Opioid overdose deaths in the U.S. rose dramatically after 1999, but also exhibited substantial geographic variation. Job loss due to international trade is positively associated with opioid overdose mortality at the county-level. This association is significantly stronger in areas in which fentanyl is present in the heroin supply. In general, the loss of 1,000 trade-related jobs was associated with a 2.7 percent increase in opioid-related deaths. When fentanyl was present, the same number of job losses was associated with a 11.3 percent increase in such deaths. The positive relationship between trade-related job loss and opioid-related overdose death is well illustrated...