ARI SHAPIRO, HOST:
And I'm Ari Shapiro in Manchester, N.H. This state has one of the highest death rates from drug overdoses in the country. That was a major focus of the presidential campaign in 2016. Four years later, deaths from opioids have started to inch down, but overdose deaths from other drugs, like meth, are climbing. Sometimes it feels like everyone in this state has lost someone to this crisis.
AARON PASKALIS: My roommate in college died of an overdose.
SHAPIRO: Aaron Paskalis is a firefighter in Manchester.
PASKALIS: He got an injury due to sports. And it's like the classic story - taking pain meds, prescribed way more than he should've. And when he ran out of the meds, he eventually went to heroin. And unfortunately, he had a wife and kid.
SHAPIRO: Paskalis is in his late 30s. We met him at his fire station, where older guys say they used to go five years without getting a single overdose call. And today, Paskalis says most of his work is not fighting fires; it's dealing with substance abuse problems.
PASKALIS: Whether it's overdoses or car accidents 'cause people are under the influence of opiates, I would say it's at least probably 60% of what we do right now. It seems like it kind of fluctuates. We'll go through a wave of heroin, and then we'll go through spice and meth.
SHAPIRO: Spice is a kind of synthetic marijuana.
Paskalis leads us to one of the fire trucks.
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SHAPIRO: We hop in and go for a drive with some of the guys through the snowy town.
PASKALIS: One of the big methadone clinics in the city is right here.
SHAPIRO: We pass a park where people use drugs when the weather's better.
PASKALIS: We had, like, eight overdoses there all at the same time this summer.
SHAPIRO: What was that about?
PASKALIS: Spice. It was, again, like, another bad batch of spice, and they were all overdosing.
SHAPIRO: It really shows how the crisis is changing.
SHAPIRO: People on the front lines of this crisis tell us some politicians and candidates are still talking about the shifting problem in outdated ways.
JACQUI ABIKOFF: The concern that I have, for the most part, is the huge focus that we hear from all of the candidates on the opioid crisis, which loses focus on what the real problem is, and that's the addiction crisis.
SHAPIRO: Jacqui Abikoff runs Horizons Counseling Center, which is opening a new sober home for women about an hour north of Manchester in the town of Laconia. We caught up with her at the ribbon-cutting ceremony.
ABIKOFF: We have to try to find a way to be creative in being able to support everyone who walks through our doors. And when we choose a specific substance to designate funding to, we're not addressing the larger issue.
SHAPIRO: When the candidates talked about that larger issue at a debate hosted by ABC News in Manchester on Friday night, a lot of the focus was on opioids, but they also talked about broader themes, like decriminalizing drug possession and expanding treatment.
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PETE BUTTIGIEG: What I've called for is that incarceration should no longer be the response to drug possession.
AMY KLOBUCHAR: And if you don't want to see repeat customers, the only answer is treatment.
ANDREW YANG: That if you are seeking treatment, you know you're not going to be sent to jail. We have safe injection and safe consumption sites for you.
SHAPIRO: That was former South Bend, Ind., Mayor Pete Buttigieg, Minnesota Senator Amy Klobuchar and businessman Andrew Yang.
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PHIL SPAGNUOLO: Hello.
SHAPIRO: Hey. Are you Phil?
SPAGNUOLO: Yes, I am.
SHAPIRO: Hi. I'm Ari.
Back up north in Laconia, N.H., Phil Spagnuolo runs a sober home for men called New Life Recovery. He's a Democrat running for state Senate, and he's also in recovery himself. Spagnuolo can rattle off quick takes on the candidates' plans to address the addiction crisis.
SPAGNUOLO: Bernie's plan is overall health coverage-wise the most comprehensive from what I've seen. I think that Elizabeth Warren's - I like very much how she wants to pay for it, taxing the top 1%. I think Amy Klobuchar's plan comes from a really personal place. She's shared openly about how her father was an alcoholic.
SHAPIRO: This town is one of the hardest-hit communities in New Hampshire, which is one of the hardest-hit states in the country. Half a dozen guys living in this house are recently out of rehab.
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SHAPIRO: They agreed to tell us about their experiences and their thoughts on the presidential campaigns' approach to the crisis that they are living through. We're only using their first names so they can speak frankly about illegal drug use. Tyler is the youngest in the group. He's 21.
TYLER: So you hear all these commercials on TV with the presidential candidates just saying, we're going to defeat Trump. We're going to do this. We're going to do that. But you don't hear anybody say, oh, let's make more shelters for homeless people and people like us. You know, you don't hear anything about that.
SHAPIRO: Almost all of these guys have spent some time living on the street. When 23-year-old Sky was ready to get help for his addiction, people at the recovery center told him to come back later.
SKY: Right after an overdose, I wanted to go into a rehab, and the police told me I had to wait two weeks to two months before I could get into a medical detox bed. And I kind of just told them, like, hey, I'm kind of scared to go back on the street 'cause, like, I'm going to go back to the same house, and I'm probably going to use, and I might overdose again. So, you know, I don't - I didn't want that to happen. So I had to tell them that I was scared to go back on the street, and that's when the ball started rolling.
SHAPIRO: And do you think that's something that a new president could improve?
SKY: Yeah. I think there definitely could be improvement 'cause, you know, someone who's dealing with drug addiction - I mean, two weeks is a lot of time, you know? And I didn't know I was going to overdose that day, you know? So if I didn't get help that day, I might not even be here.
SHAPIRO: Before he got that help, he was living on the street in Manchester.
SKY: I was lucky enough to get a sleeping bag. But this winter that just came by, I was sleeping outside. I was, like, sleeping in front of storefronts. I found an abandoned car. I was sleeping in an abandoned car.
SHAPIRO: It sounds like what you're describing is not only an addiction crisis but also a housing crisis.
SKY: Housing crisis, addiction crisis - it's, yeah, it's horrendous.
SHAPIRO: At one point, Tyler worked as a check-in clerk at a dry shelter that didn't allow people who were using.
TYLER: Anybody who had come in that had anything in their system we had to turn away when there were plenty of open beds.
JACOB: And when they're turning away like that, you know, it only makes their problem worse by going back out and using more so, you know, they're able to be outside in the cold. They're numb to it.
BRETT: When I have nowhere to go, I'll go into an emergency room and just say I want to kill myself just so I have a place to stay for five days.
SHAPIRO: That's Jacob and Brett, both 29.
I'm going to ask a tough question, if you don't mind. Will you raise your hand if you know somebody close to you who died of an overdose? Everybody at the table.
JOSHUA: My mother actually overdosed two years ago from heroin.
SHAPIRO: I'm sorry.
JOSHUA: That was tough.
SHAPIRO: This is 32-year-old Joshua.
JOSHUA: I've kind of been caught up ever since.
SHAPIRO: That was the trigger for you?
JOSHUA: Yeah. I mean, I was in and out of addiction since I was, like, 19, 20 years old. But, yeah, my little brother passed away, and my mother fell back into it pretty hard and, yeah, like I said, she OD'd. And, yeah, it's just been tough the past couple years...
SHAPIRO: Yeah, I'm sorry.
JOSHUA: ...To pull myself out of it, you know?
SHAPIRO: You must just all feel like there are, for every one of you, a hundred people who are not getting the help that you all were able to get. You're all nodding your heads yes.
SKY: We're all wicked lucky.
SHAPIRO: That's Sky. These guys all know that sobriety and recovery are not straight lines, so when I ask if they are optimistic about the future, they're hesitant. And then Jacob says he's hopeful.
JACOB: I don't see this situation really being any better than it is now. It's just you can always hope, though. Maybe the next president will really take a good look and, you know, make the right decisions.
SHAPIRO: The guys aren't sure whether they'll vote tomorrow. Most of them say they're focused on taking each day as it comes.
(SOUNDBITE OF SEBASTIEN TELLIER'S "FANTINO") Transcript provided by NPR, Copyright NPR.