New Study Finds Geographic Overlap In Opioid Use And Trump Support In 2016

A new cross-sectional study of socioeconomic measurements at a county level and a national sample of Medicare claims discovered that chronic use of prescription opioids was highly correlated with support for Donald Trump in the 2016 presidential election.

According to the study titled “Association of Chronic Opioid Use With Presidential Voting Patterns in US Counties in 2016,” which was published in the Journal of the American Medical Association (JAMA) on June 22, researchers from the University of Texas Medical Branch discovered that Trump won about 60 percent of the vote in the 693 counties with the highest rates of opioid use (90-day supply or more Medicare opioid prescriptions). Trump won 39 percent of the 2016 vote in the 638 counties with the lowest rates of long-term opioid use.

Figure 1. Opioid Use and Voting Patterns by County 

(A) 2015 Long-term opioid use by county

“The first map shows the percentage of older Medicare beneficiaries who had an opioid supply covering more than 90 days in 2015, ordered by quintile at the county level. Approximately 1 in 5 counties had long-term opioid prescribing rates greater than 20.10%, while a similar proportion had rates of less than 10.85%. Counties with the highest rates were predominately concentrated in the South and Appalachian areas, as well as Michigan and some western states.”

(B) 2016 Percentage Trump vote by county

“The second map shows the percentage of the presidential vote for the Republican candidate for each county, also ordered by quintile. The 2 maps share some similar patterns….Counties in the Great Plains states and also in the Deep South were more likely to be discordant in the 2 measures.

These illustrations from the study, depict rates of long-term opioid use and the 2016 Trump vote share at the county level, which reveals some correlation. Specific regions of the country, including parts of Appalachia, Rust Belt, Southern and Western United States show a strong relationship on both maps.

Some regions lacked parallelism between both maps, including much of the Northern Plains (low opioid rates, high Trump support) and the Southern United States (high opioid rates, low Trump support).

“When we look at the two maps, there was a clear overlap between counties that had high opioid use … and the vote for Donald Trump,” said Dr. James S. Goodwin, chair of geriatrics at the University of Texas Medical Branch in Galveston and the study’s lead author.

“It very well may be that if you’re in a county that is dissolving because of opioids, you’re looking around and you’re seeing ruin. That can lead to a sense of despair,” Goodwin said. “You want something different. You want radical change.”

The study suggests an association at the county level. And the overlap, Goodwin and other researchers said, could indicate that people who have been left behind in collapsing deindustrialized regions, may have a higher probability of supporting candidates promising light at the end of the tunnel.

Dr. Nancy E. Morden, associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, agrees. “People who reach for an opioid might also reach for … near-term fixes,” she said. “I think that Donald Trump’s campaign was a promise for near-term relief.”

“Trump tapped into something in that segment of voters,” said Katharine Neill Harris, a drug policy fellow at the Baker Institute, a nonpartisan think tank at Rice University in Houston.

“It’s about more than just prescriptions,” she said. “This is a very complex relationship, and representative of a deeper problem … of problems we are not addressing as a society.”

The study serves as an example highlighting the links between socioeconomic issues and voting patterns. With that being said, in periods of populist anger, the cause of that anger better be resolved in a timely fashion; otherwise, a backlash by the supporters could be seen. Let’s hope this does not happen, as a recession inches closer.