The dope on the Donald

A substantial proportion of votes for Donald Trump in the 2016 US presidential election came from areas with high rates of opioid addiction, a new analysis shows.

A study led by James Goodwin of the University of Texas and published in the Journal of the American Medical Association looked at the choices made by 3,764,361 voters who had in the previous 12 months been prescribed opioids for 90 days or more. The figure represents about 20% of long-term opioid users on prescription meds.

The users lived in 3100 counties across the country. Goodwin and his colleagues found that 693 of those counties had opioid prescription rates significantly higher than the national mean – and all of them recorded substantially more than 50% of voters supporting Mr Trump.

In 638 counties with an opioid-using population significantly below the national mean, support for the Republican candidate averaged just 38%.

The analysis was purely observational, meaning that it is not possible to infer that using opioids long-term predisposes anyone to vote for Mr Trump. However, the finding does align with previous research into voting patterns that found strong support for him in areas that have high rates of poor health.

And the support seems to revolve around Mr Trump himself, rather than Republican Party policies. In 2017, a study in the journal PLOS One looked at support for the current president compared to Mitt Romney, the GOP presidential candidate in 2012.

The researchers found that 88% of 3009 counties covered by the study showed a strong surge of support towards Mr Trump, and this was associated with “measure of poor public health”.

Goodwin and colleagues summarise other reports that found the 2016 Republican presidential vote at the county level was “strongly and negatively correlated with change in life expectancy between 2008 and 2016”.

Over all, “counties with drug, alcohol, and suicide mortality rates above the median showed heavier support for Trump in 2016 than for Romney in 2012.

“In many areas with high rates of drug overdose, voter turnout in 2016 exceeded that in 2012, with Donald Trump overwhelmingly favoured.”

Their own findings support the idea that community and ecological factors played a large role in voter decision-making. They found that people from “areas where residents have high rates of poor health and lack of upward mobility” were more likely to vote for Mr Trump even if “the health and economic status of the individual respondents were good”.

The correlation between counties with high levels of opioid dependence and the decision to vote for Mr Trump, the researchers suggest, emphasises “economic stressors and the sense of being left out”.