Sarah August developed an opioid addiction after being prescribed painkillers in her late 20s. She began using heroin after her doctor took her off the medication. Eventually, she decided to seek treatment. But it was hard to find the right option.
“I bounced around from place to place, because there is no long-term program,” she said.
Now in recovery, August works at an organization that’s trying to address that need, Dismas Home in Manchester. It’s a nine-month residential treatment and transitional housing program for women.
“The first time I got clean, I wish there was a program like this,” she said. "There's not enough of them out there. You need long-term treatment to build your recovery foundation.”
That kind of support is often unavailable, she said, so too many people are stuck cycling in and out of 28-day programs.
“Most people are going to fail,” she said. “And that's where we need to start coming up with a better system.”
A decade into New Hampshire’s overdose crisis, there are some signs of progress. Overdose deaths declined last year, after surging during the pandemic. Access to treatment, recovery support and the overdose-reversal drug naloxone has improved.
But hundreds of Granite Staters are still losing their lives to drugs each year – 431 in 2023, according to the latest data from the state medical examiner. And those, like August, who are on the front lines of the crisis say many people still face barriers to getting the help they need, from insurance obstacles to service gaps in rural areas to the toll of continued stigma.
“It needs to be talked about more, and we need to come up with some more resources to really take care of the issue,” August said.
In this year’s race for governor, neither Democrat Joyce Craig nor Republican Kelly Ayotte has released a detailed plan for addressing substance use, though they have outlined some policy ideas – in both cases, informed by their past records in public office.
What the candidates are saying
Both Ayotte and Craig say they would do more to support treatment, recovery and prevention, though have sometimes offered limited details.
Each candidate brings a different lens to the problem, based on their past record in public office, with Craig stressing the need for more cooperation with local communities and Ayotte emphasizing criminal penalties as a way to reduce the prevalence of drugs.
Craig served as mayor of Manchester, which has been the epicenter of the crisis in recent years, from 2018 to 2023. During that time, she frequently clashed with Gov. Chris Sununu over the state’s handling of the drug crisis and said one of her priorities as governor would be to improve communication with local officials that are on the front lines, and ensure funding for substance use services is actually meeting local needs.
Ayotte, as attorney general from 2004 to 2009, was the state’s top law enforcement officer and later served a term in the U.S. Senate. She has called for harsher sentences for people who sell fentanyl, including mandatory minimum prison sentences.
“We should have the toughest penalties for fentanyl dealers in the country here in New Hampshire,” Ayotte said during a primary debate hosted by WMUR in early September. “And when I’m governor, we will do that.”
Research has generally found that making prison sentences longer doesn’t do all that much to deter crime, with a 2014 review of the evidence by the National Academies of Sciences, Engineering, and Medicine describing the effect as “modest at best.”
Both Ayotte and Craig have said they want to improve access to treatment and recovery services by strengthening the state’s Doorways program – a network of sites from Nashua to Berlin that connect people with substance use treatment and other resources.
Craig says she would identify ways to improve Doorway locations that aren’t effective as they should be. In Manchester, for example, she said the program is underutilized because it’s located right next to a probation and parole office, so some people are uncomfortable walking in the door. (State health officials say they’re aware of the issue and taking steps to address it.)
“We need to look at data across our state and make sure that the funds that are going into our local community are best being used to meet the needs of the most vulnerable,” Craig said.
Craig also said the state should pay for longer stays in recovery housing than it does now, to give people more stability as they begin recovery.
Ayotte’s campaign declined to make her available for an interview. Her campaign instead sent a statement in response to a list of specific questions about how she plans to approach treatment, prevention and harm reduction.
In that statement, Ayotte’s campaign noted her support for a bill that increased funding for treatment, recovery and prevention while she was in the U.S. Senate. She said she would “work to strengthen” the Doorways program, “particularly focusing on areas of our state where there are gaps in access to services, such as the North Country.”
Ayotte also said expanding the behavioral health workforce would be a priority, including working with the state’s higher education system to train more recovery professionals and reducing licensing delays for drug and alcohol counselors.
Manchester in the spotlight
In many ways, Manchester has been at the center of this gubernatorial campaign. Ayotte has repeatedly attacked Craig over the city’s struggles with addiction and homelessness, airing TV ads that show sidewalks littered with used needles and feces while claiming Craig “let the homeless take over Manchester.”
Craig has strongly objected to Ayotte’s dire portrayal of the city. She said her administration took the substance use crisis seriously, including developing a harm reduction strategy, hiring a director of overdose prevention and forming outreach teams that can quickly respond and offer help when there’s a spike in overdoses.
“Being mayor of the largest city of the state, I have been on the front lines dealing with this in the city of Manchester and helping individuals,” she said in a recent interview. “We've implemented outreach programs. We have provided services that haven't been available in other areas of the state.”
Craig has credited those steps with a 20% decline in total opioid overdoses, fatal and nonfatal, in Manchester between 2017 and 2023.
It isn’t as clear-cut when it comes to overdose deaths. Fatal overdoses in Manchester dropped during Craig’s first year in office – then surged even higher during the COVID-19 pandemic, before falling again in the last year of her term, roughly in line with statewide trends. According to data from the state medical examiner’s office, Manchester had 92 overdose deaths in 2023, which is about the same as in 2017.
Some harm reduction advocates have said Craig’s administration made it harder to operate syringe exchanges – programs that allow people to dispose of used needles and receive clean ones, which has been shown to reduce HIV transmission. During her tenure, she and other city officials sought to block state funding for the New Hampshire Harm Reduction Coalition, a nonprofit that operates a syringe exchange program in Manchester, and barred it from city parks.
At the time, some of those involved with the program said they felt city officials were making it harder to help people struggling with addiction, where other municipalities had been more supportive. For their part, Craig and other officials said they weren’t opposed to syringe programs in general, but had concerns about that particular one.
In her interview with NHPR, Craig pointed to that as an example of the need for better coordination between state and local officials, and suggested she would be more proactive about oversight.
“It's got to be evidence-based, and there's got to be collection of data,” she said.
In a statement provided by her campaign, Ayotte pointed to an ordinance that passed in Manchester this month with the support of Craig’s successor as mayor, Jay Ruais, placing more regulations on syringe exchange programs.
“We should implement this practice throughout the state to make our communities safer,” Ayotte said.
A plea for more conversations on the ground
Meanwhile, some in Manchester say they want to hear more from elected officials.
Last Sunday, volunteers with the group Anchored in Hope set up tables in Manchester’s Veterans Memorial Park, full of donated clothing and other items. A barber gave people free haircuts.
Terry Everett of Auburn founded Anchored in Hope after her daughter, Sarah, died of an overdose eight years ago. The organization does outreach and gives out necessities to people who are homeless or otherwise struggling. Part of its mission is to end the stigma around addiction, Everett said.
“We were always so proud of Sarah from the day she was born. Never ashamed. She fought a good fight. She helped people along the way,” Everett said. “So we want to put that out there. We want to support people and let them know we're here for you.”
Everett thinks there still isn’t enough support for people seeking recovery in New Hampshire. Her daughter went to treatment, but the programs just weren’t long enough. She worries that too many other people are stuck in a cycle of substance use for the same reasons.
Everett would like to hear more about how, specifically, candidates for office would approach such challenges.
“What can you do?” she said. “What kind of legislation or funding or, you know, education can you provide to have these programs be a little more effective? Because obviously it's not working for everyone.”
Nearby, George Wing of Manchester was making ham and turkey sandwiches for people who stopped by.
“We try to build a rapport,” he said. “That's why I do them from scratch, instead of just handing them out. This way, I get eye contact with them. I get to ask them if they need prayer.”
Like Everett, Wing started doing outreach work after losing a loved one – his brother – to an overdose. He says he’s been volunteering at events like this for years, and never sees politicians showing up to them.
“Come out here,” he urged. “I would love for either one of them to actually come to an event like this. Do you know these people? They are people and they have stories. And, you know, they'll never know what those stories are.”
People seeking help for a substance use disorder can call 211 or visit one of New Hampshire’s Doorway locations.