Opioid epidemic increased Republican vote share and conservatism, new research finds

The opioid epidemic in the United States has contributed to a significant increase in Republican vote share and increasing conservatism since the mid-1990s, according to new research from two economists trained at the University of California, Los Angeles.

Carolina Artega, an assistant professor of economics at the University of Toronto, and Victoria Barone, an assistant professor of economics at Notre Dame, published the results in a working paper on July 17 and were surprised by the strength of their findings.

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“The opioid epidemic is not something that is seen as partisan…even though there are different responses to [it from both parties]” Artega told the Washington Examiner.

Artega and Barone utilized cancer mortality rates per county as a proxy measurement for exposure to opioid advertisements for OxyContin in 1996 when Purdue Pharma changed its marketing strategy for its opioid products toward nonterminal pain management.

From then to 2020, Republican vote share in House of Representatives races in the counties with higher cancer mortality and higher prescription opioid mortality increased by 13.8 percentage points.

“These increases initially did not come from swing districts, and it took several terms in order for these incremental gains to flip election outcomes,” wrote the authors in their paper. “We estimate that by 2012, exposure to the opioid epidemic translated into a higher number of seats in house elections for the Republican Party.”

Artega and Barone estimate that the peak of the prescription opioid epidemic was in 2012, with 81.3 prescriptions for opioids per 100 people in that year, per data from the Centers for Disease Control and Prevention. From 1999 to 2009, substance abuse disorders increased by a factor of six, and prescription opioid mortality increased by a factor of five.

CDC provisional data reported over 81,000 opioid overdose deaths in the US in 2022, compared to nearly 29,000 in 2015.

“The number of lives affected by the epidemic through its effects on disability, poverty, fertility, and foster care is orders of magnitude larger,” wrote the authors.

Previous work from Artega and Barone studied the increasing rate of Supplemental Nutrition Assistance Program benefits, also known as food stamps, during this period as a direct result of the opioid epidemic, and other scholars have found similar empirical connections of the prevalence of the opioid crisis causing increases in disability applications, foster care placements, and the percentage of children living with someone other than a parent.

Barone explained to the Washington Examiner that although they were surprised by the partisan effects and their severity, they expected some impacts on political outlook as a result of exposure to the opioid epidemic.

“Our previous research and other economic research have found that the opioid epidemic has made big changes in people’s daily lives,” Barone said.

“These also have changed the lives of people who are raising kids, making decisions on how to work, [and] filing for disability claims [among other things]. ... When you try to remember all of those changes in people’s lives, I would say that it makes sense that you are also seeing this reflection in political decisions.”

Ideological views also changed significantly during this period. Individuals in opioid-affected counties not only self-reported as increasingly conservative during this period but also supported more conservative positions on immigration, abortion, and gun control.

Although the authors said that no single factor can directly cause a particular political outcome, especially something as personal as political attitudes, they did their best to isolate the causality of the opioid epidemic among various potential influences.

The pair empirically controlled for various events in the mid-1990s that could have contributed to these results, including the introduction of Fox News and other independent media platforms, the growing U.S.-China trade relationship, and economic recessions, none of which had a significant impact on the findings of increased conservatism and vote share.

When asked why the effects of the opioid epidemic would lead to a greater share of Republican voters and conservative ideas, Artega referenced the body of political psychology and political economy research that suggests times of distress lead to greater support for populist and anti-establishment political figures and policies.

“All of this hardship that is coming through cultural changes, social changes, and economic changes is going to affect community level vision of different groups,” Artega said, “and this feeling of being excluded or being left out [stems from the perceptions that your] standing relative to others has been deteriorated.”

Both Artega and Barone said although there has been significant progress in combating prescription opioid abuse through measures such as curtailing overprescribing opioids and increasing awareness of their addictiveness, the introduction of illegal alternatives like heroine and fentanyl have made the crisis “a completely different monster.”

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In addressing this growing problem, the authors noted that addressing community fracturing as well as political division must be incorporated into combating the opioid epidemic.

“The complexity of the crisis [is] far beyond just illegal drug consumption, but it’s the broader deterioration of communities in terms of disability and employment and family structure,” Artega said.