During 2016’s First in the Nation primary, the issue of opioid addiction surged to the national stage, partly due to the Granite State crisis. President Donald Trump later credited his New Hampshire victory in part to frustration over the flow of opioids over the U.S. southern border.

“I won New Hampshire because New Hampshire is a drug-infested den,” Trump said in 2017.

Now comes a new report that opioid overdoses in Manchester and Nashua are at five-year highs, and political candidates are again focusing on the issue.

American Medical Response crews were called out to 99 overdoses in July in Manchester and Nashua, the highest number of overdoses in a single month since 2018, according to Chris Stawasz, the AMR’s Regional Director of Government Affairs — Northeast.

“The high death rate per capita is attributed to synthetic fentanyl, which is now commonly found in all types of illicit substances in New Hampshire,” Stawasz said. “People who are using illicit substances have no idea that what they are using contains synthetic fentanyl – or how potent the synthetic fentanyl in the product is. Synthetic fentanyl can be lethal the first time you use it, knowingly or unknowingly.”

Eight people died in July from opioid-related overdoses, four in each city, according to Stawasz. 

AMR’s statistics show that through the end of July, medics responded to 415 suspected opioid overdoses in Nashua and Manchester, with 68 of those calls suspected opioid deaths. Manchester accounted for 40 of the deaths and Nashua for 28.

In Nashua, suspected opioid overdoses are 10 percent lower than last year. But at the same time, fatal opioid overdoses were up 10 percent. In fact. Stawasz said more than 20 percent of the suspected opioid overdoses that AMR medics responded to in Nashua have been fatal.

In Manchester, suspected opioid overdoses are 2 percent higher than last year, though total suspected fatal opioid overdoses in Manchester are 13 percent lower.

Candidates at the federal and local levels are speaking out.

“Sadly, drug overdoses are increasing in New Hampshire faster than anywhere else in the country, and Communist China is to blame,” former U.N. Ambassador Nikki Haley told NHJournal. “President Biden should confront Xi Jinping’s drug war and put an end to it today. Stop all normal trade relations with Beijing until they stop killing Americans.”

Florida Gov. Ron DeSantis addressed the issue during an event in Rye, N.H., last week, pledging to “lean in against the drug cartels.”

“If they’re trying to bring fentanyl into our communities, that’s going to be the last thing they do. Because at the border, they’re going to be shot stone-cold dead,” DeSantis said.

And Democratic presidential contender Robert F Kennedy, Jr. just released a documentary, “Midnight at the Border,” that addresses the cross-border drug trade and the need for action.

“These numbers represent both a state and national tragedy. Our national government has failed the American people,” Kennedy said in a statement to NHJournal. “The open border has enabled an acceleration of illegal drugs including opioids and fentanyl to move across America creating a social, economic, and spiritual disaster for our country.

“The lack of enforcement at the border has far-reaching consequences for health policy and law enforcement. As President, I will close the border and make available treatment centers for those who are struggling with addiction. I intend to restore America’s sovereignty and restore the health of our people.”

In Manchester, the overdose epidemic runs in tandem with the city’s homelessness crisis. Mayor Joyce Craig has said at least 50 percent of the city’s overdoses happen among the homeless population.

The city’s Board of Aldermen will consider changing an ordinance next month that could give police more legal authority to prevent homeless people from camping on public property.

None of the Democrats running for mayor, Ward 1 Alderman Kevin Cavanaugh, Ward 2 Alderman Will Stewart, or Alderman At Large June Trisciani, responded to NHJournal’s calls and emails last week.

Republican candidate Jay Ruis wants to see police given more power as part of a larger strategy to address homelessness and addiction.

“We must deal with this issue in a comprehensive way, one that includes enforcement of our ordinances, addressing the underlying causes of this crisis like addiction and mental health, while increasing the availability of affordable housing. What we cannot do is govern in fear of lawsuits, and I support this proposed ordinance change,” Ruais said.

Republican candidate for governor Kelly Ayotte has pointed the finger at Massachusetts as one source of the problem. “Unfortunately, we’ve seen drugs, the fentanyl being trafficked off our southern border from Lowell and Lawrence, Mass. into our cities, and it’s killing our citizens,” Ayotte said.

Massachusetts officials complained, and some in the media suggested her comments were “racially tinged.” But the problem continues.

On Friday, Lawrence, Mass. man Santo Evangelista Soto, 36, was sentenced to five years in prison for being part of a trafficking ring that brought drugs into New Hampshire. Soto, a twice-convicted trafficker, reportedly sold counterfeit prescriptions made with deadly ingredients.

In one of the drug deals Soto allegedly pulled off during the investigation, he sold 1,000 counterfeit oxycodone pills that contained heroin and methamphetamine.

Soto is not the only trafficker operating in the state. Joseph Goffinet, Jr., 53, of Manchester, was arrested and charged last week on charges of distribution of controlled substances and conspiracy to distribute controlled substances in connection with the sale of fentanyl. His alleged co-conspirator, Walter Velez, 41, was arrested in late July.

Both Goffinet and Velez allegedly sold vast quantities of fentanyl in Manchester.