Out of the 82 counties with exceptionally high opioid death rates, 77 voted for President Donald Trump in 2016, and most were in rural parts of the country.

Economic regression, unemployment, and the associated social decline are correlated with high rates of drug use in white counties.

While the focus of the Trump administration has been on treatment and curbing prescription rates, experts say that underlying causes need to be addressed as well to prevent addiction in the first place.



The opioid crisis is a nationwide problem with no red-state or blue-state bias, but of the outlier counties with the highest levels of opioid overdose deaths in the country, the vast majority voted for President Donald Trump in 2016, and many lie in rural regions like Appalachia, according to data from the Centers for Disease Control and Prevention.

Out of all the counties for which opioid overdose death data has been compiled by the CDC, there are 82 outlier counties where 15 people or more died per 100,000 people. Of these 82 counties, 77 voted for Trump in the 2016 presidential election, according to Townhall.com voting data. With several exceptions, the majority of these outlying counties lie in Appalachia or the rural West.

The factors that fuel drug addiction and abuse also drive Trump's appeal in middle America

The rate of opioid deaths is now the same between rural, urban, and suburban counties, however the places most affected by the crisis remain rural areas. Skye Gould/Business Insider

To many experts, this does not come as a surprise.

Shannon Monnat, an associate professor of sociology at Syracuse University, said her findings indicate that places where rates of death due to drug addiction, alcohol abuse, and suicide are high are also places that heavily supported Trump in the election.

"I expected to see it because when you think about the underlying factors that lead to overdose or suicide, it's depression, despair, distress, and anxiety," Monnat told Business Insider.

Research Monnat did after the election suggested that counties that were largely white and had a high "economic distress index" correlated strongly with high support for Trump. The index, which Monnat has used in her research for years, combines the percentages of people who are in poverty, unemployed, disabled, in single-parent families, living on public assistance, or living without health insurance. These same places also had exceptionally high rates of drug overdoses and deaths.

Historian Kathleen Frydl's research shows an even more striking trend. She noticed that many typically Democratic counties that were particularly heavily affected by the opioid crisis went red on election night. She named this segment of the population the "oxy electorate."

President Donald Trump arrives to speaks at a campaign-style rally at Big Sandy Superstore Arena in Huntington, W.Va., Thursday, Aug. 3, 2017. AP Photo/Susan Walsh

Keith Humphreys, a professor of psychiatry and behavior sciences at Stanford University, agreed, and said that even though poverty is by no means a determinate factor in whether people will begin using drugs, he said it makes someone more likely to fall into addiction once they have already begun using.

"You can imagine communities where everybody loses their jobs, and a lot of public amenities decay, and families become more strained," Humphreys said. "In that environment, substance use that normally might not become a problem could spiral into addiction more easily than it would otherwise."

The evidence for this is no longer just anecdotal — research from the National Bureau of Economic Research shows that unemployment and opioid overdoses and deaths are directly correlated. The paper demonstrates that as the unemployment rate for a given county increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose emergency department visit rate per 100,000 increases by 0.95 (7.0%).

Monnat said Trump's campaign rhetoric on economic issues spoke exactly to the problems these downtrodden communities are facing, since many of these counties have been in the middle of a long period of economic regression ever since the early 2000s. That downward turn was compounded by the Great Recession of 2008.

"That was the message that Trump was appealing to," Monnat said. "There was such a sense of hopelessness that it makes sense they would vote for massive change."

The recommendations of Trump's opioid commission address some, but not all, of the causes of opioid abuse

Trump declared a national public health emergency in October to combat the mounting rates of death and addiction due to opioids, pledging to expand enforcement along the southern border, implement drug courts, and pursue a "just say no" strategy. However, Monnat says that more needs to be done to address the underlying causes of drug abuse and death that she has observed.

"One of the things with President Trump's announcement and the opioid commission's forthcoming recommendation is that they're very treatment based," she said. "They focus almost exclusively on keeping addicts from dying rather than keeping people from falling into addiction to begin with."

Still, more needs to be done on the treatment side, Humphreys said. He claimed that opioid death rates remain correlated to geography.

"Why are more people dying in West Virginia? When people are addicted, they're far less likely to get treatment, if they have an overdose, they're far less likely for an ambulance to come, which could be really far away," Humphreys said. "The services aren't there. So the same drug problem that is less likely to end up ruining your life if you happen to live in a city that has abundant health services, is going to harm you more when you're living in a low-income rural state like West Virginia, Kentucky, or southern Ohio.”

Overprescription of opioids has been seen as a gateway into illegal opioids like heroin and fentanyl. Skye Gould/Business Insider

One of the things the Trump administration is tackling is opioid overprescription. Research suggests that legally prescribed opioids can lead to addiction and abuse of more dangerous drugs like heroin later on, according to the National Institute on Drug Abuse.

Yet both Monnat and Humphreys agree that only tackling the immediate causes of death from opioid abuse won't solve the problem in the long-term. Humphreys, who is himself a native of West Virginia, said his personal experiences watching his home transform because of economic decline, unemployment, and the mountain of opioid deaths has made it clear to him that the social conditions that made the opioid crisis possible run deep.

“In my hometown people die every year," Humphreys recounts. "There were some drugs when I was growing up, but there was no significant problem with diverted opioids, and there certainly were not many people using heroin. And then on the economic side, the coal industry has collapsed, it used to employ a lot of people in my family. Those were very good jobs, they paid very well for someone with a high school degree."

"And so what you see is a lot of these towns, they're really strange places. There's no sense of optimism. And it just did not feel that way when I was growing up. We had problems but I think we had a lot more hope than we have now."

Shannon Monnat was incorrectly identified as a rural sociologist and demographer at Pennsylvania State University, which was one of her previous roles. This article has been updated with her current credentials.