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What We Can Learn From That Study Linking Trump Voters and Opioid Use

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Sometimes the news isn’t as straightforward as it’s made to seem. Erin Migdol, The Mighty’s chronic illness editor, explains what to keep in mind if you see this topic or similar stories in your newsfeed. This is The Mighty Takeaway.

A study was published last week that seems tailor-made for today’s headlines: Researchers discovered an association between chronic opioid use and voting for Donald Trump in the 2016 presidential election. In other words, counties that had higher rates of “chronic opioid use” also voted for Trump at a higher rate — 60 percent in counties with higher-than-average opioid prescription rates and 39 percent in counties with lower-than-average rates.

Of course, with the words “opioid” and “Trump” in the study, you can expect to see news outlets covering it, if you haven’t already. It will be all too easy for discussions about this study to devolve into finger pointing and generalizations made about “opioid addicts.”

If we’re going to say this study offers insight into the forces driving the opioid epidemic like the study’s lead author James Goodwin does, it’s important to highlight some things the study missed when linking opioid use to voting for Trump. 

As part of their study, researchers looked at people enrolled in Medicare (only 18 percent of whom were under age 65) and defined “chronic opioid use” as having a 90-day or longer prescription for opioids. In other words: the only opioid users included in this study were Medicare recipients, mostly over the age of 65 years taking prescription medication.

In an interview with NPR, Goodwin said prescription opioid use is “strongly correlated” with illicit opioid use, and prescription opioid use is easier to measure with precision. By studying only Medicare recipients, Goodwin appears to assume we can use data from Medicare subscribers to gain insight into the opioid epidemic as a whole.

And that’s the problem. Prescription opioid users, who take opioids as directed by their doctors due to chronic pain (by all accounts, the exact people utilized in the study) are always lumped in with illicit opioid users and assumed to be struggling with addiction in the same way. However, data simply doesn’t support this. Studies have shown that only between less than 1 percent and 12 percent of people with chronic pain become addicted to their medication. The majority of people abusing prescription opioids actually get their pills from friends or family, not a doctor. And in the last year, prescription opioids have decreased while deaths from opioids have gone up, due to the rise in fentanyl.

The study also doesn’t acknowledge the millions of people under age 65 who live with chronic conditions. A 2012 Gallup poll found that 9 percent of 18- to 23-year-olds have a  chronic pain condition (this doesn’t include knee, leg, neck or back conditions), as well as 24 percent of 54- to 59-year-olds.

So, while it may very well be true that those who use opioids voted for Trump in higher numbers, we need to look at this study for exactly what it is: research that indicates one subset of prescription opioid users voted for Trump in higher numbers. That way, we can ensure the conversation about this study revolves around making the results helpful instead of stigmatizing. After all, people who use opioids illicitly, as part of an addiction and not because of chronic pain, may have different political motivations than people using opioids for chronic pain.

By understanding exactly what who this study is about, we can now start to ask the right questions to learn more about the issues that correlate with opioid use and voting for Trump — hopefully, to help inform policies and strategies that lawmakers should pursue. To begin, the study’s researchers acknowledged that two-thirds of the study’s outcome could be explained by socioeconomic factors. For example, rural areas with more economic challenges favored Trump — and also tend to be areas where prescription opioid use is at the highest.

So, in order to address the concerns of those communities, we need to support policies (and politicians) that offer:

Better healthcare options. In rural areas, there may only be one healthcare provider nearby. We need more doctors, more clinics and more specialists so patients have can have access to more options and opinions about their diagnosis and treatment.

More affordable health insurance. Lower premiums and coverage for pre-existing conditions can make or break a chronically ill patient’s ability to afford treatment.

More disability services. Things like transportation, tools to make homes more accessible, and help with daily tasks like bathing and food shopping can all make life easier and less painful for patients.

Better mental health treatment and resources. Among patients that do abuse their medication, mental health struggles like depression and past addiction are major risk factors. With the right mental health support, doctors can spot risk factors that may lead certain patients to abuse their medication, and patients can more easily access treatment if they start misusing their medication.

More accessible and effective non-opioid treatment options. Remember: sometimes, opioids are the cheapest and most accessible option. But medical cannabis shows huge promise for treating chronic pain, though it’s still not legal in every state. We also need more research into non-addictive opioids. Maybe there are pain treatments out there we don’t even know about because no one has had the funding to study them.

In terms of the one-third of the link between support for Trump and opioid prescription rates that isn’t attributable to socioeconomic factors, researchers don’t have a clear answer. Goodwin told NPR one theory could be that opioid users voted for Trump out of a desire for “radical change” in their lives and communities.

The irony is that, despite the fact that opioid users favored Trump, since becoming president Trump has not advanced or supported policies that would help people with chronic pain. His administration gave states the right to impose work requirements on Medicaid recipients. He’s signed executive orders weakening the Affordable Care Act, opening the door for health insurance to become more expensive and less comprehensive. He’s proposed expanding short-term health insurance plans that wouldn’t have to cover pre-existing conditions.

He’s referred to opioids in general as “no good” and that to solve the crisis, people simply shouldn’t use them to begin with. He backed anti-opioid commercials that don’t address the chronic pain perspective. He supported reducing opioid prescriptions. Instead, he’s championed anti-immigrant, isolationist policies that, while they may be popular among the white people that post-election studies found voted for Trump out of racial resentments and fear of losing majority status, won’t do a damn thing to improve your healthcare.

Ultimately, the study and the theories surrounding it are just words, unless we use them to inform better policies. Armed with the knowledge that people with chronic opioid prescriptions favored Trump, what’s next? Rather than use this data to point fingers and dismiss opioid users as just members of one political party or another, we need to look deeper and ask the tough questions about the motivations behind their vote. And if you have chronic pain, it’s time to ask yourself the tough questions about why you voted the way you did.

Honestly, this study made me really sad. As The Mighty’s chronic illness editor, I read stories every day by people with chronic pain and other health conditions who are struggling to afford their treatment, feel disrespected and abandoned by lawmakers and desperately need policies in place that will stand up for them and their health. But we will never get there if we vote for representatives who aren’t willing to fight for the chronic illness community. We cannot expect anything to improve when people who show time and time again that they don’t care about making healthcare more affordable and accessible remain in office. It’s sad and frustrating to see people cast their votes for someone who has ultimately done nothing to improve their care.

If this study teaches you anything, let it be this: Voting for people who will fight for you is more crucial than ever. There is too much at stake to vote for someone with a bad track record and no good ideas simply because you want “radical change” or because he or she happens to supports one issue you care about. This community deserves someone who will really be in our corner, and it’s up to us to find those people — and vote for them.

Lead photo via Flickr by Gage Skidmore

Originally published: June 29, 2018
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