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How are chronic opioid use, 2016 presidential voting patterns associated?

June 22, 2018

Bottom Line: An analysis of Medicare claims data suggests chronic opioid use in U.S. counties corresponded with support for Republican Donald Trump in the 2016 presidential election, with much of the correlation explained by socioeconomic factors.

Why The Research Is Interesting: Similarities have been observed in maps showing the geographic distribution of the opioid epidemic and the results of the 2016 presidential election. This study examined 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 President Trump 2016 to explore the extent to which demographic and economic factors might explain it.

What and When: A national sample of Medicare claims data for more than 3.7 million enrollees in the Medicare prescription drug benefit

What (Study Measures and Outcomes): Chronic opioid use by county rate for receiving a 90-day or more supply of opioids prescribed in 2015

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control for all the natural differences that could explain the study results.

Authors: James S. Goodwin, M.D., of the University of Texas Medical Branch, Galveston, and coauthors

Results: Support for Republican President Trump in 2016 explained about 18 percent of the variance in county rates of opioid use in 3,100 U.S. counties, with counties whose opioid prescription rates were above average having a higher average Republican vote than counties with opioid prescription rates below average. The association is related to underlying county socioeconomic characteristics related to income, disability, insurance coverage and unemployment.

Study Limitations: The 2016 county presidential vote would include all voters while information on prolonged opioid prescriptions from 2015 would include only Medicare Part D enrollees; the associations linking opioid use and voting are at the county, not individual, level.

Related Material: The invited commentary, "The Opiates and the (Voting) Masses" by James Niels Rosenquist, M.D., Ph.D., of Massachusetts General Hospital, Harvard Medical School, Boston, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.


Editor's Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

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