Postmortem screening of opioids, benzodiazepines, and alcohol among rural and urban suicide decedents

Abstract

Purpose Fatal suicides involving opioids are increasingly common, particularly in rural areas. As co‐use of opioids with other substances contributes significantly to mortality risk, we examined whether positive screens for opioids with other substances is more prevalent among rural versus urban suicide deaths, as this could have implications for public health strategies to reduce overdose suicides. Methods Data from all states reporting opioid‐related overdose suicides in the National Violent Death Reporting System from 2012 to 2015 were used. Relative risk ratios were obtained using multinomial logistic regression, comparing opioid‐only to (1) opioid and alcohol, (2) opioid and benzodiazepines, and (3) opioid, alcohol, and benzodiazepines suicides across rurality. Models were fit using robust standard errors and fixed effects for year of death, adjusting for individual, county, and state‐level covariates. Findings There were 3,781 opioid‐overdose suicide decedents (42% female) tested for all 3 substances during the study period. Unadjusted prevalence of positive screens in decedents varied across rurality (P = .022). Urban decedents were more likely to test positive for opioids alone, while rural decedents were more to likely test positive for opioids and benzodiazepines. Conclusions Rural suicides are associated with increased opioid and benzodiazepine positive screens. These findings suggest the need for rural‐focused interventions to support appropriate co‐prescribing, better health education for providers about risks associated with drug mixing, and more linkages with mental health services.

Trends in mortality from alcohol, opioid, and combined alcohol and opioid poisonings by sex, educational attainment, and race and ethnicity for the United States 2000–2019

“…In this study, we were only able to explore differences by educational attainment and race and ethnicity. Future work should consider other demographic factors, including additional facets of socioeconomic status, specific age groups, and urban vs. rural locations [ 31 ]. The results of this study are only applicable to a US context and would not be generalizable to other countries with differing socioeconomic inequalities and access to healthcare.…”

Medical Psychotropics in Forensic Autopsies in European Countries: Results from a Three-Year Retrospective Study in Spain

“…In this regard, in 2014, 32% of suicides tested positive for opiates in the United States [6]. Furthermore, in Australia, BZDs were described as being found in 13.2% of homicide and suicide deaths [7].…”