States that lost a greater share of manufacturing jobs, and states that had steeper union decline, and states that had lower self-employment - those states had worse rises in overdose deaths. Those three factors - deunionization, deindustrialization, and low self-employment - contribute in a significant way, even net of other important factors like healthcare coverage, like racial percentages, like population size. Those three factors explain almost 40% of the rise in overdose death rates across states.