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Suicides in Geneva in those less than 25 years old, from 1993 to 2002, were reviewed. Scenes investigations, autopsy findings, toxicology results, and psychiatric history (when available) were examined. There were 65 cases. The average annual suicide rate was 11/100,000. Seventy-seven percent were male, and 23% were female. The youngest was 12 years old and most of the victims were 18 years old and over (89%). For men, the use of firearms was the most common method (38%), followed by fall from height (16%) and drowning (10%). For women, fall from height was the most frequent (40%), followed by firearms and medication overdoses (20% each), hanging (13%), and drowning (7%). Toxicological analysis was performed in 41% of the cases and showed that alcohol was present in 26% and other drugs in 67% of these cases. The most common drugs present were benzodiazepines, cannabis, and cocaine.

Suicides due to fall from height in Geneva from 1991 to 2000 were reviewed. Scene investigations, autopsy findings, psychiatric histories, and toxicology results were examined. There were 197 of these suicides, an incidence of five cases per 100,000 inhabitants per year or one fourth of all suicides in Geneva per year. Autopsies were performed on 33%, the rest had external examinations. Of the victims, 56% were female and 44% were male. The age distribution peaked at 20-29 years in men and 60-69 years in women. Most of the victims jumped from their home, the range of 2 to 7 stories being the most frequent height. Major injury sites, in decreasing frequency, were the thorax, abdomen, skull, vertebrae, pelvis and limbs. Psychiatric illness was reported in 38% of the cases. Toxicological analysis was performed in 25% of the cases and showed that the main drugs present were benzodiazepines, cannabis and antidepressant.

Aims: To estimate the number of methadone lethal intoxications in Geneva from 1994 to 1998, where the number of patients in methadone treatment has more than doubled since 1990., Design: Retrospective study of all toxicological, autopsy and clinical data., Setting: The Geneva Department of Forensic Medicine., Participants: All suspected overdose deaths in Geneva from 1994 to 1998. Cases were selected on the basis that the only cause of death was a potentially lethal drug concentration in the postmortem blood sample., Measurement: Toxicology and autopsy findings, clinical and drug history., Findings: There were 106 lethal drug intoxications over the period. The overall number of drug intoxication deaths went from 33 in 1994 to nine in 1998. Thirty-six cases had methadone identified in their blood. All the 36 cases but one had medications or other drugs used illicitly present in the blood or urine. Of these 36 cases, 21 were attributed to methadone lethal intoxication. Only seven of these 21 decedents were enrolled in a methadone programmes. The number of deaths attributed to methadone intoxication ranged from three to five per year., Conclusion: Most lethal methadone intoxication is due to diverted or illegal methadone in association with medications or other drugs used illicitly. Furthermore, the increase in methadone prescription under strict medical control with health measures aimed at drug abuse prevention did not lead, in our study, to an increase of methadone lethal intoxication and may have been partly responsible for the large decrease of overall drug intoxication deaths during the time of our study.

Methadone treatment for heroin addiction has followed three distinct periods in Geneva, Switzerland. The first period (1970-1979) corresponds to the beginning of the heroin addiction epidemic. Treatment was restricted to detoxification and did not succeed in reducing fatal overdoses. During the second period (1980-1989), methadone maintenance program was favoured but access to this program was limited. This period has brought a decrease of illegal heroin consumption and criminality but not of fatal overdoses. Finally, during the third period (since 1990), legislation was changed to allow easier access to methadone maintenance program. As a consequence there was a significant drop in lethal heroin overdoses and in deaths attributed to HIV.