For Tim Soucy, life as a city public health director is filled with reports, statistics and funding battles. Because he works in Manchester, New Hampshire, though, it’s also full of desperate phone calls.
“Everyone here has stories,” he says. “I’ve had folks call me, close friends, people saying, ‘I’ve got my brother in the back of the car and he’s going through withdrawal.’ People who have watched a loved one die in a bathtub before they could get treatment. People who say, ‘I’ve locked my son in the house and I don’t know what to do.”
These are the phone calls he dreads in the middle of the night. And there are lots of them. In 2013, New Hampshire saw 192 overdose deaths, which is expected to double two years later.
Now, as Democratic candidates descend on the Granite State for Saturday’s debate, their hosts are begging them to focus on the drug epidemic that has gripped the state. In a poll conducted by ABC Manchester affiliate WMUR-TV in October, residents named drug abuse the top issue facing New Hampshire, the only time in the past seven years the economy and jobs haven’t occupied the top spot.
ABC News spoke to government officials, health care workers and recovering addicts across the state, piecing together a portrait of what voters are facing, and what measures candidates are considering.
New Hampshire is not the only state facing a crisis. From 2002 to 2013, the number of heroin deaths in the United States nearly quadrupled, according to the Centers for Disease Control and Prevention.
Heroin is not the only culprit, either. Seventy-five percent of U.S. heroin addicts have also used prescription opioids. Pain medications like Percocet and Vicodin are highly addictive, and cost several times more than heroin, meaning patients may turn to street drugs when prescriptions run out.
“What is killing more people in New Hampshire isn’t heroin,” though, Timothy Rourke, chairman of Gov. Maggie Hassan’s Commission on Alcohol and Drug Abuse Prevention, says. “It’s fentanyl.”
Fentanyl is a powerful pain reliever up to 100 times more potent than morphine. Its fast-acting sedative effect has led to use as an anesthetic, but also as a popular recreational drug. Law enforcement officials say large quantities are now trafficked from Mexico to New England.
“Narcotics are a really unique commodity,” says Casey Currivan, who is in long-term recovery for poly-substance abuse. “Instead of supply meeting the demand, the supply creates demand.”
Currivan, 41 days sober when he first spoke to ABC News in September, now volunteers at Hope for New Hampshire, a Manchester-based peer recovery center.
Heroin and other opioids “went off like a bomb in New Hampshire,” Currivan says, adding that he has met with wealthy suburban housewives and desperate teens on the run, all struggling to escape the clutches of drugs. “We’re just starting to see the shockwaves of it.”
The state’s youth are more susceptible than most. Ten percent of 18 to 25 year olds have used illicit drugs in the past 30 days, 7.4 percent have suffered from drug dependence this year, and nearly one in five have found themselves abusing alcohol , the highest such numbers in the nation. An economic study by PolEcon Research estimated drug and alcohol misuse cost the state $1.8 billion dollars in 2012, and that was before the crisis had truly exploded.
As the inevitable overdoses mount, New Hampshire appears to be one of the least equipped states to handle the fallout.
The state ranks second to last when it comes to substance abusers finding treatment, according to the Substance Abuse and Mental Health Services Administration. The state Department of Health and Human Services maintains 250 beds available for patients with substance use disorder, which health care advocates say leads to long waiting lists.
“I had just gotten out of medical detox in Massachusetts,” Currivan recalls. “There’s extremely limited access to medical detox in New Hampshire, so I went out of state. After that, I found Hope for New Hampshire.”
As the board chairwoman of Hope for New Hampshire, Melissa Crews says she routinely meets people on the wrong end of waiting lists.
“One girl went and got a card from a treatment facility that said, ‘Come back February 27th,” Crews remembers. “It was October 22nd.”
She adds that by comparison, treatment centers and prevention programs are actually more adequately funded than long-term, peer-based recovery centers, which advocates say are key to a patient’s success.
“The only state that you’re less likely to find available treatment is Texas,” Rourke, of the Commission on Alcohol and Drug Abuse Prevention, says. “Combine the high rates of use and low treatment access rates, and you get the perfect storm.”
Where the candidates stand
To New Hampshire locals, the problems seem clear. What’s unclear, though, is whether a president can do anything about it.
For Soucy, Manchester’s public health director, one answer is funding, along with the pressure the White House can exert on Congress.
“New Hampshire doesn’t have a state income tax, it doesn’t have a sales tax,” he explains. “So anytime there’s an opportunity to get resources from the federal government, that’s important.”
All three Democratic candidates have spoken about improving funding for substance use disorder programs, along with criminal justice reforms that would prioritize treatment over incarceration. In policies outlined on their websites, Hillary Clinton and Martin O’Malley each pledge to allot billions of dollars -- $7 billion and $12 billion, respectively – in federal funds. The plans also each call for physicians to receive training on over-prescribing pain medication.
Bernie Sanders has no position paper devoted specifically to addiction but, in addition to his calls for expanded health care, the senator has pushed to lower the price of naloxone, a drug used to reverse the effects of an overdose.
Advocates say there is even more to be done, especially when it comes to enforcing federal parity laws, which, in theory, are meant to compel health insurance companies to offer equal coverage for mental and physical health issues.
“There are people out there who should be getting treatment, and it should be covered,” Rourke says. “But their insurance companies are not covering it. We need to make crystal, crystal clear that we are going to get away from treating addiction differently from other chronic illnesses.”
More than anything, Currivan says, a potential president has the power to change widespread perceptions about addiction.
“I think the language is extremely important,” he says, suggesting candidates use their media megaphones to reposition drug abuse as a health care issue.
“How do you define someone with an addiction?” he asks. “Is it a moral failing? Or do they have a medical addiction?”
Hope for New Hampshire chairwoman Crews, herself in recovery for 22 years, said voters across the country will be listening to the answer.
“There are 23 million people in long-term recovery from addiction,” she points out. “And we vote.”
Signs of hope
Less than two months before the primary, the spotlight on drugs is brighter than ever – and it’s attracting attention from both sides of the aisle.
On Tuesday, a bipartisan legislative task force presented several bills to the New Hampshire legislature. The measures, which would seek to improve insurance coverage for substance abuse and increase penalties for trafficking fentanyl, are expected to be fast-tracked early next year.
The state’s U.S. senators are united on the topic, too. Republican Kelly Ayotte and Democrat Jeanne Shaheen have pressed Congress for improvements in addiction treatment. On Wednesday, they applauded a bill that would send $159 million to states fighting opioid abuse.
Voters seem willing to reach across the aisle, as well. For all the talk about Democrats this week, Crews of Hope for New Hampshire notes that Republican N.J. Gov. Chris Christie addresses the overdose epidemic at nearly every campaign stop, while Democrats like Bernie Sanders can’t necessarily say the same thing.
“I couldn’t believe Christie’s jump [in New Hampshire polls] after that Huffington Post video,” she says, referencing a six-minute viral video of Christie recalling his mother’s addiction. “That was beautiful. I was talking to one of my friends – he’s a huge Bernie Sanders fan. But the next day there was a ‘Democrats for Chris Christie’ thing on his Facebook page. He called a guy to go work for him!”
She has also heard personal stories from Jeb Bush, whose daughter went to jail for trying to fill a false prescription, and Carly Fiorina, who has described burying a stepdaughter who lost a battle with drugs. She noted that the director of National Drug Control Policy has suffered from substance use disorder.
“There’s finally people in recovery in the White House,” she says. “The drug czar. That’s huge.”
Crews has already discovered a niece using heroin. Her fellow Hope for New Hampshire board member Kriss Blevens “woke up” to the epidemic after finding her stepdaughter dead in the street. At times, it seems like everyone in the state has a similar story.
“If only politicians knew how many of us there were,” Crews says. “We’re tired of watching our friends die.”