Did the opioid epidemic fuel Donald Trump's return to the White House?

More than any other drug since crack, the stories about fentanyl spread across the United States border on the borders of myth. It is a substance so concentrated that it is said that small quantities are enough to raise large populations: a salt shaker is worth supplying an entire neighborhood; two trucks supply a country of three hundred and thirty million inhabitants for a year. In the 1980s, stories of the crack trade sometimes followed historical maps of black migration. The Chambers brothers, for example, allegedly employed family members from the Arkansas Delta to run distribution operations in high-rise buildings in Detroit, under conditions we might today call human trafficking . Such stories have been easily exploited by politicians interested in racial demonization, much like how fentanyl trafficking is now used to stigmatize migrants crossing the Rio Grande.

Like many accounts of illegal activity, these stories, which usually come from law enforcement, are memorable in a black tabloid way, and probably true in one direction, but also difficult to verify. In the case of fentanyl, they have had particular resonance with American politicians, who seek to make sense of the country's political turmoil, which can seem out of step with the overall stable and prosperous society. The fentanyl epidemic suggests that things may not be so good here that instability, violence and suffering are just below the surface, even though unemployment is below 4 percent. It is not only the Republicans, nor the cable channel hosts, who have emphasized this point. Marie Gluesenkamp Perez, a moderate and talented young Democratic congresswoman from rural Washington state, said that forty percent of infants delivered in one of her district's largest hospitals were born to at least one parent addicted to fentanyl .

There were times this summer during the presidential campaign when it seemed to me that 2024 was going to be an election for fentanyl. The drug is generally considered to constitute a third wave of the opioid epidemic, the first being the abuse of prescription drugs like OxyContin and the second being heroin addiction. But fentanyl's distinguishing public health feature is its lethality: The rate of people killed by drug overdoses in the United States has more than doubled since 2008 and is nearly seven times higher than it was in the early 1980s. In politics, it helps explain the intensity and durability of immigration as an issue for Trump, whose most recent speech on the subject focused less on jobs and more on drugs and violence. But the presence of fentanyl could also suggest why some of the public seems so alarmed by crime in places where homicides aren't peaking and could even help explain why some politically detached young voters seem to take a darker view than would allow. hear the economic statistics because it is their friends, the young people who are dying.

In September, as part of a JD Vance profile, I spent some time in Ohio, where I became interested, among other things, in what had made the state come through over two decades , from a slightly Republican state to a convincing red. My hypothesis was that the key was economic anger, over the shift of manufacturing jobs to China and the long-term effects of NAFTA. But the Republican officials I met, when asked to explain Ohio's turn toward right-wing populism, tended to emphasize the opioid epidemic rather than the job. For people here, it's really about protecting the southern border from drugs, Mark Munroe, longtime Mahoning County GOP chairman, told me. And Jane Timken, the state's former Republican chairwoman, pointed out that partisan shifts have been concentrated in pockets of Ohio hit so hard by the opioid epidemic.

A few days ago, I came across an economic article that was circulating this year, although it had not yet been officially published. The study, authored by Carolina Arteaga of the University of Toronto and Victoria Barone of Notre Dame, takes aim at a specific problem: because the effects of the opioid epidemic have often been worst in parts of the country that These countries have also suffered from depopulation and deindustrialization and have been exposed to shocks from NAFTA and China. The social and political consequences of the drug have been somewhat difficult to separate from the broader experience of economic hardship and decline.

But in documents disclosed in the Purdue Pharma lawsuits, Arteaga and Barone found that in the mid-1990s, OxyContin's marketing initially focused on communities with high cancer rates. The idea, apparently, was to build the drug's brand as a treatment for the terrible pain sometimes experienced by cancer patients before promoting it, in those same communities, as a more general pain remedy. Arteaga and Barone hypothesized that by examining communities with higher and lower cancer rates, while controlling for measures of economic hardship and social unrest, they could isolate the effects of opioid exposure from 'a community of those of a more general decline. According to Arteaga and Barone, two regions of Appalachia could have suffered the same injuries, but if only one had high cancer rates, it would have disproportionately received the initial bolus of opioids, whose unique effects could then be seen in the differences between regions. Clever, Times opinion writer Thomas Edsall called the studies' design earlier this year.

Arteaga and Barone found that the social harms of the opioid epidemic were significantly exacerbated in areas with high cancer rates. What was bad everywhere was worse where OxyContin was initially pushed. In 2012, people in targeted areas used opioids at rates fifty percent higher than those in comparable areas, and died at twice the rate from these drugs; in 2020, populations in these hot trade areas were about ten percent more likely to apply for food and Social Security stamps.

Neither Arteaga nor Barone specialize in American politics, both are from South America, but when they studied the paper they found that other economists often wondered whether they could detect implications policies, given that the other effects were so dramatic. They did the calculations. Communities that had been singled out by Purdues officials in the mid-1990s for high cancer rates became, they found, increasingly aligned with the Republican Party in House elections for office. for governor and for president. Even compared to similar locations, which generally tilted toward the Republican Party, and accounting for exposure to economic shocks, communities targeted by opioid sales reps moved closer to Republicans by an additional 4.6 percent. during the 2020 parliamentary elections. In a country on the razor's edge, this is a remarkable effect. It was as if in their briefcases the sellers had also carried packets of red dye, the color of which is still perceptible twenty-eight years later in the now devastated places where they visited.

When I spoke with Arteaga and Barone, via Zoom, Thursday afternoon, Arteaga said, “It wasn’t obvious that the opioid epidemic would favor Republicans. In surveys conducted over the years, people have not particularly blamed either party for the outbreak. Even so, she thought there could be two reasons why the hardest-hit areas had leaned so clearly toward the GOP. The first, she said, and I don't think this would have happened without trade, was that the economic hardship of working-class, mostly white Americans became something very important to the Republican Party. . The second reason was simpler. Conservative media reported on it more, Arteaga said. She and Barone had been measuring mentions, and for many years the opioid epidemic was much more widely discussed by the right-wing press than by other media outlets. You could blame Fox News for being interested in these patterns primarily to demagogue them, in other words, but you have to credit the network with something more important and more fundamental: noticing that this was happening.

Many post-election opinion pieces have called for the Democratic Party to move to the center, become more pragmatic, or break more clearly with the neoliberal system. But Democrats' fentanyl failure has little to do with political theory or economic systems. It was much more simply a lack of political attention. The story described by Arteaga and Barone does not primarily place blame for the fentanyl crisis on more liberal immigration controls at the southern border. Bernie Sanders could look at these documents and, not unfairly, call the continuing suffering from the opioid epidemic a Purdue Pharma conspiracy. But as with the other temporary crises that ultimately doomed the Biden administration — the withdrawal from Afghanistan, the surge of migrants at the southern border and, perhaps most importantly, post-pandemic inflation — Democrats were a little too ready to dismiss the hubbub around opioids as partisan hysteria, and a little too slow to realize that people were actually troubled.

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