The Opioid Election: How Trump Won Regions of Despair

Trump offered a welcome solution to weakened communities: keep out heroin from the South by keeping out immigrants from those nations, and bring back the jobs which had disappeared over the last decades.

Strong correlation between pro-Trump states, economic decay, and addiction

Like many others, Professor Shannon Monnat was initially surprised as the election results came in on the night of November 7th, but as the map of America began to shade deeper red, she was hit by another surprise: it looked remarkably like her demographic work researching the regions in the U.S. with the highest rates of opioid addiction and suicide.

As Dr. Monnat, an assistant professor of rural sociology and demographics at Penn State University, and author of the study, Deaths of Despair and Support for Trump in the 2016 Presidential Election, explains, “As results were coming, looking at areas where Trump was seeing election wins – Michigan, the Industrial Midwest and Appalachia – there was a correlation between areas that were performing better than expected, and those regions that suffered from increased rates of drug abuse and suicide, regions where there had been a decrease in manufacturing and natural resource extraction jobs. I wasn’t looking for patterns, but in retrospect, I shouldn’t have been surprised.”

Over the past decade, nearly 400,000 people in the U.S. died from accidental drug overdoses and drug-induced diseases (five times the number ten years ago), nearly 400,000 more have died by suicide, and over 250,000 have died from alcohol-induced diseases, like cirrhosis of the liver. Approximately a fifth of these drug, alcohol, and suicide deaths involved opioids, either prescription pain relievers or heroin. As Monnat discovered in her research as a demographer, the regions where these deaths were most concentrated were in the rural areas of the Industrial Midwest, Appalachia, and New England, which had also experienced significant economic decay.

After purchasing the voter records, Dr. Monnat was able to do a deeper analysis, recognizing that, “The issues are much bigger and broader than the drugs themselves. These ‘deaths of despair’ are the results of long-term socioeconomic decline. Areas where economic distress has been building and social and family networks have been breaking down.”

Though much has been written about these regions suffering from the opioid epidemic and how both pharmaceutical companies and later, drug cartels, profited off their misery, the consequences of the crisis were brought to a national scale in the 2016 election, providing a backdrop for the Trump campaign. “Make America Great Again” carried an especially resonant message for predominantly white communities hit by poverty and addiction.

As another researcher, historian Kathleen Frydl, discovered in her own research, the regions with the most surprising flips -- counties in Ohio and Pennsylvania that swung from President Barack Obama in 2012 to Trump in 2016 -- were also regions which had experienced increased drug overdoses in recent years. This change not only of political affiliation, but also of vastly different candidates, has led researchers like Frydl to see where Trump’s campaign was able to speak to voters in a way that Democrats failed.

As Frydl explains in her own election analysis, The Oxy Electorate, “Although the apparent correlation between the places most under siege by the opioid epidemic and those that flipped or went more heavily for Trump is striking, it is only suggestive, and not by itself explanatory. It does nothing to undermine the convincing evidence that these voters were motivated by an ethno-nationalist appeal, for example. Instead, it supplements it, providing a premise to help explain why a narrative of identity, place, and belonging would have such resonance among them.”

For many of these regions, the decision to vote for Trump extended beyond just economics. Though as evidenced by Frydl, the ethno-nationalist motivation was real, there was also another drive against the Southern border: fear. The influx of heroin from Mexico and the recent rise of illegal street drugs in these communities caused people to herald the call to “Build the wall.” Though those suffering from addiction and their families might be experiencing their own morass, even people not directly impacted by drug use have begun to see its consequences in their communities.

“One of the things we have to remember,” Dr. Monnat shares, “is that drug addiction doesn’t just affect the individual. When people hear news reports of a drug arrest, when they hear about police responding to overdoses, the message that America is great already doesn’t really resonate. They instead see decay all around them.”

And Trump’s hardline policies and loud support for law enforcement spoke to those concerns. As Frydyl explains, “To slow the traffic in drugs, Trump vowed to ‘build a wall,’ a drastic measure that was widely belittled. But people who live in forgotten places understood that, even if the promise was absurd, their suffering had finally registered.”

For these regions crippled by economic depression and then overrun with opioid addiction and the influx of Black Tar heroin, candidate Trump offered a two-fold solution: keep out heroin from the South by keeping out immigrants from those nations, and bring back the jobs which had disappeared over the last decades. And for an America which found itself divided by a now impoverished working class and a sense, whether true or not, of a growing coastal elite, Trump found his message amplified in places where economic decline, depression, and addiction had replaced the American Dream.

As Monnat writes in Deaths of Despair, “In the U.S., work has historically been a source of financial, social, and moral status. But the American working class regularly receives the message that their work is not important. That message is delivered via low wages, declining benefits, government programs for which they do not qualify but for which they pay taxes, and the seemingly ubiquitous message that everyone should obtain a college degree.”

Trump’s aggressive law enforcement stance spoke to the many who believe that drugs are an issue of crime, a simple supply and demand conundrum, but as Monnat explains, “This isn’t something we are going to arrest, or even treat, our way out of. The drugs are symptoms of much larger issues.”

Recently, addiction expert Dr. Gabor Maté shared similar views on the Fox News program, Tucker Carlson Live. Dr. Maté explained that our economic system creates levels of stress and trauma which addiction then alleviates. As Dr. Maté asked on the show, “What is it that is traumatizing people? Don’t you think that poverty and the loss of jobs and the loss of hope and the loss of connection and the destruction of communities has a lot to do with why people are addicted?”

Dr. Monnat concurs, adding that these communities are not only suffering from drug addiction, but also increased incidences of suicide. “Given the economic distresses, we would have expected to see increases in drug deaths – the easy access to prescription drugs and then opioid addiction escalated a problem we would have seen either way. But what is striking is the high rates of suicide that are unrelated to drugs or alcohol. These regions are suffering from an underlying sense of despair.”

These “deaths of despair,” as Dr. Monnat calls them, are taking place in regions desperate to see change in their communities. As Dr. Monnat writes in her study, “Trump promised change. It remains to be seen whether and how the Trump Administration’s economic, health, and social policies bring relief to the individuals and communities now mired in diseases and deaths of despair.”