Here’s the brutal truth: Trump country is also opioid country. Fully 77 out of 82 counties with very high rates of opioid deaths—defined as 15 people or more per 100,000— voted for Trump in 2016. According to research published in JAMA Network Open, “in the 693 counties with adjusted rates of opioid prescription significantly higher than the mean county rate, the mean (SE) Republican presidential vote was 59.96% (1.73%), vs 38.67% (1.15%) in the 638 counties with significantly lower rates.”

These are the parts of Trump country where economic anxiety is real, not a talking point to distract from concerns about waning socio-economic status or cultural change—and where unemployment and opioid overdoses and deaths directly correlate. Trump voters are dying in these places. If the GOP wants to keep winning elections, it needs to stop this trend.