2025/11/07 by Thiago Moreira, Spencer Goidel, Brenna Armstrong · 1 voice
Medicine · Social Sciences · #HIV, Drug Use, Sexual Risk #Opioid Use Disorder Treatment #Crime, Illicit Activities, and Governance
paper · pdf · doi:10.1017/s1537592725103113
openalex publication_date 2025/11/07 · openalex created_date 2025/11/07 · openalex updated_date 2026/06/26
In this paper, we explore the electoral consequences of the opioid epidemic in the United States, particularly its relationship with the Republican vote share in US presidential elections. We argue that the worsening opioid crisis is associated with a shift toward the Republican Party, and that these gains result from a decline in both Democratic support and voter abstention. We test these expectations using county-level presidential election results and individual-level data. The findings show that increasing overdose death rates are associated with an increase in Republican votes and a decline in Democratic votes and voter abstention. Additionally, the survey analyses reveal that this relationship is strongest among independents. Independents are also more likely to support stricter border security and higher spending on law enforcement as drug death rates increase. Our study contributes to the growing literature on the political consequences of the drug crisis in the US by demonstrating how overdose death rates are associated with voting behavior, and identifying which voters are most likely to change their vote in response to this worsening situation.