Drug prices are the most important issue.

America’s opioid epidemic has rocked communities across the country. New evidence suggests that it has had an outsize role in shaping today’s political landscape, too. Drug-related deaths over the past two decades appear to have pushed the electorate to the right and helped Republican candidates in several elections.

Establishing that relationship is tricky. Some factors, such as worsening economic conditions, have been found to increase votes for conservatives and, separately, increase drug use. To try to isolate the role of the epidemic on voting, Carolina Arteaga and Victoria Barone, respectively economists at the University of Toronto and the University of Notre Dame, started by looking at areas where opioids had been heavily prescribed when they first hit the market in the 1990s. Purdue Pharma, the company that precipitated America’s opioid crisis, initially marketed OxyContin, its potent and addictive painkiller, to areas with high cancer mortality rates. In the decades that followed these towns, which were varied in terms of geography and socio-economic conditions, suffered from lethal drug overdoses more than other parts of the country.

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Source: “Democracy and the opioid epidemic”, by C. Arteaga and V. Barone, Dec 2023

*By 1990 commuting zones

Looking at cancer mortality rates also helped establish a before-and-after trend in opioid use and political outcomes. Before 1996, when Purdue patented OxyContin, cancer mortality was not a very good predictor of Republican vote share. But a relationship started to emerge in the decades that followed (see chart). The economists found that a one-standard-deviation increase in the cancer-mortality rate in 1996 predicted a 13.8 percentage-point jump in votes for Republican candidates in the 2020 congressional elections. In presidential elections, they found that it buoyed Republican nominees by an average of 12 percentage points between 1996 and 2020.

image: the economist

That is a remarkable swing. (Studies have found that the launch of Fox News on cable channels, for example, only increased the vote share for Republicans in presidential elections by less than one percentage point.) You might suspect cancer to be a proxy for poor health, which could affect political trends regardless of opioids. But the researchers found that rates of diabetes and influenza—which were not related to opioid marketing—did not influence subsequent political trends. Further analysis showed that the economy, race, migration patterns and changes in voter turnout did not explain the shift either.

Anger about the opioid epidemic may have made people more receptive to right-wing ideas. Places with high cancer rates—and therefore more opioid marketing—saw a rise in conservative views on immigration, abortion and guns, as well as a surge in animosity towards people from a different party than their own. Both white and black people shifted right by similar amounts, regardless of where they lived. They also found other signs that these areas were lurching to the right: donations to Democratic candidates fell and Fox News viewership rose.