From the Journals

Trump support high in counties with chronic opioid use

 

Key clinical point: Chronic use of prescription opioid drugs correlated with support for the Republican candidate in the 2016 U.S. presidential election.

Major finding: The mean Republican presidential vote was 60% in U.S. counties with significantly higher-than-average rates of prescriptions for prolonged opioid use, versus 39% for counties with significantly lower rates.

Study details: A retrospective, cross-sectional analysis including 3.76 million Medicare Part D enrollees.

Disclosures: One study author reported grants from the National Institute on Drug Abuse and Agency for Healthcare Research and Quality. Another reported membership in Physicians for Responsible Opioid Prescribing.

Source: Goodwin JS, et al. JAMA Network Open. 2018;1(2):e180450.

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In opioid crisis, mental health arguments may convince policy makers

This new study linking chronic opiate prescription rates to voting trends builds on previous research showing that public health, and in particular public mental health, does not exist in a vacuum, James Niels Rosenquist, MD, PhD, wrote in an editorial.

Public mental health is continually influencing economic and other societal forces, and in turn, being influenced by them, Dr. Rosenquist explained.

In the present study, opiate prescription rates were correlated with voting margins for Donald Trump in the 2016 presidential election using a “unique” data set based on Medicare Part D data, he said.

Studies such as these are good examples of how available data sources can be used creatively to test whether mental health trends such as opiate addiction might be correlated with “key outcomes such as elections,” Dr. Rosenquist wrote. “As elections are how political leaders are chosen in a democracy, arguments for focusing on mental health in this context may be particularly convincing to elected policy makers.”

James Niels Rosenquist, MD, PhD, is with the Center for Quantitative Health, Massachusetts General Hospital, Harvard Medical School, Boston. These comments are based on his editorial in JAMA Network Open (2018;1(2):e180451) . Dr. Rosenquist disclosed no relevant conflicts of interest.


 

FROM JAMA NETWORK OPEN

Chronic use of prescription opioid drugs correlated with support for the Republican candidate in the 2016 U.S. presidential election, according to a cross-sectional analysis published in JAMA Network Open.

The mean Republican presidential vote was 60% in U.S. counties with significantly higher-than-average rates of prescriptions for prolonged opioid use, versus 39% for counties with significantly lower rates, according to the study, which was based on prescription data for Medicare Part D enrollees (JAMA Network Open. 2018;1(2):e180450).

Those findings suggest the importance of economic, cultural, and environmental factors in the opioid epidemic, according to study author James S. Goodwin, MD, of the University of Texas Medical Branch, Galveston, and co-authors.

“Public health policy directed at stemming the opioid epidemic must go beyond the medical model and incorporate socioenvironmental disadvantage factors and health behaviors into policy planning and implementation,” Dr. Goodwin and co-authors wrote.

The cross-sectional analysis included data for 3.76 million Medicare Part D enrollees. They looked specifically at the proportion of enrollees with chronic opioid use, which they defined as receipt of at least a 90-day supply in 1 year.

After adjusting for age, disability, and other factors, they found 693 out of 3,100 counties (22.4%) had rates of chronic opioid use higher than the mean, and 638 (20.6%) had rates lower than the mean. The correlation between opioid use rates and the presidential vote was 0.42 (P < .001), according to investigators.

They also published two county maps that they said shared some similar patterns. The first shows the proportion of older chronic opioid users by quintile, and the second shows Republican vote percentages, also by quintile. The correlation coefficient between those two rates was 0.32 (P < .001).

This study adds to the emerging literature on the relationships between health status and support of Donald Trump in the 2016 election, according to authors.

However, there were limitations to the study, they added. Of note, the presidential vote data was from 2016, but the information on prolonged opioid prescriptions was from 2015. Moreover, the voting data included all voters, while the opioid data came only from Medicare Part D enrollees, which represent about 72% of the full Medicare population.

One study author reported grants from the National Institute on Drug Abuse and Agency for Healthcare Research and Quality. Another reported membership in Physicians for Responsible Opioid Prescribing

SOURCE: Goodwin JS, et al. JAMA Network Open. 2018;1(2):e180450.

This article was updated 6/26/18.

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