We collect data from multiple sources and construct a panel of commuting zones covering the United States from 1982 to 2020. Our approach exploits detailed features of the initial marketing of prescription opioids, [which] show that at the dawn of the opioid epidemic in 1996, pharmaceutical marketing efforts were concentrated in the cancer pain market with a plan to quickly expand to the much larger non–cancer pain market in those same geographic areas. Exposure to the opioid epidemic substantially increased the Republican vote share in congressional and presidential elections. We document that the relationship between cancer mortality and Republican vote share emerged soon after the onset of the opioid epidemic. After continuous years of increase, by the 2020 congressional elections, a rise of one standard deviation in the 1996 cancer mortality rate corresponds to an increase in the Republican vote share of 13.8 percentage points.
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