Females who abused opioids were nearly eight times more likely to die of suicide.

Veterans that abuse prescribed sedatives in addition to alcohol are four times more likely to die from suicide if they’re men and eleven times more likely if they’re female, according to a new study published in Addiction.

Narrowing it down more, females who abused opioids were nearly eight times more likely to die of suicide.

“There is an opiate crisis in America, including among our veterans, and this paper provides evidence that opiate addiction and suicide are strongly linked,” Rajeev Ramchand, a researcher in military mental health and suicide prevention at Rand Corporation who wasn’t involved with the study, told Reuters.

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Reuters reports the medical information and death records of more than 4.4 million veterans who received care through the Veterans Health Administration were examined in the study. During the two-year study, 9,087 veterans died from suicide, which translated to a suicide rate of 34.7 cases per 100,000 person-years. Of those who suffered from substance-abuse problems, the suicide rate spiked to 75.6 cases per 100,000 person years.

From Reuters:

After researchers accounted for veterans’ age and the severity of any medical conditions, the increased risk of suicide associated with substance abuse diminished somewhat but remained meaningful in most cases.

Once researchers also factored in mental health diagnoses, however, the findings changed. Differences between men and women diminished, and only alcohol and opioid misuse remained associated with an elevated suicide risk for female veterans.