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Background Suicide remains a major public health problem in the United States. The purpose of this study was to examine trends in suicide ideation, planning, and attempts among a national sample of US adults. Method We used aggregated 2015-2018 data from the National Survey Drug Use and Health Survey. We utilized demographic and substance use questions with each suicide behavior. We assessed weighted absolute and relative changes in a national sample of 7,654 adults. Results Results revealed that from 2015 to 2018, there was a 16.0% incr