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As co\u2010use 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from all states reporting opioid\u2010related 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\u2010only 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\u2010level covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>There were 3,781 opioid\u2010overdose suicide decedents (42% female) tested for all 3 substances during the study period. Unadjusted prevalence of positive screens in decedents varied across rurality (<jats:italic>P<\/jats:italic> = .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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Rural suicides are associated with increased opioid and benzodiazepine positive screens. These findings suggest the need for rural\u2010focused interventions to support appropriate co\u2010prescribing, better health education for providers about risks associated with drug mixing, and more linkages with mental health services.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12574","type":"journal-article","created":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T08:25:14Z","timestamp":1617611114000},"page":"77-86","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Postmortem screening of opioids, benzodiazepines, and alcohol among rural and urban suicide decedents"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5494-0810","authenticated-orcid":false,"given":"Kara Marie Kubiak","family":"Bensley","sequence":"first","affiliation":[{"name":"School of Public Health University of California  Berkeley California USA"},{"name":"Alcohol Research Group Public Health Institute  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