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One of Donald Trump’s first political successes was his embrace of the opioid addiction issue in New Hampshire during the 2016 campaign. Long overlooked, the scourge of addiction was hitting working-class Americans hard, with the Granite State suffering more than 300 drug overdose deaths in 2015.

In 2018, the data analysts at WalletHub ranked New Hampshire as having the third-highest drug use rate in the U.S.

But a decade after Trump came down the golden escalator and helped raise the profile of the opioid issue, New Hampshire’s fortunes have reversed. The latest WalletHub report, released Wednesday, ranks New Hampshire 11th best overall in terms of its drug problem. The report looks at factors like recovery availability, law enforcement efforts, and rates of addiction. Hawaii, Utah, and Nebraska were in the top three for states doing well, while New Mexico, West Virginia, and Nevada have the most dire drug addiction problems according to the report. 

“I think we’re doing significantly better,” said Chris Stawasz, regional director with ambulance company American Medical Response.

Only one New England state, Connecticut, has a lower rate of drug abuse than New Hampshire. Massachusetts and Maine rank 26th and 27th, respectively; Rhode Island comes in at 28th, and Vermont is last in the region at number 32.

Stawasz, who has been collecting and publishing overdose data from the cities of Manchester and Nashua for years, said data from this year is already showing a major improvement.

“Nashua and Manchester are at half of where we were a year ago, and statewide it’s down as well,” Stawasz said. 

Part of the credit goes to state government, where Gov. Chris Sununu led a bipartisan effort to make treatment more readily available to Granite Staters. Mental health and confronting addiction have been among a handful of issues where, despite some differences in approach, support for solutions has been strong on both sides of the aisle.

As a result, New Hampshire ranks 48th among states with adults whose drug-treatment needs are unmet, WalletHub reports.

In Manchester, which has been ground zero for the Granite State’s battle with addiction, Mayor Jay Ruais — who has struggled with his own addiction issues — says the battle has been hard fought. But, he told NHJournal, the results are undeniable as the number of fentanyl overdoses and deaths continues to decline.

“Trend lines have been extraordinarily clear,” Ruais said. 

Stawasz will release numbers for the first quarter of 2025 within the next few days, but he said Manchester and Nashua have seen at least a 50 percent reduction from the first quarter of 2024. The projections for the total 2025 number of overdoses and deaths could be their lowest in at least a decade. 

Getting from the worst of the opioid crisis to the recovery being seen today takes a combination of different people and agencies working on different aspects of the problem, Stawasz said.

“I can’t point to one specific item. There’s a lot of effort going into the recovery, prevention, and law enforcement.”

Focusing police agencies on busting fentanyl dealers and stopping the traffic of drugs coming up from Massachusetts has been a big part of the recent success, Stawasz said. Ruais said police are a major component of Manchester’s success in combating the epidemic, along with the city’s Rapid Overdose Assessment and Response (ROAR) Team, assembled to deal with different aspects of addiction.

“This is an entirely collaborative effort,” Ruais said. 

Now, the ROAR team can redouble efforts and hopefully get ahead before there is a next wave, Ruais said. The city can start looking more at prevention, targeting efforts to schools and youth in the city to keep them away from drugs. 

“We can further reduce these numbers so that a person never gets into an addiction,” he said. 

When Granite State politicians talk about the opioid crisis and drugs moving across the border, they’re talking about Mexico.

But sit down with law enforcement fighting the flood of fentanyl into New Hampshire, and their “southern border” is Massachusetts.

Specifically Lawrence, Mass.

The drugs smuggled across the Mexican border and sold to gangs in Lawrence, largely from the Dominican Republic, make up the vast majority of illegal drugs abused in New Hampshire, according to New Hampshire’s U.S. Attorney Jane Young and Paul Spera, the assistant special agent in charge for the DEA.

“Those organizations have a connection with Mexican cartels, and so they’re able to get bulk quantities, distribution level quantities, kilogram quantities of the drugs,” Spera said. “They’re the organizations. They’re the drug distribution networks that have direct connections to the Mexican cartels.”

Synthetic drugs, like fentanyl and methamphetamine, are cheaper, deadlier, and more abundant than anything on the streets in decades. Young, who oversaw drug prosecutions as New Hampshire’s deputy attorney general, said the drug market in Lawrence is having a more devastating impact on the Granite State than in the past.

“There wasn’t this sort of free market in the next state that we see now. And so as time has evolved, what we see now are a lot of people who can pool money amongst other people, whether friends or community and go down and get –what I would tell you, having done this for the bulk of my career — a staggering amount of drugs.”

United States Attorney Jane Young says drugs supplied by Mexican cartels are flooding New Hampshire streets.

It used to be big news when police seized a kilo of cocaine, Young said. That amount, about 2.2 pounds, can sell for between $25,000 and $30,000. Now, a kilo of fentanyl can be had for about $6,000.

Spera said the drugs start out as precursor chemicals shipped directly from China to Mexican cartels with ports on the Pacific coast. Those chemicals make their way north to factories in Mexican warehouses and similar buildings, where the drugs are manufactured. Cartels are out of the agriculture business and no longer worry about weather, blight, pests, or growing seasons. They can make the drugs year round.

Once produced, the drugs are typically packed into vehicles headed to the United States — hidden in produce trucks, or in secret compartments of passenger cars. Cartels generally use people with legitimate reasons to cross the border to get the drugs and money back and forth, he said.

On the East Coast, in New York and in New England, Dominican gangs control the trade. They sell at street level, and they can set up somewhat sophisticated schemes to move the drugs. These gangs have been known to operate a delivery service, with the equivalent of a customer service rep taking orders during set business hours over the phone and arranging drop offs throughout the day. Spera said the operator taking the calls can be in the U.S., but just as often that person is in the Dominican Republic.

The people the Lawrence gangs sell to are rarely other gangs or major dealers, according to Young. Even when buying a kilo of fentanyl or bulk methamphetamine, they aren’t budding kingpins and wannabe Walter Whites. Typically, they are addicts selling to support their own habits, Young said.

“Today, it’s a lot of individuals who, because of their addiction, can go into the Merrimack Valley, buy significant quantities of drugs, and come back and flood the street. I don’t think that there’s another word to say that. They can flood it into the street for much smaller amounts of money, but with much more deadly consequences,” Young said.

Fentanyl now fuels New Hampshire’s opioid epidemic, with hundreds of overdoses each year. The number of fatalities is declining somewhat this year, though Young suspects the lull is because of how normalized opioid addiction has become. Many people now carry Narcan, which can stop an opioid overdose death.

Narcan can save lives. But without treatment, it also leaves people mired in the throes of prolonged addiction and misery, Young said.

“That is where we are now. Horrific.”

Spera worries about the growing market for methamphetamine. The meth coming in from Mexico is as much as 98 percent pure.

“It’s an absolute issue that’s coming into our state,” Spera said.

The amount of methamphetamine seized by the Manchester DEA office, which includes operations in neighboring states, more than doubled last year to 52 kilos. The drug is also linked to violence. Several officer-involved shootings in the past few years involved a meth user acting erratically and dangerously. The drug ratchets up the danger for communities and police, Spera said.

Spera’s worry is compounded by how openly the gangs operate. Recently, an undercover DEA agent stood on a Lawrence street corner waiting to meet a contact as part of an investigation. The agent had traded his typically clean-cut look for long hair, a scruffy beard, and street clothes. The kind of look that says, “I just got out of bed.” As he waited for the contact, a car pulled up, and the driver tossed out a bag containing a small amount of fentanyl and a card with a phone number.

“Let me know if you ever need anything,” the driver said before peeling off.

Even with the total number of opioid-related overdoses dropping in Nashua and Manchester, the number of overdose deaths continues to rise, based on figures released Tuesday.

Nashua saw a 16 percent increase in opioid deaths in May, according to data from ambulance company American Medical Response (AMR). Manchester is holding steady at last year’s record-breaking death total.

Fentanyl fuels the crisis that is engulfing the Granite State, said Chris Stawasz with AMR.

“The high death rate per capita is attributed to synthetic fentanyl, which is now found in all types of illicit substances,” Stawasz explained. “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.”

Where those drugs are coming from is not a mystery. While the bulk of the fentanyl and methamphetamines reaching New Hampshire originate in Mexico, plenty of illegal drugs are crossing the border from Canada, too.

Last month, federal agents arrested 31 people in the North County near the Canadian border who were allegedly engaged in large-scale drug trafficking. Agents seized 14 pounds of fentanyl and another two pounds of methamphetamine in the operation. 

Republican Gov. Chris Sununu has been pushing for another $1.4 million to beef up border security in New Hampshire, something Democrats have opposed. 

Sununu announced Monday that he would not run for president, but he is considering a run for an unprecedented fifth term as governor. Sununu told Drew Cline the opioid epidemic is something GOP presidential candidates who come to New Hampshire should focus on.

“I think there’s a big winning issue with mental health and opioids and drugs; we’ve made many strides here,” Sununu said.

Asked about the ongoing opioid epidemic in her city, Manchester Mayor Joyce Craig declined to respond. Craig has formed an exploratory committee for a possible run for governor next year. NHJournal also contacted her potential opponent in the Democratic primary, District 2 Executive Councilor Cinde Warmington, about the latest opioid statistics. She, too, declined to respond.

The opioid problem is serious across the state, as highlighted by AMR’s statistics from New Hampshire’s two major cities. Medics responded to 80 suspected opioid overdoses in May — 58 in Manchester and 22 in Nashua. There were 11 suspected opioid deaths in Nashua and Manchester in May;  seven deaths in Manchester and four in Nashua.

There have been 358 opioid overdoses in Nashua and Manchester through the end of May, with 53 suspected opioid overdose deaths. There were 32 in Manchester and 21 in Nashua.

In Nashua, suspected opioid overdoses are trending 17 percent lower than last year annually. However, suspected fatal opioid overdoses are trending 16 percent higher, according to AMR. Some 25 percent of all suspected opioid overdoses in Nashua this year have been fatalities.

The number of opioid-related overdoses first responders treated in Nashua rose sharply in March, up nearly 80 percent over the previous month, according to stats compiled by American Medical Resources (AMR). It is yet another sign the state’s opioid crisis continues in its two largest cities.

Chris Stawasz, the Northeast Regional Director of Government Affairs at AMR, said medics responded to 87 suspected opioid overdoses in March; 62 in Manchester – up 13 percent from February and 25 in Nashua – up 79 percent from February.

While the total number of opioid-related overdoses for the year in both cities is trending lower than last year’s record-setting high, 2023’s death count continues to rise. Last month, there were 10 suspected opioid deaths in Nashua and Manchester, with three in Manchester and seven in Nashua. 

Nashua is getting hit particularly hard this year, according to Stawasz. Suspected fatal opioid overdoses in Nashua are trending 29 percent higher than last year. Even more alarming: one in four suspected opioid overdoses (27 percent) in Nashua this year have been fatal.

AMR medics have responded to 224 suspected opioid overdoses in Nashua and Manchester through the end of Marc,h with 35 resulting in suspected opioid OD deaths; 21 in Manchester and 14 in Nashua.

Jay Ruais, who’s running for mayor of Manchester and has had his own struggles with addiction, points a finger at Mayor Joyce Craig’s management during the ongoing crisis.

“Our city needs to alter our approach to this crisis, the current trajectory is clearly unsustainable. We must grow our police department and fully empower them to go after drug dealers while building better systems for vulnerable individuals at critical intervening moments in our hospitals, jails, and schools.

“As Mayor, I will work to ensure we are coordinating with all those fighting to improve our community and save lives,” Ruais said.

Why are such a high percentage of overdoses becoming deaths? Stawasz believes fentanyl is the culprit.

“The significant increase in deaths is attributed to very potent synthetic fentanyl,l which is now found in all types of illicit substances,” Stawasz said. “People who are using illicit substances can 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.”

In all, there were 62 suspected opioid overdoses in Manchester during March, bringing the year-to-date first-quarter total to 173. The total number of suspected opioid overdoses in Manchester is currently trending the same as last year on an annual basis, with 12 percent of all suspected opioid overdoses responded to by first responders in Manchester this year having been fatal.

There were 25 suspected opioid overdoses in Nashua during Marc,h bringing the year-to-date first-quarter total to 51. The total annual number of suspected opioid overdoses in Nashua is currently trending 15 percent lower than last year on an annual basis, Stawasz said.

Manchester is breaking new ground in misery as the Queen City death totals from the opioid crisis keep rising. It is a crisis, Republicans say, driven by illegal fentanyl pouring over a border Democrats refuse to secure.

Manchester and Nashua experienced a record-high number of opioid-related overdose deaths last year. Manchester is on track to exceed that number in 2023 said Chris Stawasz with American Medical Response.

“There were 18 suspected opioid deaths in Nashua and Manchester in February. That is the most suspected opioid deaths in one month for Nashua and Manchester combined since tracking began in 2015.”

Nashua suffered 44 opioid-related overdoses last year, the most since 2018 when 35 people died. Manchester saw 79 people die from opioid overdoses in 2022, the highest number since 2017’s 67 deaths. More troubling, while Nashua is estimated to see a slight dip in deaths this year, Stawasz anticipates Manchester’s death toll to reach 111, the most ever.

Synthetic fentanyl, the type being smuggled over the southern border by Mexican cartels, is the most likely culprit for the increase in deaths. Fentanyl is used in counterfeit pills, and it is used to lace other illegal drugs.

“The significant increase in deaths can most likely be attributed to very potent synthetic fentanyl which is now being found in nearly all types of illicit substances,” Stawasz said. “In many cases, 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.”

Fentanyl is responsible for the majority of overdose deaths in the country, according to federal government statistics. In 2021, 90 percent of all overdose deaths were connected to the drug. And most of that is coming from Mexican cartels who are producing the synthetic drug using ingredients from China, then using their control of the southern border to smuggle it into the U.S.

“The source of fentanyl is Mexico and its drug labs,” said Todd Bensmen with the Center for Immigration Studies. “I’m not seeing any evidence that the Biden administration is interested in damming up the source.”

Gov. Chris Sununu acknowledges New Hampshire is being hit hard by the opioid crisis, but he noted it is part of a national problem.

“States across the country are seeing a rise in opioid-related deaths and New Hampshire is not immune. Every death is tragic; it is someone’s son, daughter, and family member,” Sununu said. “The bottom line is that fentanyl is now in all different types of substances, whether that be cocaine, methamphetamine, fake pills, or vape cartridges – assume it is in anything and everything.

“There is no safe experience with substances, unless they are prescribed by a provider, and taken only as directed by the person they are prescribed to.”

Getting a handle on the crisis in Manchester calls for more police support, and getting cops the tools they need to do the job, said Jay Ruais, a Republican running to replace Democratic Manchester Mayor Joyce Craig.

“We must provide greater resources for our police department to go after drug dealers and fight for bail reform at the state level to keep them off our streets,” Ruais said. “Additionally, most who suffer a fatal overdose have previously overdosed, meaning we have to build better systems for individuals when they are at their most vulnerable like in hospitals, jails, and prevention programs in schools. Solving this crisis doesn’t cost more money. It requires prioritization and better coordination with existing community partners.”

Sununu announced a new PSA campaign this year, “No Safe Experience” to educate Granite Staters, especially young people, about the danger of fentanyl and other illegal drugs. Expected to run through the fall, the campaign includes video and public service announcements, social media campaigns, an informational website, billboards, and highly visible signs, posters, and materials that will be widely disseminated across the state and made available to schools, and an active media campaign to share that there is no safe experience through personal stories and data. 

New Hampshire law enforcement is dealing with the one-two punch of fentanyl and methamphetamine, as opioid deaths continue to surge and methamphetamine fuels deadly violence. 

And the source of those drugs is 2,400 miles away at the U.S.-Mexico border.

Last month, Manchester and Nashua reported a combined 95 opioid-related overdoses, a 13 percent increase from December. Nine deaths are believed to be linked to these overdoses.

The figures from last year show a sharp rise in opioid overdoses and deaths, after an initial dip due to the 2020 COVID-19 related lockdowns.

November overdose totals in Manchester and Nashua were up 110 percent from the same time in 2020, according to American Medical Response regional director Chris Stawasz.

“I know there are a lot of competing priorities with COVID-19 and the variants that are out there, but this is, unfortunately, if not more deadly, as deadly as the COVID-19 crisis is,” Stawasz told WMUR.

Manchester had more than 500 suspected overdoses in 2021, 30 percent more than the previous, and Nashua had 250 suspected overdoses in 2021, which was 29 percent more than 2020.

Opioid fatalities are typically linked to fentanyl, the powerful synthetic drug being manufactured by Chinese syndicates and distributed by Mexican drug cartels. Those cartels continue to find ways to smuggle the drugs over the border, flooding American streets.

According to The Washington Post, The U.S. Customs and Border Patrol’s Laredo field office alone seized 588 pounds of fentanyl during the 2021 fiscal year, an eleven-fold increase over the 50 pounds it snared in 2020.

United States Attorney for New Hampshire John Farley said that while fentanyl is still the state’s main drug problem, methamphetamine is making gains among Granite Staters as well. It is now the second most common drug on the streets. Again, methamphetamine is a product from the cartels, he said.

“What we’ve seen is a real growth in the Mexican cartels manufacturing and distributing methamphetamine,” Farley said. “They are able to produce a cheap and very pure form of methamphetamine, what people call crystal meth, and they are very aggressive in distributing that highly addictive drug.”

One main method of distributing those drugs is dark web marketplaces. According to The New York Times, dark web sites are accounting for more and more of the fentanyl traffic in the country.

Farley said local and federal law enforcement are seeing come up from the border, and then getting shipped to the east coast. Many times, dealers are using the dark web to buy and sell large quantities of the drugs. 

“Almost anyone who wants to find a connection can find a connection,” Farley said.

New Hampshire Attorney General John Formella has said methamphetamine keeps popping up in investigations involving people shot by police officers. The last five complete investigations into fatal police shootings have found people with methamphetamine in their system who turned violent in confrontations with police, resulting in their deaths.

“Methamphetamine and fentanyl distribution continue to plague New Hampshire. As the Attorney General, I will continue to partner with federal and local law enforcement agencies to implement the most effective strategies to disrupt the flow of illegal drugs into New Hampshire,” Formella said in a statement. “It is only by this collaborative effort that law enforcement can marshal assets to protect not only our citizens but the  officers who work tirelessly to protect our state.”

Last year, Claremont’s Jeffry Ely, 40, was shot and killed during an armed standoff with New Hampshire State Police troopers. Ely had been suffering greater mental health problems as he increased his drug use, including methamphetamine, according to the shooting investigation. 

David Donovan, 35, was shot and killed by police in Meredith in November 2020 when he charged at police, armed with a knife and covered in blood from having just stabbed his mother’s boyfriend, according to the New Hampshire Attorney General’s report. Donovan’s methamphetamine use caused him to become violent, paranoid, and delusional in the months leading up to his fatal encounter with Meredith police.

In October of 2020, Ethan Freeman, 37, of Thornton, was shot and killed by Thornton Police Officer Matthew Yao when a naked and bleeding Freeman charged Yao during a confrontation. Freemen had a history of methamphetamine and other drug abuse, as well as a significant history of mental health issues.

In December 2020, Mark Clermont, a paranoid felon who was known to carry an assault-style rifle and wear a ballistic vest while hunting for alien spacecraft, was shot and killed by New Hampshire State Police Trooper Matthew Merrill during a gun battle Clermont had started. Clermont was known to use methamphetamines. Merrill suffered gunshot wounds during the incident. He survived.

Those drugs ending up in the hands of armed dealers and users are a real concern of law enforcement, Farley said.

“We’re seeing a lot more drug dealers who are armed,” he said. “When a methamphetamine dealer is armed, or is using, the public safety risk is substantial. The impacts that methamphetamine has on thought processes can really create a public safety risk.”