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Carlson is wrong that people were ignored or mocked, but the government was slow to move.
The problem with prescription opioids drew attention in the mid-2000s, and by 2011, the White House released a plan on how to tackle it.
Federal funding came more slowly, rising to the billion dollar level only by 2016.
Before Election Day, Fox News host Tucker Carlson explained why supporters of President Donald Trump love him so much. Tucker gave the example of thousands of people at a Trump rally in Butler, Pa.
They loved Trump, Carlson said, largely because "because no one else loves them."
"The country they built, the country their ancestors fought for over hundreds of years, has left them to die in their unfashionable little towns," Carlson said. "Mocked and despised by the sneering half wits with finance degrees, but no actual skills, who seem to run everything all of a sudden."
Carlson found proof of this disdain from "the professional class" in the opioid epidemic that ravaged Butler.
"When large numbers of people in Butler started killing themselves with narcotics, no one in Washington or New York or Los Angeles said a word about it," Carlson said. "Whatever Donald Trump's faults, he is better than the rest of the people in charge. At least he doesn't hate them for their weakness."
We can’t quantify whether leaders in Washington or large cities on the East and West coasts hate people in smaller cities and towns beset by opioid addiction, but we can assess whether these leaders ignored the epidemic.
The pattern that emerges from the record of budgets and reports, and from interviews, is that the response at both the federal and state levels was slow in coming, but the epidemic was not ignored.
Butler is just north of Pittsburgh in western Pennsylvania. The city has only about 13,000 people, but nearly 188,000 people live in Butler County. The area has lost manufacturing jobs over the decades, but it is no post-industrial wasteland. The AK Steel Corp, maker of rolled steel and other products, is the county’s fourth largest employer.
There are theaters and museums, and fans of local beer can tour a dozen microbreweries.
Amenities aside, like every part of the country, Butler County has struggled with opioid addiction. Compared with other Pennsylvania counties, it has an overdose death rate that is about average — 24 deaths per 100,000 in 2018. That’s essentially unchanged from four years ago, but the rate spiked to 50 per 100,000 in 2017, before dropping back down.
Emergency room physician Jeanmarie Perrone in Philadelphia said that by about 2008 or so, it was clear that prescribing opioids wasn’t making people better. But it took a few more years for doctors and the public health community to see that opioid addiction had spread widely.
"The awareness came that this wasn't an urban problem, the pills were ubiquitous," Perrone said. "You didn't need to be in a city to find a doctor to prescribe them."
Perrone said that the federal Drug Enforcement Administration was the first to sound the alarm, followed by the Justice Department and later still, the Food and Drug Administration and the Centers for Disease Control and Prevention.
Congress and the Obama administration were not silent about prescription opioids such as oxycontin, but it took awhile for them to back up their words with dollars.
In 2011, the Obama administration unveiled the government’s first plan to tackle prescription drug abuse.
"Prescription drug abuse is the nation’s fastest-growing drug problem," a White House report said.
It listed the statistics. A four-fold increase in 10 years in the amount of opioids prescribed. Between 2000 to 2009, the number of prescriptions rose by nearly 50% to reach 257 million.
But the report dialed back the urgency.
"These realities demand action, but any policy response must be approached thoughtfully, while acknowledging budgetary constraints at the state and Federal levels," the report said. "Any policy in this area must strike a balance between our desire to minimize abuse of prescription drugs and the need to ensure access for their legitimate use."
That lack of urgency allowed the problem to fester.
"The problem was already severe in 2008, and it got worse every year after," said Andrew Kolodny, medical director of opioid policy research at Brandeis University. "It wasn’t until 2015 that the administration and Congress began to address the problem."
In March 2015, the administration said it wanted an additional $99 million to focus on curtailing opioid prescription trends and reduce opioid deaths. In February 2016, the president’s budget called for $1 billion over two years to "expand access to treatment for prescription drug abuse and heroin use."
The sense that more needed to be done grew, but Johns Hopkins School of Public Health epidemiologist Caleb Alexander said Carlson’s dichotomy of coastal elites and inland workers doesn’t hold up.
"I don’t think that this is a Washington vs. Main Street matter," Alexander said. "It is a matter of a broad and multifaceted epidemic that has impacted urban and rural America alike."
In Pennsylvania, Perrone said the sense among frontline workers was less that of abandonment by the government, and more that of uncertainty of how to respond.
"Nobody knew what to do," Perrone said. "You couldn’t just stop giving opioids. You couldn’t take them all off the market. We were teaching doctors to prescribe them more safely, but that’s not easy. The horse was out of the barn, and there wasn’t an obvious answer as to what would work."
Perrone added that the makers and distributors of prescription opioids formed a potent lobby that successfully argued against any moves that would reduce their sales.
Carlson’s point that Washington ignored places like Butler County is undercut by a working group of U.S. attorneys. They met in 2014 to tackle the epidemic and presented a plan to change their approach. The head of that group was David Hickton, the U.S. attorney for Western Pennsylvania.
Hickton also co-chaired a national Justice Department task force on addiction.
We reached out to Fox News and did not hear back.
Carlson said that as opioid deaths climbed in rural communities, "no one in Washington or New York or Los Angeles said a word about it." Carlson went so far as to say that the elites "mocked and despised" such communities.
Looking at the response at the federal level, literally speaking, Carlson is wrong. By 2011, the administration had put forth a strategy to reduce prescription opioid deaths. The U.S. Attorney for Western Pennsylvania led a Justice Department task force focused on the epidemic.
There is room to criticize Washington for failing to put more money into the problem sooner, but by 2015, the White House was calling for a major increase in spending of $1 billion over two years.
A frontline clinician at a Philadelphia hospital said if the response was delayed, it was partly because the sense of what would work evolved along with the epidemic.
We rate this claim Mostly False.
Fox News, Tucker Carlson, Nov. 2, 2020
U.S. Food and Drug Administration, Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse, accessed Nov. 4, 2020
White House, National drug control strategy, 2011
White House, Epidemic: Responding to America’s Prescription Drug Abuse Crisis, 2011
U.S. Justice Department, U.S. Attorney’s Working Group on Drug Overdose and Addiction: Prevention, Intervention, Treatment and Recovery, Sept. 29, 2014
U.S. Health and Human Services Department, Opioid Abuse in the U.S. and HHS Actions to Address Opioid-Drug Related Overdoses and Deaths, March 26, 2015
OverdosefreePA, Death Data Overview: 2015-2018, accessed Nov. 3, 2020
Office of National Drug Control Policy, Budget and Performance, accessed Nov. 4, 2020
House Majority Policy Committee, Combating Pennsylvania’s Opioid Epidemic, October 2016
Pennsylvania Department of Health, Prescription drug monitoring program Q and A, accessed Nov. 4, 2020
ProPublica, American Recovery and Reinvestment Act: Butler County, Pa., accessed Nov. 4, 2020
University of Pennsylvania Leonard Davis Institute of Health Economics, Pennsylvania Launches its Prescription Drug Monitoring Program, Aug. 25, 2016
U.S. Senate Homeland Security Committee , Field hearing: Examining the impact of the opioid epidemic in Ohio, April 22, 2016
Washington Post, Deaths from opioid overdoses set a record in 2014, Dec. 18, 2015
Interview, Andrew Kolodny, medical director, Opioid Policy Research, Brandeis University, Nov. 4, 2020
Email exchange, Caleb Alexander, professor of epidemiology, Johns Hopkins Bloomberg School of Public Health, Nov. 4, 2020
Email exchange, E. Van Nostrand, assistant professor, Department of Health Policy and Management, University of Pittsburgh, Nov. 4, 2020
Interview, Jeanmarie Perrone, professor, Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Nov. 5, 2020
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