The Opioid Epidemic and Presidential Elections

Nicole Siegal

American Journal of Health Economics, 2026, vol. 12, issue 3, 460 - 485

Abstract: This paper examines the relationship between early exposure to the opioid epidemic and voting behavior in US presidential elections. After its 1996 national release, OxyContin quickly penetrated local markets, contributing to addiction, economic disruption, and community distress that may have increased demand for political change. I exploit cross-state variation in triplicate prescription laws, which required physicians to produce an additional copy of each opioid prescription for state monitoring and shaped differential exposure to the emergence of OxyContin. In subsequent elections, states without triplicate prescription laws experienced a 2.60 percentage point higher Republican vote share relative to states with these policies. The voting response was nearly twice as large in areas with lower baseline GOP support, approximately three times larger in Southern compared with non-Southern states, and more pronounced in counties with lower employment rates. The results indicate that state policy environments associated with greater opioid exposure were followed by persistent shifts in presidential voting patterns toward the Republican Party.

Date: 2026
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