Quantitative Analysis of the Relationship Between Political

Identity and Opioid Prescription Rates in the United States

By Adam Throne

February 28, 2018

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Research Question

Why do some states have higher opioid prescription rates than other states do? How do

these varying rates impact the prescription opioid abuse epidemic within the United States?

Literature Review

Drug abuse is an increasingly popularized topic within the United States. Movies

involving DEA busts in Latin America and TV shows about meth labs in suburban garages

dominate popular media. A key aspect of health education across America is the danger of drug

abuse. This past weekend, my 9-year old cousin said the following to his older sister who attends

Dartmouth University: “Drugs are bad. Don’t do drugs. Did you know that drugs can kill you?”

Typically, on the national scale, patterns of drug abuse are fairly easy to identify, predict, and

prevent. Recently though, a new drug epidemic has developed within the United States that

challenges this conception. The abuse of prescription drugs, and specifically pharmaceutical

opioids, is growing at an exponential rate. Scholars are baffled by the lack of consistency in

patterns of abuse between states. Existing literature focuses on the scope of the epidemic and

characteristics shared by abusers. However, in order to resolve the opioid epidemic in the United

States, scholars must step back and analyze the pathways through which opioids are introduced

into society. This quantitative study identifies characteristics of states with high prescription

rates. In the future, the findings of this study can be used to prevent the distribution of opioids to

abusers through targeted education campaigns and policies.

For those unfamiliar with opioids, they are a class of substance that manipulate opioid

receptors in the brain, spine, and digestive system to produce a pain relieving effect (Freye and

Levy 2008; Yaksh and Wallace 2011). In 1874, with the goal of creating a cough suppressant

and sedative, C.R. Alder Wright synthetically derived them for the first time (Yaksh and Wallace
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2011). Today, opioids are commonly prescribed for a variety of pain relief treatments including

surgery, sports injuries, and even cancer treatment (Forbes 2007; Frey and Levy 2008).

Additionally, close to 125 million Americans suffer treatable chronic pain each year (Skolnick

2017). Examples of common prescription opioids include oxycodone (OxyContin), hydrocodone

(Vicodin), codeine, and morphine. Sadly, naturally derived from opium poppy, these drugs are

highly addictive (Yaksh and Wallace 2011).

Were prescription opioids solely used for the purposes of their prescriptions, there would

not be an issue to analyze. However, over the past decade there has been an increase in the

number of drug prescriptions, number of drug overdoses, and number of drug fatalities related to

prescription drugs throughout the United States (Calcaterra, Glanz and Binswanger 2013; Rudd

et al. 2016). It is estimated that 3 million people in the United States have a current or past opioid

addiction, and the treatment for such addictions often involves other harmful drugs such as

methadone (Schuckit 2016). On a national level, the abuse of prescription opioids has remained

steady in recent years, but the use of traditional heroin has spiked (Rudd et al. 2016). It seems

that prescription opioid addicts may be transitioning to illegal compliments as prescriptions

become more difficult to obtain.

In addition to a variety of online forums, several recent studies have attempted to identify

the populations directly susceptible to high opioid abuse rates. Multiple reviews point out how

the prescription drug epidemic, unlike similar epidemics, has spread beyond the confines of

urban epicenters (Hall et al. 2008; Paulozzi and Xi 2008). A recent journal expands this finding

by determining that changes in pharmacy density are significant in rural settings while changes

in income and manual labor industries are significant in suburban and rural settings (Cerda et al.

2017). Although I respect the validity of these statistical discoveries, they seem somewhat
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narrow and may be extraneous. For this same reason, certain scholars even discredit their own

statistical findings. In December, research journalists from the New York Times determined that

opioid mortality rates are growing at the highest rate for middle-age African American men. The

same article claims that this finding is too specific to discredit the existing theory that opioid

addiction transcends typical dividing factors of race, socioeconomic class, gender, and age (Katz

and Goodnough 2017). Essentially, to the limits of existing literature, all individuals with

addictive personalities risk becoming opioid addicts.

A broader explanation is that states with medical or recreational marijuana policies are

less likely to have problems with opioid addiction. Although marijuana is illegal on the federal

level, many believe that it is less addictive than opioids are while still having a pain-relief effect.

Furthermore, it has been proven that self-imposed abuse treatments are more effective than

government controlled ones, such as methadone clinics (Sindelar and Fiellin 2001). For those

worried about the lack of election support for recreational marijuana, there is evidence that states

with medical marijuana laws have an increasing chance of legalizing recreational marijuana

(Kilmer and MacCoun 2017). Nevertheless, many individuals do not support the use or

legalization of marijuana. It is likely that at-risk individuals would continue to use legal

prescription opioids rather than break federal law even if state laws were to legalize marijuana.

Varying state laws, diverse populations, and inter-state movement make it very difficult to

establish a direct correlation between general characteristics and state drug abuse rates.

Therefore, the focus of scholars and policymakers must be on stopping excessive

prescriptions from leaving the pharmacy. When analyzing drug prescription patterns, there is

also clear state-to-state variability (Maxwell 2011). Some states overprescribe prescription drugs

while others under-prescribe them. In general, it seems that prescription patterns vary at the
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county level (Zhang, Baicker and Newhouse 2010). In many of these counties, the demand for

prescription opioids has no correlation to injury or chronic pain rate (McDonald, Carlson and

Izrael 2013). This fuels the conflict of whether or not governments should intervene at the risk of

unintentionally limiting the supply of legal opioids for those who use them appropriately

(Larance et al. 2011). Before implementing general policies that could further limit necessary

painkiller prescriptions, policymakers must first identify and educate the populations responsible

for high prescription rates.

Limiting the distribution of opioids directly has proven to be a challenge. A 2008 case

study of West Virginia found that pharmaceutical diversion was the cause of over 60% of opioid-

related deaths followed by doctor shopping at around 20% (Hall et al. 2008). Even in states with

strict regulations on the use and prescription of these drugs though, it is very difficult to control

their distribution and consumption once they leave the pharmacy (CDC 2017; Kantor et al.

2015). Prescription drugs, including opioids, are most easily obtained through friends and family

(National Institute on Drug Abuse). With this in mind, there has been a change in focus among

public health officials from preventing the distribution of prescription opioids to learning how to

treat addiction to them (Kolodny et al. 2015; McCarty, Priest and Korthuis 2017). This is

concerning, because overdoses are common for first-time abusers.

Currently, it is not possible to accurately measure the success of existing policies

targeting the prescription of opioids. A popular theory when the opioid epidemic first broke out

was that the quality of clinicians and prescription patterns impacted the number of prescriptions

and amount of drug abuse in a region (Hall et al. 2008; Lin et al. 2018; National Institute on

Drug Abuse). In response, states implemented broad statewide counter-prescription policies

including drug monitoring programs, daily supply limits to written prescriptions, substance abuse
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disorder assessments, ID checking mandates, and continuous medical education for clinicians

(Athena Insight 2017). Unfortunately, since states have only recently introduced these policies,

they are not useful control variables. States with high prescription rates are more likely to enact

policies targeting high prescription rates. Many of these policies are intended to have long-term

impacts. Current addicts will either find loopholes to obtain prescriptions or transition to illegal

heroin as it becomes more difficult to receive prescriptions for chronic pain. Additionally, the

common dissemination of prescriptions between families and friends questions the effectiveness

of each program, specifically statewide drug monitoring programs (Lin et al. 2018). In order for

policies to be effective, they must be formulated specifically for the individuals who are willing

to prescribe excess opioid prescriptions.

Theory

I believe that a conservative political viewpoint successfully encapsulates the

characteristics shared by generous opioid prescribers. The American political climate is primarily

bipartisan. Recent studies have favored an expressive party identification model over an

instrumental one (Huddy, Mason and Aarøe 2015). Under this model, strongly identified

partisans feel angrier than weaker partisans when threatened with electoral loss (Huddy, Mason

and Aarøe 2015). This has created a climate in which conservatives and liberals are severely

polarized over key policy conflicts (Lee 2015). This bipolar system poses serious constraints to

policymaking within public health (Oliver 2005). On the individual level, it is even more likely

that individuals will adhere to their own political beliefs than follow the government’s. Liberals

tend to be progressive with respect to drug use (Marietta 2012). Conservatives on the other hand

typically support minimal government intervention, the maintenance of existing policy, and

adherence to traditional values (Marietta 2012). The tendency for conservative voters to live in
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rural settings supports the inconsistency that opioid abuse has spread outside of cities. The

preference of conservative individuals to retain strong ties with family members explains the

unique circulation of opioid prescriptions beyond the counter. Conservative disapproval of

medical marijuana favors the promotion of alternative legal prescription painkillers (Republican

Views). Although not all conservative voters share these viewpoints, particularly due to the

radical candidates of the previous few elections, there should be consistency on the statewide

scale.

Therefore, due to their traditional preferences, conservative voters are more likely to

support the prescription of opioids for chronic pain than liberal voters are. Thus, states with more

conservative voters tend to distribute more prescriptions of opioids than states with fewer

conservative voters do. Due to the fact that the opioid epidemic is a current and growing national

issue, existing solutions are incomplete and evolving. If the results of my study are significant,

they will provide a significant contribution towards identifying the populations which must be

educated on the dangers of opioids.

Data

Due to the fact that the prescription opioid epidemic is still an emerging issue within the

United States, data exclusive to my topic is fairly restricted. Prescription-specific data is

collected from scholarly articles, government-sponsored infographics, and non-profit institution

reports. Independent variables associated with population demographics are collected from more

conventional well-respected sources including the United States Census. For each variable, data

is sorted by state.

To measure the political identity of each state, I use ratios calculated from the 2016

presidential election. I choose to represent this variable with presidential election results for two
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reasons. First, presidential elections produce the highest voter turnout due to their large

implications and widespread media attention. Second, uneducated voters tend to vote more

consistently with their individual ideological stances than their partisan preferences in

presidential elections (Huddy, Mason and Aarøe 2015). I choose the 2016 election, because it is

the most recent election. Lack of partisan support for both Hillary Clinton and Donald Trump

may impact these results. In a future study, I would suggest using average election percentages

from presidential elections of the past twenty years. However, variation between elections is

small enough that the general trends and correlations I predict should not be affected. Official

election data is available through the Federal Election Commission (Federal Election

Commission 2016). My dataset includes a column for percent of voters in each state who voted

“conservative”, “liberal”, and “other.” These percentages are calculated manually using a

spreadsheet function.

To measure the prescription rate of each state, my dependent variable, I use data from the

Center for Disease Control (Center for Disease Control 2017). Rather than calculating a mean

from multiple years of data, I use the dataset available from 2015. This is a recent dataset that

also represents the peak of the opioid epidemic. This allows me to accurately analyze the impact

of independent variables without controlling for policies targeting opioid prescription.

Additionally, the year of the dataset fits well with the election data chosen for my primary

independent variable. If my hypothesis is accurate, I should find a significant positive correlation

between prescription rate and conservative political identity.

In order to ensure the validity of the study’s hypothesis, it is essential to address other

unrelated variables which may impact the study’s dependent variable. Wealthy individuals are

capable of purchasing more prescriptions, so wealthy states may have larger prescription rates.
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Alternatively, wealthy individuals have more access to drug education and materials highlighting

the dangers of prescription opioids. In such a case, wealthy states would have lower prescription

rates. I control for these scenarios by including a Median Household Income column. Data

associated with this control variable was collected by the United States Census in 2016. I divide

each value by 1000 to make results more consistent with an individual’s typical change in

income.

States with large populations tend to have greater ideological variability than states with

small populations. Initial testing demonstrates that without controlling for population, New York

and Texas, states with 2 of the nation’s 3 largest populations, are significant outliers. Using rate

measurements rather than total counts for my key variables helps eliminate some state-to-state

population variability. In order to ensure that this imbalance does not reduce the effectiveness of

my model though, I include state population as a control variable. Data for this control variable

was collected by the United States Census in 2016. I divide each value by 1000, because a 1000

person change in population is more likely and significant than a 1 person change on a state

level.

Participation in workforce likely impacts opioid prescription rates. Individuals who are

working or looking for jobs have less time to be under the influence of opioid painkillers or any

other substance. Thereby, states with high labor participation rates should have lower

prescription rates than states with low labor participation rates. Alternatively, individuals who

work more are more likely to be in pain. Accordingly, states with high labor participation rates

should have higher opioid prescription rates for chronic pain. I control for these likelihoods by

including a “participation rate in the economy” column. Data for this control variable was

collected by the United States Census in 2016.

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A variable that has a significant impact on similar social variables, including other types

of drug abuse, is race. Typically, African Americans and Latinos are more likely to abuse street

drugs such as heroin. However, literature on opioid abuse claims that race does not have an

influence in this case. In order to prove this widely supported claim, I include a column for race.

I bundle all racial identities besides Caucasian in this column as a percentage of the total

population. If there is a significant correlation between race and prescription rate, a future study

should break this variable down into more specific classifications. Data for this control variable

was collected by the United States Census in 2016. I manually calculate the proportions and

multiply by 100 to create a form consistent with other percentage variables.

Elderly citizens tend to have greater access to prescription opioids and tend to hold

conservative ideologies. The most common off-record method for abusers to obtain prescription

opioids is through elderly relatives and friends. These characteristics suggest that states with

more elderly citizens may have higher opioid prescription rates than states with fewer elderly

citizens do. I account for this alternative by including a column for “percent of population over

the age of 65.” Data for this control variable was collected by the United States Census in 2016.

Methods

The goal of my quantitative analysis is to prove a substantively significant positive

relationship between opioid prescription rate and conservative political identity while controlling

for significant external factors. My entire analysis is completed in R Studio using the guidance of

R for Beginners or: How I learned to Stop Worrying and Love R by Kent Freeze and Melanie

Freeze. Packages I use for my analysis are readxl, car, ggplot2, MASS, stargazer, and lmtest. I

use the self-compiled dataset OpioidDataFinal which is described above and available upon

request.
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To test for a relationship, I transform political identity into a categorical variable. To

accomplish this, I create a modified dummy variable. States in which less than 40% of the

population voted for Trump in 2016 are “very liberal.” States in which 40% to 50% of the

population voted for Trump in 2016 are “liberal.” States in which 50% to 60% of the population

voted for Trump in 2016 are “conservative.” States in which greater than 60% of the population

voted for Trump in 2016 are “very conservative.” I then calculate the mean opioid prescription

rate for each of these categories. The outcome is illustrated in a bar plot between Opioid

Prescribing Rate 2015 (Y-Axis) and Conservative 2015 (X-Axis).

To test the strength of this relationship for individual cases, I compare the interval values

of the study’s main variables. I accomplish this by running a scatterplot between Opioid

Prescribing Rate 2015 (Y-Axis) and Conservative 2015 (X-Axis). I choose to use the basic plot

function, but a more advanced ggplot2 scatterplot would also be effective. The purpose of this

method is to observe if there is a workable pattern in the distribution of the data.

To prove the central relationship of my hypothesis, I incorporate control variables which

may have significant influence. To start, I run a multiple regression. Opioid Prescribing Rate

2015 is my dependent variable. Conservative 2015, 2016 Median Household Income,

Participation Rate in Economy Total, Age Over 65, Percent non-white, and Population are my

independent variables. I summarize the results of this regression in a Stargazer table and run tests

to interpret the significance of the output. I test the bivariate partial relationship between each

independent variable and Opioid Prescribing Rate 2015 while controlling for all other variables

through an Added Variable Plot. The avPlots function also helps to identify consistent outliers. I

check for outliers and heteroscedasticity by examining a Residual vs. Fitted Values Plot. This is

produced by running the multiple regression through the plot function. I confirm observations of
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heteroscedasticity by completing a Breuch Pagan test through the bptest function. I test for error

term normality by observing a Q-Q plot created using the qqPlot function. Finally, I check for

multicollinearity by creating a correlation matrix for my independent variables.

Results

Overall, there is significant statistical evidence in favor of my hypothesis that states with

more conservative voters tend to prescribe more opioids than states with more liberal voters. The

following bar graph depicts the mean opioid prescription rate for each category of state voter

identity:

This graph shows that there is a clear association between political identity and opioid

prescription rate. Very liberal states have an average opioid prescription rate of 59.3. Liberal

states have an average opioid prescription rate of 72.6. Conservative states have an average

opioid prescription rate of 80.9. Very conservative states have an average opioid prescription rate

of 95.9. This means that very conservative states issue 95.9 prescriptions per 100 people. It is
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interesting that strength of political identity seems to have an impact. This suggests that political

identity itself may have a larger impact than other associated variables.

It seems that this correlation exists on an individual case basis as well. The following

scatterplot shows the relationship between opioid prescription rate and political identity without

accounting for control variables:

There appears to be an upward sloping linear relationship in this scatterplot. This matches the

theory of my hypothesis. The only exceptions to this trend are outliers in the upper quartile of

percent conservative. The outcome of this scatterplot is promising, because it shows that there is

a fairly strong correlation but still freedom to improve my model with control variables.

After introducing control variables to my model, there is still significant statistical proof

in support of my hypothesis. However, there is also evidence that control variables play valuable

roles in influencing states’ opioid prescription rates. Below is the Stargazer output of the study’s

multiple regression:
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Percent Conservative, Median Household Income, State Population, Participation Rate in

Workforce, and Percent of Population over 65 are each significant within a 95% confidence

level. The adjusted R2 value suggests that this model accounts for 78.1% of variance in opioid

prescription rate. Given how intricate and recently developed the opioid epidemic is, this is an

acceptable value. Race does not appear to be statistically significant, but its existence in

contributing literature and importance to social science support its presence in the model.

There is no significant issue with linearity in this model. In the added variable plot,

Percent Conservative 2015 has a moderately strong positive relationship with Opioid Prescribing

Rate 2015. Population and Participation Rate in the Economy Total have strong negative

relationships with Opioid Prescribing Rate 2015. 2016 Median Household Income and Age Over
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65 have moderately weak negative relationships with Opioid Prescribing Rate 2015. Percent

non-white has a weak negative relationship with Opioid Prescribing Rate 2015. Outliers

consistent to multiple models include Alabama, New Mexico, New York, and Tennessee. It

seems that these outliers may skew the slopes of trend lines but not in a manner significant

enough to change their direction.

Error terms in this model have an adequate normal distribution. Heteroscedasticity does

not appear to be a significant element of this model. In the RVF plot, there does not seem to be

much change in the variance of residuals across the x-axis. The outliers Alabama, New York,

and Tennessee challenge this claim. However, a Breusch-Pagan Test produces a p-value of

.6568. With this value, one is unable to reject the null that there is no heteroscedasticity.

Additionally, the Q-Q Plot shows that error terms seem to match the ideal line of best fit closely

and almost entirely fall within the 95% confidence interval.

Although there is a case of multicollinearity within this model, it is not significant

enough to limit the findings of the study. There is a -.65 correlation between Percent

Conservative 2015 and 2016 Median Household Income. This makes sense, because wealth and

economic policy are critical influencers of voters and election outcomes. There is a .54

correlation between Participation Rate in the Economy Total and 2016 Median Household

Income. This also makes sense, because people who are employed always have household

incomes. Other correlations are not significant. In each of these cases, the model would be more

statistically accurate if median household income were removed from the model. However, this

variable adds the element of socioeconomic class that is an essential category of society. I

believe that the inclusion of this variable is important even if it does limit the effectiveness of my
 16

model slightly. Therefore, the statistical quality of this model is well-founded enough to support

an association with opioid prescription rate.

Analysis

A variety of factors, including conservative voter identity, contribute to a state’s

propensity to have a high opioid prescription rate. A 1% increase in the number of conservative

voters in a state predicts a .487% increase in opioid prescription rate. This is a substantively

significant value due to the high population of each state. For example, .487% of California’s

39.25-million-person population is 189,930. One prescription can kill, so having nearly 200,000

additional prescriptions is momentous. Additionally, although most states only fluctuate

approximately 1.3 percent between elections, some states experience a surge in conservative

voters over 10 percent. Although not all of these voters adamantly support opioid prescribing,

this serves to show what could happen if conservative opioid-supporters were to flock together as

liberal drug policies are passed in swing states. Direct government intervention will only

empower many conservative individuals to prescribe out of protest. This will put more opioid

prescriptions on the streets and further contribute to climbing abuse rates. It is not possible to

classify opioids as illegal drugs, because many individuals do rely on them for medical purposes.

Recognizing this, policymakers must work to educate conservative populations on the dangers of

opioids with targeted information that appeals to their political preferences.

Information gained from the control variables in this study is also useful for isolating

specific target populations. A 1,000-dollar increase in Median Household Income predicts a

.616% decrease in a state’s opioid prescription rate. This suggests that wealthy individuals

understand the risk of opioid prescriptions better than poor individuals do. A 1% increase in

Participation Rate in the Workforce predicts a 2.776% decrease in a state’s opioid prescription
 17

rate. This is a substantial impact for a variable which is fairly easy to monitor and control. A 1%

increase in population over the age of 65 predicts a 2.734% decrease in a state’s opioid

prescription rate. This significant outcome contrasts with the findings of literature on other forms

of prescription drug abuse. Perhaps elderly folks living in assisted care have responsible

individuals administering their prescriptions. Alternatively, states with fewer elderly folks may

be forced to release prescriptions to abusers in order to meet the demands of pharmaceutical

corporations. Or maybe the new generation is sociologically more interested in feeling the

impact of drugs including opioid prescriptions. Either way, it is clear that having an older

population decreases a state’s prescription rate. State population is not a substantively significant

variable. Even if it were, it would be very difficult to control overall population growth or the

movement of people between states without violating the constitution. Race is neither a

statistically or substantively significant variable.

The findings of this study can be used to develop specific policies and education

curriculums which are effective for high-risk individuals. Ideally, everyone in the nation could

receive the educational benefits and experiences of wealthy individuals, but this is not a

component of the capitalist system. Instead, curriculums in low-income communities should

have an increased focus on the dangers of prescribing or requesting opioids. This will help to

ensure that future generations will consider opioids as dangerous as more popularized drugs like

heroin or meth. As soon as possible, government-sponsored and private advertisements should

target low-income members of society and those who are not actively pursuing work. Great

locations for these advertisements include community centers, bus stops, billboards, public soup

kitchens, and churches. These locations are accessible to all and particularly those who have

graduated or do not have access to continuous education. Additionally, policymakers should

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focus on increasing the participation rate in the economy for each state. This can be

accomplished by requiring unemployment benefit recipients to pursue job searches, monitoring

social welfare recipients to ensure they are not abusing the system, and working to create job

opportunities through economic policies. The existing political climate will challenge these

potential policy changes, so both sides of the political spectrum will need to sacrifice for the

greater good of society. State policies would be more effective than national policies, because

voters feel as though they have more power at the state level. There are countless other policy

initiatives possible, and this study provides a foundation for these policies to build from.

Conclusion

In conclusion, there is significant evidence in favor of my hypothesis that conservative

voter identity positively impacts opioid prescription rates. Other factors, including household

income, participation rate in the economy, and age of population, also contribute significantly. It

is still unclear which factors directly contribute to variation in abuse and overdose rates between

states. Scholars may be puzzled by this question for decades to come. However, this study’s

approach of focusing on opioid prescriptions helps to fill this gap enough for targeted policies to

be developed. I suggest adjusting national health education curriculums to include prescription

drug abuse, implementing inclusive opioid drug abuse advertisement campaigns, and focusing on

creating job opportunities to keep potential abusers occupied. More advanced scholars and

politicians may have better insights on the specific policies which match the findings of this

study. I recommend indirect intervention, because current abusers will transition to heroin abuse

if they are abruptly cut off from their opioid supplies.

I recognize that there are some minor limitations to my study. To start, as a cross-state

study, there is naturally a problem with IID. It is very easy for policymakers, doctors, and
 19

abusers to base their behavior off of policies in other states. Additionally, drug abusers can easily

move opioids across state lines once they are prescribed. Fortunately, the independent variables

in this model are not severely impacted by this discordance. By focusing on the prescriber side of

this epidemic, I remove the possibility for interstate transactions. Additionally, individuals are

not able to change their income, age, or identity with ease. Therefore, like other diagnostic

problems mentioned in the methods section, this issue with IID is inconsequential. Additionally,

I base many individual decisions off of statewide or national trends. The largest example of this

is my assumptions about election voters. I identify individuals who voted for Donald Trump with

conservative ideologies. The rest of my study is built off of this assumption. Particularly in the

past year, it has become clear that many true conservative voters do not support the president’s

policies. His drug policy is fairly standard, but Trump’s selection in the primary may have

caused disproportional voter turnout. In the future, with more time, I would use survey data

specific to party identity and drug-policy stance to frame my analysis. Furthermore, there is a

severe time disparity between some of my sources, and this limits the number of samples

available. I only use data from one year for each of my variables. I think that my results may

have been more precise if I used cases from several years. This is difficult though, because there

is no clear start or end date for the opioid epidemic. Perhaps taking median or means of data

from all years available would be an affective alternative.

The results of this study are accurate but incomplete. This is largely due to the limited 10-

week period of the course. With more time and resources, I would take several additional steps.

First, I would experiment with alternative measures and datasets for each of my variables.

Second, I would conduct interviews to incorporate a qualitative aspect into my analysis. Third, I

would conduct experiments in closed environments to see how individuals of different

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backgrounds respond to suggested policy changes. Fourth, I would expand the extent of my

study to the county level. Finally, I would collect individual data on voter preferences, chronic

pain status, and prescription drug use. I would use this data to explore the relationship between

prescription rates and drug abuse more acutely. For now, my study provides an interesting

perspective to the field of public health policy focusing on solving the opioid epidemic within

the United States.

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