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Opioid epidemic reaches beyond health impacts to influence politics

Vicky Barone, assistant professor of economics at Notre Dame, researched the origins and development of the opioid epidemic and found that the unregulated marketing of potent painkillers led to increased access to prescription opioids and subsequent overdose mortalities. Tracing the long-term consequences of opioid overdose deaths on the political landscape in America, she found an increased support for conservative beliefs and Republican candidates.
Photo of spilled bottle of prescription pills onto a wooden table that is designed to look like the U.S. Flag.

The health shock of the opioid epidemic in America is a “huge crisis in people’s lives right now,” a University of Notre Dame researcher said.

And it undeniably is. According to the Centers for Disease Control and Prevention (CDC), drug overdose deaths in the United States topped 100,000 in 2022 — with nearly 83,000 of those deaths involving opioids. And over the past two decades, mortality from opioid overdoses in the U.S. has increased at an alarming rate, claiming the lives of more than 645,000 individuals. In that same 20-year period, nearly 280,000 people died from overdoses involving prescription opioids.

Vicky Barone is pictured wearing a bright green checkered blouse and has long dark hair and glasses.
Vicky Barone, assistant professor of economics at the University of Notre Dame. (Photo by Matt Cashore/University of Notre Dame)

Vicky Barone, assistant professor of economics at Notre Dame, along with her co-author Carolina Arteaga, assistant professor of economics at the University of Toronto, researched the origins and development of the opioid epidemic and found that the unregulated marketing of potent painkillers led to increased access to prescription opioids and subsequent overdose mortalities. The two researchers then traced the long-term consequences of opioid overdose deaths on the political landscape in America, finding an increased support for conservative beliefs and Republican candidates.

Their research culminated in two working papers completed this academic year: “A Manufactured Tragedy: The Origins and Deep Ripples of the Opioid Epidemic” and “The Political Consequences of the Opioid Epidemic.”

In their first study, “A Manufactured Tragedy,” the researchers examined areas of the country that witnessed high rates of opioid prescriptions when opioids first entered the market in the mid-1990s. They found that Purdue Pharma, the manufacturer of OxyContin — a prescription opioid that is a highly potent and addictive painkiller — intentionally and aggressively targeted the marketing of its drug to areas with high cancer mortality rates to treat cancer pain.

According to the researchers, unsealed court records drawn from litigation against Purdue Pharma indicated a strategy by the pharmaceutical company to expand their marketing efforts from the cancer pain market to the much larger non-cancer pain market in those same geographic areas. This meant that physicians and patients not involved in cancer exposure or treatment would then be targeted by OxyContin promotion, the researchers said, and would eventually gain access to potent prescription opioids to treat moderate and chronic pain.

In the years following that initial marketing campaign, those targeted communities suffered from deadly opioid drug overdoses more than any other towns across the country, Barone and Arteaga calculated. Focusing on those areas already experiencing cancer mortality, the researchers found that there was a 55 percent increase in prescription opioid deaths and a 33 percent increase in deaths from all opioids. As noted in the study, the CDC determined that opioid prescriptions reached their peak in 2012; however, mortality from prescription opioids rose for another five years to reach its maximum in 2017, and deaths involving any opioids were at an all-time high in 2021.

The researchers explained that the opioid crisis quickly spiraled out of control due to several factors. First of all, it was not initially or fully understood how addictive the opioids were and how risky it was to prescribe and use them without stricter dosing parameters. Second, there was a spread of misinformation regarding any such risks or dangers of addiction surrounding their use. Third, the U.S. Food and Drug Administration lacked oversight in terms of how the drugs were marketed. And finally, once the drugs hit the black market, there was no controlling how and how many of them were distributed within the community.

Building on the research from that first study, Barone and Arteaga turned the focus of their second study toward the opioid epidemic’s connection to political perceptions and whether or not the “health shocks” of drug overdose deaths occurring in those affected communities influenced how their members chose to vote.

Focusing on the period between 1982 and 2020, including the 2016 and 2020 presidential elections — as well as any congressional elections within that period — the researchers documented a causal relationship between those areas experiencing epidemic-related health shocks and an increased support of the Republican party and its values.

Specifically, the researchers discovered that the opioid epidemic increased Republican vote shares and started to flip elections in the early 2000s. In areas hit harder by the opioid epidemic, Barone explained, there was more support for Republican candidates and a higher Republican vote share, which translated into Republicans winning additional seats in the House from 2012 until 2020, in addition to an increase in House members who tend to hold more conservative views.

“The opioid epidemic has shaped the views of the American population in terms of who voters are supporting,” Barone said. “And from electoral survey data, we see a real shift toward more conservative beliefs in the areas affected most by the shock of high opioid mortality rates.”

“The opioid epidemic has shaped the views of the American population in terms of who voters are supporting. And from electoral survey data, we see a real shift toward more conservative beliefs in the areas affected most by the shock of high opioid mortality rates.”

These effects are explained by changes in voter views rather than voter composition, the study said. For example, when voters were asked what their views were on abortion, gun control and immigration policy, those who were more exposed to the effects of the opioid epidemic had stronger feelings in alignment with those of conservatives.

The researchers offered one potential explanation for this shift: the perceived greater effectiveness of the Republicans’ approach to curbing the opioid epidemic over the Democrats’ approach. The Republican party favors increased law enforcement to curb drug trafficking and crime, while Democrats prefer harm reduction policies and funding increases for opioid abuse treatment and recovery.

It is important to note that the original opioid epidemic has transformed over the past several years to become a fentanyl epidemic — fentanyl being a synthetic opioid that can be deadly even in small doses and is found on the street rather than being prescribed. Barone explained that the idea of keeping these particular drugs out of the country altogether resonated with the public, boosting support for the Republican party’s directive.

“The Republican response was generally more appealing to the public,” Barone said. “And in places where people were more exposed to the epidemic, it made more sense in their minds.”

The co-authors concluded that the potential effects of the increased supply of prescription opioids stretches beyond the uptick in overdose deaths and touches communities in health, economic and social dimensions, “and indicates how it will continue to shape these communities through its effects on their elected officials and intergroup perceptions.”

Contact: Tracy DeStazio, associate director of media relations, 574-631-9958 or tdestazi@nd.edu

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