Gaps in crises of mental health emerge from poor distinction between the qualities of people who suicide and those who murder and then kill themselves. The role, if any, that substance use has in such lethal violence is an example of such a lack of distinction. In this study, a sample of medical examiner investigative and toxicology reports from Los Angeles and Orange counties in California were available for analysis for 432 suicide cases and 193 homicide-suicide cases. This informed clearer toxicological and pharmacological distinction of suicide from homicide-suicide. Blood alcohol levels were higher in persons committing suicide than in homicide-suicide perpetrators (p=.004). Homicide-suicide perpetrators had almost twice the level of stimulants in their system than people who suicide (p=.022) but did not have comparatively elevated levels of drugs or alcohol. Predictors of suicide included the following: substance abuse history, high number of drugs in system, death inside a house, and legal impairment by alcohol. Predictors of homicide-suicide included gunshot as the cause of death, female gender, domestic conflict, children living in the home, and prior arrest for substance abuse.
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