Does exposure to opioid marketing raise Republican vote share?
Core argument: The authors estimate that by the 2022 House elections, a 1 standard deviation increase in exposure to the opioid epidemic raised the Republican vote share by 4.5 percentage points, with continuous increases from the mid-2000s to 2022.
We establish a causal connection between the opioid epidemic and the political realignment between the Republican and Democratic parties. At the dawn of the opioid epidemic in 1996, marketing [to] the cancer pain market expanded within the same geographic areas to the much larger non-cancer pain market. We exploit the [resultant] geographic variation in cancer mortality as a proxy for the cancer pain market served by pharma companies and use it as a quasi-exogenous measure of exposure to the crisis. Geographic variation in the marketing of prescription opioids serves as a quasi-exogenous source of exposure to the epidemic. We use this variation to document significant increases in drug-related mortality and greater reliance on public transfer programs. This induced economic hardship led to substantial changes in the political landscape of the communities most affected by the opioid epidemic. We estimate that from the mid-2000s to 2022, exposure to the opioid epidemic continuously increased the Republican vote share in House, presidential, and gubernatorial elections. By the 2022 House elections, a 1SD increase in our measure of exposure led to a 4.5 percentage point increase in the Republican vote share.



