A new study indicates that there is a geographic relationship between support for Trump and prescriptions for opioid painkillers. The study, published in the medical journal JAMA Network Open, says that the counties and states with highest opioid use were often areas carried by the Republican candidate in the election.
The similarities between the places hit by the opioid epidemic and a map of Trump strongholds is easy to see. The fact that rural, economically disadvantaged parts that supported the Republican candidate in the year 2016 is well known.
D. James S. Goodwin, the study's lead author and chair of geriatrics at the University of Texas Medical Branch in Galveston says, "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."
He says, "There were blogs from various people saying there was this overlap. But we had national data."
Goodwin and his team took the 2016 election data from Census Bureau, and Medicare Part D, a prescription drug program which serves the disabled and elderly.
How did they estimate?
To estimate the opioid usage in a county, the researchers took the percentage of enrollees who received prescriptions supply of opioids for three-month or longer.
Goodwin says illicit opioid use is hard to quantify as much of the use is fuelled by physician prescribing habits.
Goodwin says, "There are very inexact ways of measuring illegal opioid use. All we can really measure with precision is legal opioid use."
With about half of opioid-related deaths caused by prescription opioids, a county's opioid use could be influenced by many factors.
Goodwin's team examined how those factors could have influenced the rate of chronic opioid prescriptions.
Factors taken into consideration
Demographic variables such as age and race, the team closely tracked opioid prescriptions. In counties where there were higher-than-average opioid prescriptions, 60 percent of the voters favoured Trump. In counties with lower-than-average rates, only 39 percent voted for Trump.
The difference between the counties could be due to social factors and economic woes. Rural counties and economically-depressed voters went strongly for Trump in the 2016 election.
So, the support for Trump and opioid use might not be directly related but it just shows the symptoms of the same problem - lack of economic opportunity.
To prove this factor, Goodwin and his team included other county-level factors in the study. Factors included median income, unemployment rate, how rural the county is, education, and religious service attendance among others.
These socio-economic factors were about two-thirds responsible for the correlation between the support for Trump and opioid rates. But not all correlation can point only to socio-economic factors.
"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. You want something different. You want radical change," Goodwin says.
Counties with the high opioid epidemic may have wanted unconventional Trump candidacy to win.
Dr. Nancy E. Morden, associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, says it is true.
She said, "People who reach for an opioid might also reach for ... near-term fixes. I think that Donald Trump's campaign was a promise for near-term relief."
The study has limitations and cannot be a definitive proof of the correlation between opioid use and Trump support.
Elene Kennedy-Hendricks, an assistant scientist in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health warns, "With that kind of study design, you have to be cautious in terms of drawing any causal conclusions. The directionality is complicated."
The study indeed has some shortfalls agrees Goodwin.
"We were not implying causality, that the Trump vote caused opioids or that opioids caused the Trump vote. We're talking about associations."
Of course, the study can give a broad view of the links between social issues, economic opportunity, and political views.
"The types of discussions around what drove the '16 election, and the forces that were behind that, should also be included when people are talking about the opioid epidemic," Goodwin says.