Inter-Party Mayoral Political Competition and Opioid Mortality in Populous Urban Peer Counties.

The impact of political competition on opioid-related mortality in the United States is examined in urban metropolitan counties (2001 to 2024). County groups were matched for 19 socio-demographic factors, and each county was categorized as having competitive, transitional, or monopoly mayoral governance based on duration of one-party control. There is higher opioid mortality in Black people versus White people from both prescription and non-prescription opioids in monopoly versus competitive counties. Rather than bringing health stability, mayoral political monopolies potentially harm vulnerable populations and strengthen structural racism based on political privilege. Interestingly, the political party itself is not the factor; duration of party control drives the observed disparate opioid mortality. We hypothesize a framework for understanding structural racism in opioid mortality based on political privilege and monopoly rather than racial privilege and political party affiliation. Analytic epidemiologic studies are needed to test the extent to which political control affects opioid outcomes.