one or two medicines alone. Taking a combination of different medicines also reduces the risk that the virus will become resistant to any individual medicine. In 2008 the first one pill a day treatment was launched. Each pill contains three different medicines. This is popular, as it is convenient to take and has few side-effects.

The choice of medicines is considered and chosen for each individual patient. The treatment for HIV can be complicated but the majority of people diagnosed with HIV now take anti-retroviral treatment in a combination-format just once or twice a day. A team of healthcare professionals is usually involved in looking after you and giving you your treatment.

The aim of treatment is to reduce the viral load to low levels. In most people who are treated with ART, the viral load reduces to very low levels and the number of CD4 T cells rises. This means your immune system is no longer as weakened and you are not likely to develop opportunistic infections. However, it is vital to take the medication regularly and exactly as prescribed to maintain success, and to help to prevent the virus from becoming resistant to the medicines.

As with other powerful medicines, antiretroviral medicines can cause side-effects in some cases. In addition, some of these medicines can react with other commonly used medications. It may be necessary to change an initial combination of medicines to a different combination because of problems with side-effects, reactions or resistance of the virus to an initial medicine. Therefore, different people with HIV can often take different combinations of medicines. Common side-effects include nausea, vomiting and headaches.

When is treatment with antiretroviral medicines started?
As a general rule, antiretroviral medicines are usually started if:

Your CD4 T cells fall below a certain level (around 350 cells per cubic millimetre of blood or less) – even without symptoms. The exact level when treatment is started depends on various factors which your doctor will discuss with you. These include any symptoms present and the rate of decline of the CD4 T cells.
Opportunistic infections or other AIDS-related problems develop.
However, the treatment of HIV is a rapidly changing area of medicine. Trials are underway to assess whether antiretroviral medicines should be started earlier in people who have no symptoms, even as early as when first infected with HIV. The trials aim to show whether there are benefits from treatment before symptoms develop, which outweigh the risk of side-effects from the medicines. You are likely to have regular blood tests to monitor for side-effects whilst taking treatment.

Treatment and prevention of infections
Wearing a condom when having sex is very important to protect against other sexually transmitted infections, including herpes and hepatitis. People with HIV are usually vaccinated against hepatitis A and hepatitis B, influenza and the pneumococcus (a common cause of pneumonia).

Opportunistic infections are usually treated with antibiotics, antifungals or anti-TB medicines, obviously depending on which infection develops. Even if you have not developed an infection, once the CD4 T cells fall to a low level, you will normally be advised to take a regular dose of one or more antibiotics or other medicines to prevent certain opportunistic infections from developing.

How can infection with HIV be prevented?

There is no vaccine to prevent HIV. Development of one is proving to be very difficult, as the HIV virus is constantly mutating and changing. Therefore, the main way to prevent infection by HIV is to avoid activities that put you at risk, such as sharing needles and having sex without a condom.

Some cases of HIV can be prevented in other ways – for example:

If you are an injecting drug user then do not share needles or other injecting equipment. If available, use local needle exchange schemes.
If you think they have been exposed to HIV through sharing needles or sexual contact you should contact your GP or a sexual health clinic as soon as possible. If it is thought that there is a high risk that you may pick up the infection you will be offered a course of anti-HIV medicines. These are most effective when taken as soon as possible after exposure and certainly within 72 hours.
Healthcare workers should follow local guidelines to reduce the chance of needlestick injury. If you do have an injury, see your occupational health specialist urgently. A course of anti-HIV medicines started as soon as possible and no later than 72 hours after the injury may prevent infection with HIV developing.
If you are pregnant and have HIV infection then you need special antenatal care to reduce the risk of passing on the virus to your baby. HIV treatments can be taken during pregnancy. An HIV test is offered to all pregnant women in the UK.
What is the prognosis (outlook)?

People with HIV who are diagnosed in good time can expect to lead a near-normal lifespan. A study to predict the life-expectancy of men infected with HIV at 30 years of age in 2010 found that they could expect to live to 75, based on access to current treatments. Those who are diagnosed late (with a CD4 count below 350 – the point at which treatment should commence), are more likely to have a poor prognosis. However, even when someone has been diagnosed with a low CD4 count, treatment can effectively bring them back to a good level of health. Life expectancy also depends on other factors such as smoking, alcohol intake and use of other medicines.

In short – for people who have access to modern medicines, the outlook (prognosis) has improved greatly in recent years.

Further help and information

HIV aware
Web: http://www.hivaware.org.uk
Developed by NAT, the website provides all the basic facts about HIV plus additional information and real stories from people living with HIV.

National Aids Trust
New City Cloisters, 196 Old Street, London, EC1V 9FR
Tel: 020 7814 6767 Web: http://www.nat.org.uk
Aims to promote a wider understanding of HIV and AIDS, develop and support efforts to prevent the spread of HIV and improve the quality of life of people affected by HIV and AIDS.

Terrence Higgins Trust
314-320 Grays Inn Road, London, WC1X 8DP and various offices around the country (see website)
Tel: 0808 802 1221 for an adviser or 020 7812 1600 for switchboard Web: http://www.tht.org.uk
A national HIV and sexual health charity. Their helpline offers information and support to anyone living with HIV, affected by HIV indirectly or concerned about their sexual health.Once you’re infected with the HIV virus, it most commonly attacks your T-cells, which are also known as CD4 cells. When one of these cells is infected, and if it is untreated, it goes through several steps to reproduce and copy itself to create more of the virus.

The HIV life cycle process is commonly broken up into the following steps:

Binding and Fusion:

This is the process by which HIV binds to a specific type of CD4 receptor (a protein present on the outside of infection-fighting white blood cells, CD4 receptors allow HIV to fuse to and enter cells) and one of two co-receptors (another protein, one known as CCR5 and the other known as CXCR4) on the surface of the CD4 cell. Once this occurs, HIV can fuse with the host cell (CD4 cell) and release its genetic material, its RNA, into the host cell.

HIV drugs that are used to block this particular step are called Entry Inhibitors. Entry Inhibitors work by preventing HIV from entering healthy T-cells. There are currently two FDA approved Entry and Fusion Inhibitors – Selzentry and Fuzeon.

Reverse Transcription:

An enzyme called Reverse Transcriptase changes the genetic material of the virus (from single-stranded HIV RNA to double-stranded HIV DNA) so it can be integrated into the host DNA.
This Reverse Transcription process can be blocked by two HIV drug categories: Nucleoside Reverse Transcriptase Inhibitors (NRTIs or Nukes) and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs or Non-Nukes).

There are currently 7-different NRTIs approved for use by the FDA, two of which are considered “Preferred” – Emtriva and Viread.

Four different NNRTIs are approved by the FDA. The “Preferred” drug in this category is Sustiva.

The drugs in these two categories are also co-formulated with drugs from other HIV-fighting categories in single-pill regimens such as Atripla, Complera and Stribild or combination pill regimens like Truvada.

Integration:

The virus’ new genetic material enters the nucleus of the CD4 cell and uses an enzyme called Integrase to integrate itself into the host cell’s own genetic material, DNA, where it may “hide” and stay inactive for several years producing few or even no new copies. This integrated HIV DNA is called Provirus.

The drugs in this HIV drug category that are meant to stop this process are called Integrase Inhibitors. Isentress is “Preferred” by the FDA but 2 new drugs are awaiting approval in this category – one of which, Elvitegravir, is already present in single pill, once-daily Stribild.

Transcription:

When the host cell receives a signal to become active, the provirus uses a host enzyme called RNA polymerase to create copies of the HIV genetic material and shorter strands of RNA called messenger RNA (mRNA). The mRNA is used as a blueprint to make long chains of HIV proteins.

Assembly:

An enzyme called Protease cuts the longer HIV proteins into individual proteins. As the smaller HIV proteins come together with copies of HIV’s RNA genetic material, a new virus particle is assembled.

This viral assembly can be blocked with the HIV drug category called Protease Inhibitors. There are currently 8-drugs approved by the FDA in this category. Reyataz and Prezista are listed as “Preferred” in this category.

Budding:

This is the final stage of the virus’ life cycle. The virus pushes itself out of the host cell, creating “buds,” taking with it part of the membrane of the cell. This outer part covers the virus and is covered with protein/sugar combinations called HIV glycoproteins. These HIV glycoproteins are necessary for the virus to bind CD4 and co-receptors. The new copies of HIV can now move to infect other cells.

STAGES OF HIV

The HIV virus has a progression. It’s important to understand that if you are infected with HIV, you don’t have Acquired Immune Deficiency Syndrome (AIDS). However, if you don’t get treatment, HIV will eventually overtake your immune system—and this will lead to your being diagnosed with AIDS. Here are the common stages of untreated HIV:

Acute Infection:

Within 2-4 weeks after being infected with HIV, you can experience an acute illness that can often feel like severe flu symptoms. This is called Acute Retroviral Syndrome (ARS) or Primary HIV Infection and it’s the body’s natural natural response to fighting the HIV infection. According to the U.S. Department of Health and Human Services, not everyone develops ARS and it can take up to 3 months for it to appear in some people.

During this period of infection, large amounts of virus are being produced. The virus uses CD4 cells to replicate and destroys them in the process. Because of this the CD4 count can fall rapidly. Eventually the immune response will begin to bring the level of virus back down to a level called a Viral Set Point, which is a relatively stable level of the virus. At this point, the CD4 count begins to increase, but it may not return to pre-infection levels.

Clinical Latency:

After the acute stage of HIV infection, the disease moves into a stage called Clinical Latency. This period is also called Asymptomatic HIV Infection or Chronic HIV Infection. During this stage, HIV reproduces at very low levels, although it is still active. An undetectable viral load and a healthy CD4 cell count may be maintained during the earlier years of this phase. There may not be symptoms. This period can last up to 8 years or longer.

While some people progress through this phase faster than others, it is important to remember that HIV is still able to be transmitted to others during this phase.
Toward the middle and end of this stage, the viral load will begin to rise and the CD4 cell count will begin to drop. When this happens, their may be constitutional symptoms of HIV (fever, night sweats, weight loss and fatigue) as the virus levels increase.

AIDS:

If the number of CD4 cells falls below 200 cells per cubic millimeter of blood or an opportunistic infection is developed, a person is considered to have AIDS. A normal CD4 count is between 500 and 1,600 cells/mm3. This is the stage of infection that occurs when your immune system is badly damaged and you become vulnerable to opportunistic infections. At this stage, it is important to know that treatment is still absolutely possible yet extremely urgent.

Aidsmap website
Web: http://www.aidsmap.com
A comprehensive web-based resource on matters relating to HIV and AIDS.

Averting AIDS and HIV (AVERT)
Web: http://www.avert.org
An international HIV and AIDS charity with lots of useful information on its website.
Tel: 01403 210202 or email info@avert.org.

References | Provide feedback
Original Author: Dr Tim Kenny Current Version: Dr Laurence Knott Peer Reviewer: Dr John Cox
Last Checked: 15/03/2012 Document ID: 4832 Version: 39 © EMIS
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

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cure for HIV is now a a realistic possibility

This week in Paris, the world’s leading Aids scientists will gather to mark the 30th anniversary of the discovery of HIV. At least one of them, who won the Nobel Prize for her work, is quietly confident that very soon something approaching a cure for HIV will be possible.
Françoise Barré-Sinoussi believes that HIV is no longer the invincible agent she and her colleagues had once imagined. In fact, she speaks openly of the “C” word, which for years was taboo among HIV researchers.
“Normally when you say ‘cure’, you mean eradication of the virus from the body,” she says. “But this is going to be very difficult, not to say impossible. However, there is another definition of cure, which is a ‘functional cure’. This means people can be treated with drugs or whatever, and they will be able to stop their treatment and continue to control the virus without treatment. It is like remission in cancer. As part of this control we will limit the capacity of patients to transmit HIV to others, so there is a double benefit.”
Since the early 1980s, HIV is estimated to have infected 60 million people worldwide, claiming the lives of about 25 million who have died of Aids-related illnesses. Anti-retroviral drugs have dramatically changed the outlook for people with HIV. In the past, infection was almost always followed a few years later by Aids and death. Now, with life-long drug treatment, most patients can expect a near-normal life expectancy. But a cure for HIV has not, until recently, been considered a realistic possibility. The strengths of the virus were believed to be too overwhelming.
“We are clearly making progress in understanding the early phase of HIV infection, the establishment of the [viral] reservoir and the mechanism of latency,” she says. “As a result, in the coming years I am convinced we will have wonderful progress in terms of treatment for patients.”
For 30 years, virologists have marvelled at the apparent unassailability of this tiny, viral speck of genetic material that can bring down a person’s immune defences so completely.
Dr Barré-Sinoussi, working with her colleague at the Pasteur Institute in Paris, Luc Montagnier, with whom she shared the Nobel Prize, isolated the virus in 1983 from a French patient’s lymph tissue. In their scientific paper, published later that year, they tentatively called the virus lymphadenopathy associated virus (LAV) to reflect this fact.
A year later, in 1984, an American team led by Robert Gallo of the US National Cancer Institute announced the discovery of another “Aids virus”, which they called HTLV-3. After an acrimonious legal dispute, it was finally agreed that the discovery was a joint effort – although the fact that Dr Gallo was excluded from the 2008 Nobel Prize shows that the French had scientific primacy. Dr Barré-Sinoussi said that scientific collaboration in HIV research is critical to finding a functional cure.
Recent omens have been promising. For a start, there is the “proof of concept” in the form of the “Berlin patient”, an American gay man in Germany, who in 2007 was given a bone marrow transplant that appears to have cured him of HIV. The transplant donor had a mutation in a gene called CCR5, which is known to confer resistance to HIV. People carrying such mutations, who number fewer than 1 per cent of the population, are known as “elite controllers” because they seem to control HIV without letting it progress to Aids. “They are HIV-positive but have not had any treatment for up to 15 years, and they are naturally able to control their infection,” Dr Barré-Sinoussi says.
More recently, French doctors have identified a group of 14 HIV-positive people, known as the Visconti patients, who similarly are able to survive the withdrawal of drugs for long periods without developing signs of Aids.”They were treated very early after infection,” she explains. “It has now been more than seven years since they stopped their treatment, and they have a very low viral reservoir.”
This is why she and some of her colleagues are confident that at some point in the next 30 years we will see a functional cure for HIV. “I have no idea when, but I do know that if we work together in an integrated way it will be faster.”
At which point one can’t but ask whether she has a collaborative relationship with Robert Gallo. “My relationship with Gallo? I know where you want to go, but I will not answer the question. I mean I have a good relationship personally with Bob. I’ve no problem at all.”

Mr. Cyrus P. Mistry appointed Deputy Chairman of Tata Sons

 

The Board of Directors of Tata Sons at its meeting today appointed Mr. Cyrus P. Mistry as Deputy Chairman. He will work with Mr. Ratan N. Tata over the next year and take over from him when Mr. Tata retires in December 2012. This is as per the unanimous recommendation of the Selection Committee.

 

Endorsing the appointment, Mr. Ratan N. Tata, Chairman of Tata Sons, said:

 

“The appointment of Mr. Cyrus P. Mistry as Deputy Chairman of Tata Sons is a good and far-sighted choice.

 

He has been on the Board of Tata Sons since August 2006 and I have been impressed with the quality and caliber of his participation, his astute observations and his humility. He is intelligent and qualified to take on the responsibility being offered and I will be committed to working with him over the next year to give him the exposure, the involvement and the operating experience to equip him to undertake the full responsibility of the Group on my retirement.”

 

Mr. Cyrus P. Mistry, currently Managing Director, Shapoorji Pallonji Group, has been a Director of Tata Sons since August 2006. He is a graduate of Civil Engineering from Imperial College, London, and has a Master of Science in Management from the London Business School.

 

 

About the Tata Group

The Tata Group comprises over 100 operating companies in seven business sectors: communications and information technology, engineering, materials, services, energy, consumer products and chemicals. The group has operations in more than 80 countries across six continents, and its companies export products and services to 85 countries. The total revenue of Tata companies, taken together, was $83.3 billion (around Rs379,675 crores) in 2010-11, with 58 per cent of this coming from business outside India. Tata companies employ over 425,000 people worldwide. The Tata name has been respected in India for 140 years for its adherence to strong values and business ethics. Every Tata company or enterprise operates independently. Each of these companies has its own board of directors and shareholders, to whom it is answerable. There are 31 publicly listed Tata enterprises and they have a combined market capitalisation of about $77.44 billion (as on November 17, 2011), and a shareholder base of 4.3 million. The major Tata companies are Tata Steel, Tata Motors, Tata Consultancy Services (TCS), Tata Power, Tata Chemicals, Tata Global Beverages, Indian Hotels, Tata Communications, Tata Teleservices and Titan.

Ratan Tata’s successor: Cyrus Mistry to lead Tata Group

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Tata Group today announced its new boss of Tata group. The 46-year-old Cyrus Mistry will take over reins of the company from Ratan Tata in 2012. Mistry will work with Ratan Tata for one year and take over in Decembe 2012.

TNN | Nov 23, 2011, 06.11PM IST

MUMBAI: Tata Sons, the holding company of over $80 billion conglomerate Tata Group, announced that Cyrus P Mistry, the 43-year-old MD of Shapoorji Pallonji Group, will succeed Ratan Tata.

“The board of directors of Tata Sons at its meeting today appointed Cyrus P Mistry as the deputy chairman. He will work with Ratan N Tata over the next year and take over from him when Tata retires in December 2012,” Tata Sons said in a statement.

This is as per the unanimous recommendation of the selection committee, it added.

Shapoorji Pallonji Group holds 18 per cent stake in Tata Sons.

Commenting on the appointment, Ratan N Tata, Chairman of Tata Sons, said: “The appointment of Cyrus P Mistry as Deputy Chairman of Tata Sons is a good and far-sighted choice.

“He has been on the Board of Tata Sons since August 2006 and I have been impressed with the quality and calibre of his participation, his astute observations and his humility.”

Tata further said: “I will be committed to working with him over the next year to give him the exposure, the involvement and the operating experience to equip him to undertake the full responsibility of the Group on my retirement.”

Born on July 4, 1968, Mistry graduated from the Imperial College, London with a BE in civil engineering. He also holds a masters degree in management from the London Business School, and is a fellow of the Institution of Civil Engineers. Apart from the Tata Group, he also serves as a director on the board of several other companies, including Shapoorji Pallonji & Co, Forbes Gokak, Afcons Infrastructure and United Motors (India). At 38, he was one of the youngest directors of the company, set up as a trading firm in 1868.

The Mistry family continues to hold a valuable 18% stake in Tata Sons and Pallonji Mistry has been board member for a long time. His father Shapoorji Pallonji Mistry bought 12.5% from the FE Dinshaw Estate some time in the 1930. He later acquired more stake from other Tata family members, taking his holding to about 16.5%.

JRD Tata, who was appointed Tata group chairman in 1938, was incensed. But cooler heads prevailed and the two families decided to let the matter subside and maintain a cordial relationship. Pallonji Mistry, who took over from his father in the 1970s, built on that and his daughter Aloo Mistry’s marriage to Noel Tata, Mr Ratan Tata’s step-brother, seemed to indicate that relations were on a normal level.

Pallonji Mistry’s family is the biggest non-Tata shareholder in Tata Sons. In the early 1990s, he invested over Rs 60 crore of his own money in the Tata Sons rights issue to maintain his stake in the company. The other major shareholders of Tata Sons are the Tata Trusts and some of the Tata group companies.

Cyrus Mistry’s appointment ends a long suspense over who will take Pallonji Mistry’s position on the board. The elderly, soft-spoken construction magnate had wanted one of his sons to be nominated, but the Tata group and Ratan Tata in particular had not taken a decision on it for a long time.

In ’05, Ratan Tata told a business daily that “Mr Mistry has no right of nomination. If there were a member of the Mistry family that comes on the board, it would be to represent the shareholding – if we chose to make that happen. Mr Mistry himself came on the board, we recognised him as the largest shareholder (of Tata Sons). (Inputs from PTI)

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