New Hampshire addiction crisis turns personal tragedy into national issue

With hundreds of overdose deaths annually, state is ground zero of drug scourge and the politics of what to do about it

Democratic Presidential candidate Hillary Clinton speaks during a community forum on substance abuse September 17, 2015 in Laconia, New Hampshire.
Darren McCollester/Getty Images

HOLLIS, N.H. — Visits to the local pharmacy by presidential candidates have become a tradition in Hollis, a town of 7,600 people in southern New Hampshire. On a brisk morning in January, Republican hopeful Carly Fiorina was surrounded by children on one side and veterans in garrison caps on the other while she spoke passionately about the problems in Washington she wants to fix.

Her appearance had extra meaning for the pharmacy’s owner, Vahrij Manoukian. Both he and Fiorina have lost children to addiction.

When he asked her about her plan to combat drug addiction, she recalled the day her stepdaughter was convicted of driving under the influence. “I can remember standing in a courtroom and pleading with a judge not to send my daughter to jail,” Fiorina said. “But his hands were tied, and off to jail she went. That did not help her. It did not treat her.”

New Hampshire is a small state, but it has an outsize role in presidential politics. It hosts the first primary in the nation, this year on Feb. 9, and it is at the center of the nation’s heroin and opioid abuse epidemic, with 351 deaths from heroin or other opioids in 2015, according to the state’s Office of the Chief Medical Examiner — up 116 percent since 2013. With voters across the state affected, presidential hopefuls in both parties have turned opioid addiction into a national political issue.

As she waited for Fiorina to arrive at the pharmacy, Anita Beaulieu, a retiree from Hollis, said that she knows several people who have also lost adult children to addiction. “When you’re losing young lives almost every day, it’s a problem, and it’s time to do something about it,” she said.

New Hampshire Office of the Chief Medical Examiner

Mary Savage, 67, had several employees who struggled with addiction when she was the chief operations officer of a company in Hollis. The company stood by them, she said, and some were able to find help. But she wants to see much more done at the state level. “I think we locally have to get our acts together and do some other things coming out of Concord.”

That’s starting to happen. On Thursday, New Hampshire Gov. Maggie Hassan signed two fast-track bills recommended by a special commission created last year. The new legislation will create a commission to study naloxone, a drug used in emergency treatment of opioid overdoses; increase funding for the state’s prescription monitoring system; and strengthen the penalties for distributing fentanyl, a powerful drug that contributed to 72 percent of New Hampshire’s known opioid deaths last year. A bill on addiction education in schools is pending.

Earlier this month, the Addiction Policy Forum, an advocacy group based in Washington, D.C., hosted a forum for presidential candidates to discuss the opioid epidemic with New Hampshire policymakers. Fiorina and four of her GOP rivals — Jeb Bush, Chris Christie, John Kasich and Jim Gilmore — attended. Democratic candidates Hillary Clinton, Bernie Sanders and Martin O’Malley sent surrogates.

During the event, which drew national media coverage, Fiorina and Bush shared stories of seeing their children struggle with addiction. Months before, a video of Christie talking about a law school friend who died from prescription painkiller addiction went viral online, and Ted Cruz has since spoken at campaign events about his older half-sister’s death from drug abuse.

That represents a real shift and may help lift the stigma around addiction, according to Jessica Nickel, the Addiction Policy Forum’s executive director. “No one brings you casseroles and homemade apple pies when your kid is struggling with a heroin addiction,” she said. “I’m really hopeful that having so many prominent leaders really be honest and open about this will help us change that a bit.”

While some candidates are telling their stories, others are mostly listening. At a town hall in Rochester last week, Clinton said New Hampshire’s opioid epidemic became an “obsession” for her after learning about the extent of the problem while on the campaign trail. “I wouldn’t have necessarily known that if I hadn’t been sitting in a little cafe in Keene listening to people tell me about what was breaking their hearts,” she said.

In September she released a plan to combat drug and alcohol addiction. It includes $7.5 billion for federal-state partnerships and changes in regulations so nurse practitioners and physician assistants may prescribe medicines to treat opioid addiction.

Sitting in the balcony before Clinton’s town hall, Karen Prazar, 35, said she sees the effects of addiction every day as a community health nurse. The state’s Medicaid expansion last year helped, she said. But she believes the federal government should do more to make up for what she says is a lack of state services, from food and housing assistance to the number of opioid addiction clinics that accept Medicaid. “We see the problem,” she said. “But we have nowhere to send people.”

Sanders, Clinton’s main rival, has other proposals. He has pushed to lower the price of naloxone, and at a Democratic debate in December he laid much of the blame for the opioid crisis at the feet of doctors and pharmaceutical companies.

“They have got to start getting their act together,” he said. “We cannot have this huge number of opiates out there throughout this country, where young people are taking them, getting hooked and then going to heroin.”

The week before Clinton’s Rochester event, nearly 1,500 people crowded into an auditorium at Dartmouth College in Hanover to hear Sanders. There he didn’t address the opioid epidemic, focusing instead on his plan to decriminalize marijuana under federal law — a move that he said would cut down on drug convictions, which make it difficult for people to find work.

This focus on broader drug policy and economic issues seemed to resonate with Sanders’ supporters. Allison Zito, a 55-year-old teacher who attended the Hanover event, tied the opioid problem to income inequality — a cornerstone of his campaign. She said she has seen neighbors making good money selling drugs while others scrape by. An increase in the minimum wage, she argued, might lessen the appeal of dealing drugs. “If you’ve got no hope, why not go ahead and live up the life that you want?” she said. “I mean, the drug dealers have people coming over every seven minutes bringing them money.”

Aaron Cheese, 19, a member of the Dartmouth College Democrats, linked the opioid crisis to a broader lack of social services, consumerist thinking and what he called failed drug policies. Growing up in Atlanta, he saw two high school classmates overdose on heroin. “I haven’t really heard many politicians speaking about it, but it’s been fairly present in my life,” he said. “It is something I’d like to see addressed — the war on drugs, which hasn’t been very effective.”

‘[Doctors and drugmakers] have got to start getting their act together. We cannot have this huge number of opiates out there throughout this country where young people are taking them, getting hooked and then going to heroin.’

Bernie Sanders

Democratic presidential candidate

Republican candidates, too, have tried to connect drug addiction to broader political themes. At a town hall in Rochester last week, Bush quickly pivoted from a question about civil service reform to a discussion of border security and drug addiction. “The epidemic of heroin here relates to a lax border because cheap heroin makes its way up here,” he said. “It’s potent, highly addictive, cheap, because we haven’t controlled it.”

In an interview with Al Jazeera after that meeting, he expanded on the federal government’s role in helping states like New Hampshire fight addiction, saying Washington should continue to fund mental health programs and intensify an anti-trafficking program. “There’s a lot of roles I think the federal government can play in this regard,” he said.

Donald Trump also tied the heroin problem to border security at a rally earlier this month in Lowell, Massachusetts. Trump told the cheering crowd that his controversial plan to build a wall on the U.S.-Mexico border would stem the heroin epidemic. “You know where that stuff is coming from,” he said. “They’re not going to be sending it over so easy anymore, folks.”

He has fleshed out his position considerably since August, when he largely dodged a question about solutions to the heroin epidemic at a press conference in Hampton. “Education. Working hard. You have to get people to understand the problems,” he responded when a reporter pressed him.

Still, the personal stories seem to resonate most strongly with New Hampshire voters, who raise questions about drug addiction regularly at campaign events. Bush’s daughter Noelle Bush has struggled with addiction, and he has told her story often on the campaign trail.

That approach hits home with Barbara Smith, an 83-year-old retired housewife. Three of her 11 adult children have battled addiction, she said. “It’s very meaningful, because I’ve been through it,” she said. “I’ve got three sons that were in drugs, and I see the struggle they went through. But I also see the progress that they have made and that they can be helped if people will give them the chance to do it.”

Find Al Jazeera America on your TV

Get email updates from Al Jazeera America

Sign up for our weekly newsletter

Get email updates from Al Jazeera America

Sign up for our weekly newsletter