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Opioid overdose deaths in the U.S. rose dramatically after 1999, but also exhibited substantial geographic variation. This has largely been explained by differential availability of prescription and non-prescription opioids, including heroin and fentanyl. Recent studies explore the underlying role of socioeconomic factors, but overlook the influence of job loss due to international trade, an economic phenomenon that disproportionately harms the same regions and demographic groups at the heart of the opioid epidemic. We used OLS regression and county-year level data from the Centers for Disease Controls and the Department of Labor to test the association between trade-related job loss and opioid-related overdose death between 1999 and 2015. We find that the loss of 1000 trade-related jobs was associated with a 2.7 percent increase in opioid-related deaths. When fentanyl was present in the heroin supply, the same number of job losses was associated with a 11.3 percent increase in opioid-related deaths.

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Scholars of international political economy often argue that workers automatically share the same trade policy preferences as their employers. However, this approach assumes that trade policies that increase profits necessarily lead to increases in wages. In contrast, I argue that capital and labor are more likely to share the same trade policy preference when "profit-sharing institutions" permit capital to credibly commit that an increase in profits will lead to an increase in wages. In support of my argument, I present a structured, focused comparison of the American textile and steel workers' unions during the late nineteenth century. Both unions supported the high tariffs that protected their industries when credible profit-sharing institutions were in place, but did not support high tariffs when such institutions were absent.