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Trump supporters linked to chronic opioid use
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There were parallels between voting for Donald J. Trump in the 2016 presidential election and chronic opioid use, according to findings recently published in JAMA Network Open.
“A number of studies have described state and county characteristics associated with high opioid use. These include education, racial/ethnic composition, health care utilization, physician supply, percentage uninsured, percentage on Medicaid, poverty, income inequality, and rural vs. urban setting. In general, these characteristics explain about one-third of the geographic variation,” James S. Goodwin, MD, of the department of preventive medicine and community health, University of Texas, and colleagues wrote.
“This study examines the association at the county level between the rate of Medicare Part D enrollees receiving prescriptions for prolonged opioid use and the percentage of votes for the Republican candidate in the 2016 election,” they added.
Researchers looked at data from 3,764,361 people. Of this total, 81.1% were non-Hispanic white, 9.3% were non-Hispanic black and 5.3% were Hispanic. In addition, 60.6% were women and 18% were aged younger than 65 years.
Goodwin and colleagues found that the correlation between a county’s Republican presidential vote and the adjusted rate of Medicare Part D recipients who received prescriptions for extended opioid use was 0.42 (P < .001). Among the 693 counties with opioid prescription rates significantly higher than the mean county rate, the mean vote for the Republican presidential candidate was 59.96% vs. 38.67% in the 638 counties with significantly lower opioid prescription rates. The researchers also indicated the findings add to the growing body of work that suggests a link between health status and whom a person voted for.
“The current study ... [was] ecological, measuring associations at a county level between the presidential vote and health indicators. There is some evidence that the association is indeed contextual,” researchers wrote, noting that many of those who endorsed the recent Republican presidential candidate were from areas with “high rates of poor health and lack of upward mobility, even if the health and economic status of the individual respondents were good.”
“Many studies have shown that the relationship between health and social variables (such as employment status, income and neighborhood) is at least as strong as the relationship between health and biological variables. Public health policy directed at stemming the opioid epidemic must go beyond the medical model and incorporate socioenvironmental disadvantage factors and health behaviors into policy planning and implementation,” Goodwin and colleagues concluded.
In a related editorial, James Niels Rosenquist, MD, PhD, of Massachusetts General Hospital stated that the findings were “not surprising” and raise “important questions.”
“What is at the root of the observed dynamic between opiate use and voting behavior? Are these trends specific to voting for Trump or are there other candidates who perform similarly at the state level?” he wrote, adding that the restrictions of the data Goodwin et al used restricts the extent to which these queries can be answered.
“Limitations aside, this article’s findings add to a growing body of literature showing the interrelationship between public (mental) health and society, including the all-important economic and political realms. Further work will undoubtedly continue to explore these connections and, by extension, bring attention to the importance of addressing mental health and addiction in the policy realm,” Rosenquist added. – by Janel Miller
Disclosures: Neither Goodwin nor Rosenquist report any relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.