Opioid addiction is because opioids make you feel really good and they are really addictive and they had a tendency to be overprescribed. Blaming the economy for opioids is like blaming airplanes for AIDS.
As far as the wasteland heartland, I am not sure if Texas is included in the heartland, but the Texas economy is one of the biggest in the world — about as large as the GDP of Canada and larger than that of South Korea. Basically Texas is the 9th or 10th largest economy in the world. California is 5th or 6th. The state of Ohio’s economy is only slightly smaller than the entire country of Belgium.
The desolate wastelands are in the non-major cities and towns of Europe. Avignon France, for example, in the city center, has blocks and blocks of boarded up storefronts. Unemployment in Avignon is over 15% and only 35% even earn enough to have to pay income tax. Gary, Indiana, about as heartland as it gets, has a 7.6% unemployment rate — a rate that is declining. By European standards of GDP, disposable income and unemployment, Gary is a boomtown.
Don’t just consume the NPR-worthy stories of the death of the US heartland. Remember, most media outlets in the vein of the Atlantic, NPR, etc., they are typically coastal elites who have barely ever visited the heartland, let alone actually lived or worked there. They are also an echo chamber pushing an when’d a of a certain political persuasion, so it helps their narrative when “fly-over country” isn’t doing well.