If you walk past Serenity Place in downtown Manchester, New Hampshire, it might not be obvious that the dingy building is on the front lines in the state's battle against addiction. But inside, you'll find the largest substance treatment facility in the city, with about 30 beds for both men and women undergoing various detox and recovery programs. Those beds are "always full," says Stephanie Bergeron, Serenity Place's director of development.
Manchester is the epicenter of the so-called "heroin epidemic" that has swept across New Hampshire and much of the Northeast in recent years. There were about 400 deaths in New Hampshire last year from opioid-related overdoses, up from 193 just two years before. In Manchester alone, 69 people died from overdoses last year, and there have been 17 overdoses in the city since last Friday, four of which were fatal, according to the chief of police Nick Willard.
As New Hampshire gears up to hold the nation's first primary vote on Tuesday, the state's drug crisis is being thrust into the national spotlight. Nearly all of the presidential candidates have brought up the subject — specifically heroin addiction — during the frenzied campaigning in the state over the past year.
Carly Fiorina has been one of the earliest and most vocal candidates to speak on the subject. On Friday, she was involved in a roundtable discussion at the HOPE for New Hampshire Recovery, a rehab center in Manchester located just a few blocks down the street from Serenity Place.
"We need to start recognizing addiction as a disease," Fiorina told a room of about two dozen New Hampshire residents, including several recovering addicts. "We have to cover it, we have to treat it."
She went on to discuss how her daughter struggled with alcohol and prescription opioid abuse before her death from an overdose, emphasizing how that experience made the issue deeply personal. Heads emphatically nodded across the room in agreement throughout her speech.
People affected by substance abuse are a sizable constituency in New Hampshire, and candidates have taken note.
Related: Heroin Kills White People More Than Anyone Else — And Nobody Is Sure Why
"There's 23 million people in recovery across the country," said a recovering addict at Fiorina's event who gave his name as Brian. He was apparently referencing survey data released in 2012 that showed 10 percent of Americans 18 and older consider themselves to be in recovery from drug or alcohol abuse problems.
"And they're all voting," Brian added. "They're voting on whoever talks about this issue and relates to this issue the best."
His message came through loud and clear at the recovery center, where the walls were plastered with signs that read "Recovery Voices Count," and "We Recover And We Vote."
The number of people admitted to state-funded treatment programs has increased by 90 percent for heroin addiction in the last 10 years and 500 percent for prescription opioids, according to the New Hampshire Department of Health and Human Services. New Hampshire has one of the highest rates of substance use by young people in the country, and ranks second-to-last among all US states in terms of access to substance abuse treatment.
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Drug abuse ranked as the single most important issue to New Hampshire voters in the 2016 presidential election, according to an October 2015 survey by the University of New Hampshire. Terry Cote, a Manchester resident who came to see Fiorina at HOPE for New Hampshire Recovery, said the issue is "so huge" in the community that it's the focus of many primary voters.
"We're just losing too many people," Cote said. "We're losing the next generation right now and it's scary." Cote said she planned to support Fiorina after hearing her speak on the issue.
Fiorina, however, is hardly the only candidate to speak openly about a personal connection to addiction. Jeb Bush has frequently discussed his own daughter's struggle with addiction and the felony charge she faced for illegally possessing prescription pills. While making an emotional plea for drug reform here last October, New Jersey Governor Chris Christie recalled his mother's smoking addiction and memory of a friend who became addicted to the prescription painkiller Percocet.
"It would be cruel for a politician to know that a state has a problem and come here and not even try to do anything about it," says Kate Recupero, a student at Manchester Community College who also came to see Fiorina speak. She described losing two family members to substance abuse, and said she will vote for a candidate that will push for treatment and recovery over criminal punishment for addicts.
At Serenity Place, Bergeron said the fact that candidates from both parties are discussing substance abuse and addiction is a notable change from previous election cycles.
Related: Why America's Ongoing Heroin Epidemic May Soon Run Its Course
"The way [substance abuse] is being addressed now, compared to four years ago, is light years apart," said Bergeron. Not only are candidates talking openly about addiction, she added, they are describing it as a medical issue instead of a criminal one.
Both the Republican and Democratic candidates have called for solutions to New Hampshire's drug crisis. Hillary Clinton proposed a $10 billion plan to combat drug addiction by increasing federal funding for local drug treatment programs "so we can end the era of mass incarceration," she wrote in an op-ed in September.
Christie has called the drug war a "failure," and has been an outspoken advocate for reform. Fiorina also called for criminal justice reform on Friday, though she did not elaborate on what specific changes she would support.
'We're just losing too many people. We're losing the next generation right now and it's scary.'
New Hampshire might have become the face of the heroin epidemic in this current election, but surging drug addiction has hardly been limited to the Granite State. The national rate of heroin-related deaths nearly quadrupled between 2002 and 2013, according to the Centers for Disease Control. In 2014, more than 47,000 people died from heroin and opiod drug overdoses, an all-time record. Drug overdoses now kill more people in the US than car accidents or HIV/AIDS during the height of the crisis in the 1980s.
Much of the current rise in heroin use has been attributed to the increase in prescriptions for painkillers like OxyContin. As the pills became more expensive and harder to obtain, many moved over to heroin as a cheaper alternative, explained Bergeron. Serenity Place's female inpatient program currently has 16 beds, 14 of which are occupied by recovering heroin addicts, she said.
Though a number of candidates have vowed to take a progressive approach to fighting drug addiction, many New Hampshire residents have lived through enough election cycles to be wary of what politicians say in their stump speeches during primary season.
Related: Critics Say New Plan to Stop Heroin Overdoses Shows White House 'Still Doesn't Get It'
"Heroin has become a hot topic," said Dominic Donahue, the clinical director at Serenity Place. He has 25 years of experience in the field of addiction and recovery, and said that after the primary is over, he expects the attention to "dwindle in the media, yet we'll still be here dealing with it."
Heroin has been around for decades, but what makes this current epidemic so shocking, Donahue and Bergeron say, is that it is now affecting communities that are white, suburban, and relatively wealthy.
Ultimately, New Hampshire voters will have to wait until after a new president is elected in November to see if the big talk on addiction by the candidates translates to meaningful action.
"We're happy that they're listening to the citizens of New Hampshire and that this conversation is happening," Bergeron said "But we're fearful that once they leave on the 10th, are we going to be left in the dust?"
Follow Olivia Becker on Twitter: @obecker928