"A new analysis by historian Kathleen Frydl looks at the strong correlation between the opioid painkiller and heroin epidemic — which led to a record number of overall drug overdose deaths in 2014 — and the counties in Ohio and Pennsylvania that swung from President Barack Obama in 2012 to Trump in 2016. Both of these states were crucial to Trump’s victory on Election Day.
In Ohio, 26 counties reported around 20 or more drug overdose deaths per 100,000 people in 2015. In all but two of these counties, Frydl said there was at least a 10 percent surge in voters who went to Trump compared with Republican candidate Mitt Romney in 2012, a 10 percent or more drop in voters who went to Hillary Clinton compared with Obama, or both of these trends. In five counties, the shift was big enough for the county to flip from Democrat in 2012 to Republican in 2016.
And in Pennsylvania, all but four of 33 high-overdose counties followed a similar trend. In three counties, the shift was enough for a complete Democrat-to-Republican flip.
In total, eight of 13 Ohio and Pennsylvania counties that flipped from Obama to Trump had around 20 or more deadly drug overdoses per 100,000 people.
Unlike past drug epidemics, the opioid epidemic has largely hit white and rural areas. The two states suffering the most from the epidemic, based on 2014 numbers, have been West Virginia and New Hampshire, both of which are very rural and very white. And a 2014 study found that nearly 90 percent of treatment-seeking patients who began using heroin in the previous decade were white — a big shift from equal racial representation prior to the 1980s. So Trump’s Rust Belt support appears to reflect, at least partly, the unique levels of suffering in these communities."
Most Ohio and Pennsylvania counties that flipped from Obama to Trump are wracked by heroin - Vox
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