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Background Past research shows that individuals with opioid use disorder (OUD) have a higher rate of co-occurring mental health conditions, but little research has examined suicidal behavior (suicidal ideation and/or attempts) and utilization of behavioral health services among individuals with OUD using a nationally representative sample. Methods Using the 2015–2018 National Survey of Drug Use and Health, this study examines the risk of suicidal behavior among individuals with OUD. In addition, the study examines how utilization of behavioral health treatment among individuals with OUD might mitigate the risk of suicidal behavior. Results The rate of suicidal behavior was higher among individuals with OUD (22%) than among those without OUD (4%). Among those with OUD, 43% reported receiving neither substance use disorder nor mental health treatment. Multivariable logistic regression estimates indicate that individuals with OUD had odds of suicidal behavior 2.9 times as high as those without OUD. Odds of suicidal behavior among people with OUD were 49% lower with substance use disorder treatment, 5% lower with mental health treatment, and 28% lower with both. Conclusion Individuals with OUD have a high risk of suicidal behavior, which can be mitigated with utilization of behavioral health treatment. These findings underscore the importance of policy initiatives directed at increasing treatment utilization among those with OUD.