Simultaneous Co-use of Opiate: Benzodiazepine and Alcohol Among Rural and Urban Suicide Decedents

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Acknowledgements: Contributors to this report included participating Violent Death Reporting System states; participating state agencies, including state health departments, vital registrars’ offices, coroners’ and medical examiners’ offices, crime laboratories, and local and state law enforcement agencies; partner organizations, including the Safe States Alliance, National Violence Prevention Network, National Association of Medical Examiners, National Association for Public Health Statistics and Information Systems (NAPHSIS), Council of State and Territorial Epidemiologists (CSTE), and Association of State and Territorial Health Officials; federal agencies, including the Department of Justice (Bureau of Justice Statistics and the Federal Bureau of Investigation), the Department of the Treasury (Bureau of Alcohol, Tobacco, and Firearms); the International Association of Chiefs of Police; other stakeholders, researchers, and foundations, including The Joyce Foundation, the National Institute for Occupational Safety and Health, and the National Center for Health Statistics, CDC..

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Disclaimer: This research uses data from NVDRS, a surveillance system designed by the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control. The findings are based, in part, on the contributions of the 42 funded states and territories that collected violent death data and the contributions of the states’ partners, including personnel from law enforcement, vital records, medical examiners/coroners, and crime laboratories. The analyses, results, and conclusions presented here represent those of the authors and not necessarily reflect those of CDC. Persons interested in obtaining data files from NVDRS should contact CDC’s National Center for Injury Prevention and Control, 4770 Buford Hwy, NE, MS F-64, Atlanta, GA 30341-3717, (800) CDC-INFO (232-4636). The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute on Alcohol Abuse and Alcoholism, the National Institutes of Health, CDC, or the American Public Health Association.

Funding: This study was supported by a New Investigator Award to Dr. Bensley from the American Public Health Association. Authors were also supported by two grants from the National Institute of Alcohol Abuse and Alcoholism: T32AA007240, Graduate Research Training in Alcohol Problems: Alcohol-related Disparities, and P50AA005595, Epidemiology of Alcohol Problems: Alcohol-Related Disparities, both from the National Institute on Alcohol Abuse and Alcoholism.

Abstract (limit 250 words): 242

Manuscript (limit 4000 words): 3487


  • Rural (vs. urban) decedents had greater risk of opiates and benzodiazepines
  • No differences in alcohol and opiate co-use across rurality
  • No differences in benzodiazepine, alcohol, and opiate co-use across rurality
  • Simultaneous co-use among suicide decedents also varied by region


Background: Fatal suicides involving opiates are increasingly common, particularly in rural areas. While co-use in addition to opiates contributes significantly to mortality risk, it is unknown whether the prevalence of co-use relative to opiate-only deaths varies across rurality.

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