Speaking with the "Shockwaves"/"HardRadio" podcast, frontman Dave Mustaine said the song is about the epidemic running through the nation of taking painkillers. Mustaine has personal experience of their addictive qualities having taken pain pills as a result of a broken bone in his neck and becoming chemically dependent to them. "The song 'Kingmaker' is about how people are running from their problems," he explained, "and there's a lot of that on this particular record — just looking at, like, 'Here's what I've got. What are you gonna do with it?' It's talking a lot about this generation, how people, their lives are falling apart and they just take pills. Instead of sucking up and doing what I did and going and getting the surgery and getting off the medication, they'll continue to just trudge it out until the end of their life where they just take pills until their body is eaten.
"And the other thing that's part of that song," Mustaine continued, "is talking about how when you take these things how they make you feel different. Some people, they get into that 'cause they like the way it makes you feel, 'cause it makes you kind of feel warm and fuzzy. In the song, it talks about wanting to fly and being ten feet tall. Booze does that to some people. And this is just something that, I think, if there is a way that I can help educate a lot of our fans, especially the younger ones that still have their whole life ahead of them, it's not as glamorous as you think it is to go down that path of just checking it out and drugging yourself up and not facing reality."
Speaking with the Reno Gazette-Journal, Mustaine described this as a scorching narrative on the scourge of the pharmaceutical industry on society, in particular teenagers. "When I was growing up, pot was like the real big thing among young guys," he said. "I smoked when I was 13. Now, you see lots of young kids doing crack and ecstasy and crystal meth. It's so sad. And while I don't deny anybody the right to have an out-of-body experience, music can do that for you. Love can do that for you."
"My concern is we have a new generation of people who really don't want to experience any emotions, whether it's themselves or the people around them," continued Mustaine. "Instead of learning to communicate and share their lives and emotions with other people, we're just putting them on psycho-pharmaceutical stuff just to shut them up. Like One Flew Over The Cuckoo's Nest kind of stuff."