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Commentary: Will suicide become the "opioid epidemic" of the 2018 midterm elections?

Politics of opioid epidemic, suicide crisis

This may seem like a strange question to ask, but political campaigns can have a profound impact on public policy, and there is a direct connection between the current focus on America's opioid epidemic and Donald Trump's 2016 presidential campaign.

After losing the Iowa caucus to Sen. Ted Cruz, R-Texas, Donald Trump came to New Hampshire and won his first (of many) GOP primary victory. And one of the key issues in his Granite State campaign was the state's overwhelming opioid addiction crisis.

Long before the topic was part of the national conversation, it was front-page news in New Hampshire. Drug overdose deaths hit a record high in 2015—doubling the number just two years earlier. The culprits were fentanyl and heroin. Then-candidate Trump stumped across the Granite State talking about the issue and pledging help from Washington, D.C. To outsiders, it seemed a somewhat odd topic, but it resonated with local voters, too many of whom have to address the ravages of opoid abuse in their everyday lives.

Trump won a huge victory, doubling the vote total of second-place Gov. John Kasich.

The opioid issue was so central to Trump's campaign strategy that, during a 2017 phone conversation with Mexican President Enrique Peña Nieto, Trump claimed he'd won the New Hampshire because it was a "drug-infested den."   New Hampshire politicos bristled at the language, but they couldn't deny that the magnitude of their state's drug problem or the impact it had on the 2016 campaign. 

And while Trump would eventually lose New Hampshire to Hillary Clinton in the general election, he had the best performance of any Republican since George W. Bush won the Granite State in 2000.

Today, the headlines in New Hampshire contain eerie echoes of 2015. The state's suicide rate jumped by 48.3 percent between 1999-2016—the third-highest increase in the U.S., according to a new report from the Centers for Disease Control. It's the state's second highest cause of death among young people and eighth overall.

And as was the case in 2015, New Hampshire's struggles are part of a national narrative.  From 1999 to 2014, the number of opioid overdose deaths in the U.S. rose by around 400 percent.  According the CDC's new report, suicide rates in the United States have risen nearly 30 percent since 1999, rising in every state except Nevada. Suicide is now the 10th leading cause of death in the U.S. and, like New Hampshire, the second-leading cause among young people.

The overlap between the opioid epidemic and suicide doesn't end there. Just as fentanyl and heroin have disproportionately ravaged rural, white communities, a recent report in the American Journal of Preventative Medicine finds that suicide rates are rising faster in those communities as well.

On the geography side, "nearly half of the most rural counties (49 percent) exhibited increases in estimated suicide rates of more than 30 percent, compared with 19 percent of suburban counties and only 10 percent of the most urban counties," the report found.  

As for the demographics, the new CDC report confirms that middle-aged adults (45-64) had the highest suicide rate increase of any age group. More than 80 percent of people who commit suicide are white and about 77 percent are men.


Based on this data, it's hardly a surprise that—similar to the opioid epidemic—Appalachia's suicide rate is higher than the the nation as a whole. 

Rural. White. Male. Living in the Appalachians—if you see a pattern emerging, you're right. This is the demographic most responsible for Donald Trump's 2016 election victory.  When Trump made opioid deaths a central part of his 2016, it was an issue that directly impacted hundreds of thousands of families in key swing states like Ohio and Pennslyvania. 

Now there is a new crisis that is even more directly impacting Trump voters. In fact, President Trump carried seven of the 10 states that suffered the biggest increases in suicide rates. 

When Washington saw the political impact of the opioid issue on the 2016 campaign, a flurry of legislative initiatives followed. According to the Washington Post, June "has unofficially become opioids month for lawmakers and policymakers in Washington," with 57 bipartisan bills passing through committee and the White House launching public service TV ads targeting opioid addiction. While critics of President Trump complained when he declared a "state of emergency" over the opioid crisis but didn't request any new resources, Republicans are preparing to spend an additional $1 billion on the opioid crisis.

The question now is whether we'll see a similar response to the surge in suicide rates? For example, Montana and North Dakota both have high-profile U.S. Senate races this year with Democratic incumbents in states carried by Donald Trump. The former has the highest suicide rate in the U.S. The latter had the highest rate of increase. It's easy to imagine the president who seized the opioid issue in 2016 incorporating suicide into his stump speeches campaigning for GOP candidates in those states.

The good news for people suffering with the depression and despair that can lead to suicide is that, where politicians go, money and resources follow. If suicide prevention does become part of the 2018 campaign, the results could mean more help for people who need it most.

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