Drug overdose death rates were higher in urban counties than in rural counties from 2016 to 2019, a new government report finds.

In 2019, the rate of drug overdose deaths was 22 per 100,000 people in urban counties, compared with 19.6 per 100,000 in rural counties, according to U.S. News & World Report.

The types of drugs most commonly involved in overdose deaths were different in urban and rural counties. Rates for drug overdose deaths involving heroin or cocaine were higher in urban areas between 1999 and 2019. Rates for deaths involving synthetic opioids such as fentanyl were similar or slightly higher for rural counties through 2014, but higher for urban counties starting in 2015. Deaths involving meth have been higher in rural counties since 2012.

“The big player still in these more recent times has been synthetic opioids,” said report co-author Dr. Holly Hedegaard of the Centers for Disease Control and Prevention. “There’s been a lot of focus on the opioids, but the reality is there are some other drugs in our communities that warrant some attention as well.”