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It’s a well-known figure that New Hampshire has the second-highest per capita drug overdose deaths in the United States, right behind West Virginia. The state also has the highest rate of fentanyl-related overdose deaths per capita, leading researchers, health care providers, first responders, and lawmakers to wonder what about the Granite State makes it one of the most ravaged by the drug epidemic.

That was the subject of a forum at Dartmouth College last month, which included Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health; Lisa Marsch, director of the Dartmouth Center for Technology and Behavioral Health (CTBH); and U.S. Rep. Annie Kuster, D-N.H.

“Not only did we want to bring together a broad group of stakeholders about the crisis in our communities, but we also wanted to have a discussion about the response to the crisis,” Marsch told NH Journal. “Why New Hampshire? What’s going on in New Hampshire that’s distinct and giving rise to it?”

To find out why the rate of opioid overdoses increased by nearly 1,600 percent from 2010 to 2015, the New Hampshire Fentanyl “HotSpot” Study was funded by the NIDA. The rapid epidemiological study focuses on the increase of overdoses from fentanyl, a drug that is 50 to 100 times more potent than heroin and often is mixed with heroin. In Phase I of the study, researchers spoke with medical responders, law enforcement officers, state authorities, and policymakers.

The study was conducted by the CTBH, in collaboration with the National Drug Early Warning System, and funded by the NIDA.

Marsch said they quickly realized that they needed to speak with opioid users to better understand the trajectory of fentanyl use, the tracking of the drug, and fentanyl-seeking behavior in order to effectively inform policy and community response.

Phase II was then commissioned to do just that. March’s team interviewed 76 opioid users, 18 first responders, and 18 emergency department clinical staff from six counties in New Hampshire during October 2016 to March 2017. The results of the study are not publicly available yet, but Marsch presented key findings at the forum.

The report found that the recent increase in the availability of fentanyl is because it is less expensive and quicker to take effect than heroin. However, the high doesn’t last as long and requires users to use more often, increasing the risk of overdose.

About 90 percent of the drug users interviewed for the study indicated they actively sought out drugs that would cause overdoses.

“We want whatever is strongest and the cheapest. It’s sick,” one respondent said. “I now me using, when I hear of an overdose, I want it because I don’t want to buy bad stuff. I want the good stuff that’s going to almost kill me.”

Marsch said the study allowed researchers to analyze “a whole array of factors that set up the perfect storm” for New Hampshire to be one of the hardest hit states by the opioid crisis. She said the Granite State consistently rates in the top 10 states with the highest drug use rates and opioid prescribing by doctors exceeds national averages.

New Hampshire is also in close proximity to a supply chain for the fentanyl drug in Massachusetts.

According to the U.S. Drug Enforcement Administration’s 2014 National Drug Threat Assessment Summary, most heroin supplies in the New England region are brought in from New York along the vast interstate highway system, naming I-95 and I-93 as the major routes for New Hampshire’s heroin traffickin. The report also named Lawrence, Mass. as a main distribution center for northern New England states.

The New Hampshire “HotSpot” Study pointed to these other factors contributing to the heroin and fentanyl crisis in the Granite State:

• Treatment admission rates per capita are lower than both the national average and all other New England states
• N.H. has the lowest per capita spending on treatment in all of New England and it’s the 2nd lowest in the nation
• The state has the lowest rate of Suboxone, a medication used to treat opioid addiction, providers per capita in all of New England
• Public health funding per resident is lower than the national average and surrounding states
• N.H. is the only state in the Northeast with no needle exchange program (The legislature recently passed a bill legalizing the programs and Gov. Chris Sununu said he would sign it.)
• The state’s rural setting keeps people in tightly knit social networks and has limited access of “things to do.”

“The economic factors, the rural nature, the politics, lack of resources, and the close proximity to the source of these drugs has created a really bad scenario for the state,” Marsch said.

In order to curb the alarming trend of opioid overdose deaths in the Granite State, the researchers suggested the state increase public health resources for substance use prevention and treatment, expand prevention programs in elementary and middle schools, assist physicians with understanding opioid prescribing, and collaborate with Massachusetts on addressing the manufacturing and trafficking of fentanyl and other opioids.

At the forum, Kuster, who co-chairs the House Bipartisan Task Force to Combat the Heroin Epidemic, said she was confident that Granite Staters’ “certain blend of tenacity and creativity” will help find solutions to this epidemic. Officials point to the Safe Station program, which allows anyone who is struggling with drug addiction to go to fire stations in the state to connect with recovery resources, as a New Hampshire solution to the drug epidemic.

Yet, Kuster was worried that it would be difficult to get more funding and resources under President Donald Trump’s leadership.

“We cannot get this job done without Medicaid expansion. I’m concerned about cuts for mental health and behavioral health services,” she said. “If they’re [Republicans] going to walk the walk, as they have talked about opioid addiction, they’ve got to fund the programs that will bring the services to our communities.”

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As with the rest of the country, it appears New Hampshire is pretty divided on the Paris Climate Agreement. At the state level, Republicans are applauding President Donald Trump’s decision to pull the United States out of the global climate pact, while Democrats are hoping to use the issue as political ammo in next year’s elections. At the local level, a couple cities, colleges, and universities are figuring out how they can commit themselves to reducing carbon emissions to show the rest of the world that not everyone agrees with Trump.

That division was very apparent Thursday during one of the last full House sessions of the year. Several House Republicans staged a walkout after Rep. Lee Walker Oxenham, D-Plainfield, was granted the right to speak on the House floor about Republican Gov. Chris Sununu’s decision not to join the U.S. Climate Alliance, a group of 12 states and Puerto Rico that are committed to upholding the Paris climate deal.

NH Reps narrowly ok member to speak on Climate Change. GOP choose to walk out. Forced to return. pic.twitter.com/uhO10aNfX7

— Raymond Gagnon (@gagnon03743) June 8, 2017

The representatives that walked out were forced to return to their seats because House Speaker Shawn Jasper needed quorum in order finish the day’s business. In her speech, Oxenham mentioned Trump’s withdrawal from the Paris climate accord and Republicans let out a cheer. The New Hampshire Democratic Party was quick to criticize Republican members for their actions.

“Rather than hear their colleague on a key issue, Republicans decided to continue to plug their ears in ignorance on climate change,” said Ray Buckley, NHDP chairman, in a statement. “In doing so, they are standing with Governor Sununu and President Trump against the rest of the world. This Republican walkout is symbolic of their willful ignorance on basic science.”

Sununu stated last week that he “stands by” Trump’s decision to leave the Paris Climate Agreement and he said Monday that New Hampshire would not join the U.S. Climate Alliance.

“Not at this time, especially when we do not yet know its impact on our economy and environment,” he told the Concord Monitor.

That drew criticism from U.S. Sens. Maggie Hassan and Jeanne Shaheen, and U.S. Reps. Carol Shea-Porter and Annie Kuster — all four members of New Hampshire’s Democratic congressional delegation — who wrote a Wednesday letter to Sununu encouraging him to change his mind.

“Governor, we write in support of New Hampshire joining the U.S. Climate Alliance. It is vital that the Granite State continues to be a leader on climate change and clean energy,” they wrote. “Just as the United States’ withdrawal from the Paris Climate Accord cedes American global leadership, New Hampshire’s refusal to acknowledge the clear consensus on climate science will similarly damage our state’s reputation.”

New Hampshire already participates in a regional cap-and-trade pact with nine other states in the Northeast that works to reduce carbon emissions. Under the Regional Greenhouse Gas Initiative, fossil fuel power plants have to buy allowances for every ton of carbon dioxide they emit. Sununu has previously indicated he would be support withdrawing from RGGI, but only if other states also did it.

While lawmakers battle it out at the State House on climate change, several cities and universities in New Hampshire are reaffirming their commitment to reducing greenhouse gas emissions.

A national movement called “We Are Still In” has gained steam since Trump made his announcement last week. As of Monday, a total of 1,219 governors, mayors, businesses, investors, and colleges and universities across the country declared their intent to ensure the United States remains a global leader in the effort to combat climate change.

“In the absence of leadership from Washington, states, cities, colleges and universities, businesses and investors, representing a sizable percentage of the U.S. economy will pursue ambitious climate goals, working together to take forceful action and to ensure that the U.S. remains a global leader in reducing emissions,” the statement reads.

While no Granite State cities have signed on to that specific statement, two colleges have joined the cause — the University of New Hampshire and Southern New Hampshire University.

In a separate statement from the Mayors National Climate Action Agenda, 274 mayors committed to adopt, honor, and uphold the Paris Climate Agreement goals.

“We will continue to lead. We are increasing investments in renewable energy and energy efficiency. We will buy and create more demand for electric cars and trucks,” the statement reads. “We will increase our efforts to cut greenhouse gas emissions, create a clean energy economy, and stand for environmental justice

Nashua Mayor Jim Donchess and Portsmouth Mayor Jack Blalock have signed on to that statement, but not the one from “We Are Still In.”

In other communities in the Granite State, Durham officials held a Tuesday forum about the feasibility of scaling down the targets of the Paris agreement to a municipal level. The town of Hanover also voted in May to establish a goal of transitioning to 100 percent clean and renewable energy by 2050.

Dartmouth College President Phil Hanlon didn’t sign on to the “We Are Still In” statement, but he signed onto a similar letter with the presidents of 11 other leading research universities. That letter commits the universities to transition to low-carbon energy and enhance sustainability practices on their campuses.

In the letter released Monday, the presidents “reaffirm that commitment, which is consistent with the Paris Agreement and recognizes the concerted action that is needed at every level to slow, and ultimately prevent, the rise in the global average temperature and to facilitate the transition to a clean energy economy. Universities have a critical role to play in reducing our own greenhouse gas emissions, continuing to advance evidence-based understanding of the causes and effects of climate change on the environment, the economy and public health, and developing solutions.”

The other signatories include all the Ivy League institutions, except Princeton University, and also Duke University, Johns Hopkins University, Massachusetts Institute of Technology, and Stanford University.

Earlier this year, Dartmouth announced it would reduce greenhouse gas emissions from campus operations by 50 percent by 2025 and by 80 percent by 2050. They also pledged to transition their campus to renewable resources by 2025.

In its announcement, Dartmouth admitted that it had fallen behind some of its peer institutions on a number of sustainability fronts.

“Although Dartmouth has substantially reduced campus energy use and made other significant advances over the last decade, we lag our peer institutions with respect to commitments, actions, and reporting in the sustainability domain,” the college released in its sustainability report. “Our report recommends principles, standards, and commitments in the areas of energy, waste and materials, water, food, transportation, and landscape and ecology.”

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Republican Gov. Chris Sununu made waves in New Hampshire politics over the weekend as he became the first governor in the New England region to say that he “stands by” President Donald Trump’s decision to withdraw from the Paris Climate Agreement. As expected, Democrats are using his words as political ammo to attack his position on environmental issues, but none more so than a gubernatorial candidate challenging Sununu for the Corner Office in 2018.

“I don’t have a real reaction right now to be honest,” Sununu told New Hampshire Public Radio on Friday. “It’s nothing I’ve really thought about. It’s a federal issue at this point. It’s nothing. I’m focused on the 603 and what we do here.”

He continued to say that withdrawing from the global climate agreement, which involves nearly 200 nations aiming to slow the effects of climate change, could be significant, but he hasn’t spent a lot of time looking at the issue

“You know it’s not my job to go through the whole accord and look at the in-depth impacts across the country, economically,” he said. “The president has done that, his team has done that, and they’ve made the decision they feel is in the best interest of the United States and I stand by that.”

Although some people can interpret that statement as taking a non-position, many supporters and opponents are reading into it that he agrees with Trump’s decision to leave the climate deal.

Republicans took to Twitter to reiterate their support for Sununu and Trump, like Rep. Victoria Sullivan, R-Manchester.

@GovChrisSununu Says He 'Stands By' Trump's Decision To Withdraw From Paris Accord. As do I. #NHPolitics https://t.co/PIjDPjvc4d

— Victoria Sullivan (@VSullivan4NH) June 4, 2017

Sununu’s statement is significant because it marks a drastic departure from other states in New England, including his fellow Republican governors.

Four states in the region announced they were joining a bipartisan coalition committed to meeting the goals of the Paris Climate Agreement. The U.S. Climate Alliance was started by the Democratic governors of California, New York, and Washington state.

Massachusetts Republican Gov. Charlie Baker said he decided to join the alliance, along with Vermont Republican Gov. Phil Scott. The Democratic governors of Connecticut and Rhode Island have also joined the coalition.

Maine Republican Gov. Paul LePage has not publicly made a statement about Trump’s decision to pull out of the climate pact, making Sununu the only GOP governor in the area, so far, to “stand by” Trump.

The New Hampshire Republican Party has also applauded Trump’s decision, saying the Paris climate deal did not put U.S. taxpayers first.

.@POTUS knows a bad deal when he sees one. Leaving the #ParisClimateDeal means putting taxpayers first! pic.twitter.com/WI8fYgtH2k

— NHGOP (@NHGOP) June 2, 2017

State Democrats are using Sununu’s words as political fodder to motivate their base and prepare for Democratic candidates to challenge him next year. As expected, all four Democratic members of New Hampshire’s congressional delegation disagree with Trump’s decision.

Wow. A bafflingly ignorant and lazy position by @GovChrisSununu. Granite Staters should be outraged he's not standing up for us #nhpolitics https://t.co/UFVjttYi7j

— NH Democratic Party (@NHDems) June 2, 2017

The New Hampshire Democratic Party is calling Sununu out for commenting on other federal issues, like the GOP-led repeal of the Affordable Care Act and the president’s travel ban to several Muslim-majority countries. They’re also blasting him for being an environmental engineer who “must not understand, the environment does not recognize borders.”

Steve Marchand, a Democratic candidate who announced that he would run for governor in 2018, has also taken issue with Sununu’s stance on the global climate pact.

In his first official statement since he announced his candidacy in April, Marchand said as governor, he would support the Paris Climate Agreement and advocate for New Hampshire’s involvement in the U.S. Climate Alliance.

“Unlike many of the nation’s governors, Governor Sununu has not pushed back on President Trump’s decision,” he said. “Both President Trump and Governor Sununu are wrong.”

Marchand, who ran for governor in 2016 but lost the Democratic nomination to eventual nominee Colin Van Ostern, is pushing his progressive message by meeting with various Democratic groups around the state. He is a former mayor of Portsmouth and said Portsmouth was the first community in New Hampshire to sign onto the Cities for Climate Protection Campaign and the U.S. Conference of Mayors Climate Protection Agreement.

“I’ve been a passionate progressive on environmental protection and energy policy throughout my public life, as a mayor, and as a candidate for statewide office,” said Marchand. “I strongly believe we can lower energy costs for consumers, reduce demand for energy, create New Energy jobs, and protect our natural beauty if we are willing to lead on energy and the environment. I’ve got a specific plan for New Hampshire that will do this, and being a part of the U.S. Climate Alliance would improve our ability to do the right thing — both economically and morally. President Trump will not lead, and neither will Governor Sununu. I have, and as Governor, I will.”

Over the entire weekend, Marchand and the NHDP have taken to Twitter to criticize Sununu for not being a supporter of the climate deal. It can be expected for the Democrats to raise this as a campaign issue in the 2018 governor’s race.

In several other states, various cities have said they would still adhere to the Paris Climate Agreement’s terms and reduce their carbon footprint. The only town in New Hampshire to take a similar environmental stance is Hanover, which voted in May to establish a goal of transitioning to 100 percent clean and renewable energy by 2050.

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It started with a 139-word story about Kellyanne Conway’s visit last week to speak at a state Republican Party fundraising dinner. Although the event was closed to the press, an Associated Press freelance reporter managed to get in and the NHGOP is not too happy with her or her article, claiming the piece was biased and inaccurate. Now, the incident has spread to right-wing media outlets lambasting the “liberal mainstream media.”

Conway, counselor to President Donald Trump, was in Nashua on May 18 as the keynote speaker for the NHGOP’s Spring to Victory fundraiser. Members of the press were told ahead of time that it would be a closed event due to a “mutually agreed upon” decision by the White House and the state party.

Some reporters said they tried to get in to the Radisson Hotel to interview people outside of the room Conway was speaking in, but were told they were not allowed. For AP freelancer Melanie Plenda, she apparently walked in without much trouble.

“I was perfectly prepared, if anyone asked me who was I? Did I have a ticket? Anything like that, I was going to be honest,” Plenda told the New Hampshire Public Radio. “I was going to say no, I’m a reporter and could I speak with an organizer or I would like to get an interview with Ms. Conway. But no one did.”

Plenda said someone who appeared to be a guest invited her into the room, even after she said she didn’t have a ticket.

After the event was over, Plenda filed a four-paragraph story about the event that led with the statement that Conway told attendees to ignore Trump’s critics and the 150-person crowd was “largely friendly.”

“Some people in attendance withheld applause when Conway let loose with snarky comments about Democrat Hillary Clinton,” she wrote in the article.

After it was published, the NHGOP did not hold back from criticizing her for “sneaking” into their event and for misrepresenting the size of the crowd.

AP's @mcasey1 and @MelaniePlenda conspired 2 sneak into an event and lied about the attendance https://t.co/Zc86LDxjow #nhpolitics

— NHGOP (@NHGOP) May 19, 2017

“This is an absolute outrage,” said NHGOP spokesman Patrick Hynes to WMUR. “The crowd was wildly enthusiastic in support of Kellyanne Conway’s justified criticism of the atrocious Democratic nominee, Hillary Clinton.”

He said 430 people attended the event and her report was “grossly inaccurate”and “objectively wrong.”

The AP typically has a State House reporter in New Hampshire. Kathleen Ronayne was their reporter for the past few years, with several freelancers picking up work, but she left this month to run the State House bureau in California. It’s unclear if the AP has hired someone to take her place.

It didn’t stop there, though. The NHGOP blasted out an email on Monday using the incident as an attempt to raise funds for the state party.

“The reporter snuck into our event and misreported on it,” the email read. “She and the Democrats are peddling fake news! Her agenda is to discredit Republicans and we aren’t going to let her write our narrative!”

The email included a screenshot of Plenda’s Facebook post from November where she called for people to resist Trump’s presidency.

“There are a lot of us — roughly more than half to be exact — who said Trump’s vision of the future is not what we want our country to be,” the post reads. “We need to support the ACLU, we need to run for office, we need to oppose legislation that seeks to hurt and further marginalize, we need to join advocacy groups, we need to not be silent.”

Plenda said she regrets the Facebook post, which she has since deleted. She also concedes that she might have been wrong about the crowd size. However, she and the AP are standing by the legitimacy of the story.

“A freelancer covering the NHGOP fundraiser for AP was outside the event when she was invited in by a woman who appeared to be a part of the event,” the AP said in a statement. “AP stands by its reporting. AP standards require employees to refrain from sharing political views in any public forum.”

Due to NHGOP’s efforts to bring awareness to this controversy, it eventually was picked up by other right-wing media outlets, including The Washington Times and even Breitbart.

Plenda said she has now received several threats and emails, including one that said, “We know where you live.”

“Now they’re fundraising off of this, and it’s gone national, and it’s affecting me and my family,” Plenda said. “And I don’t think that is proportional to what they perceived happened.”

Hynes told NHPR that he called attention to the story because the AP at first refused to issue a correction. On Wednesday afternoon, the AP updated the story to indicate they reported the crowd size incorrectly. Breitbart wrote another longer article published Wednesday saying the AP is refusing to “publicly and transparently clarify that its freelance journalist Melanie Plenda did in fact engage in leftwing activism in violation of the newswire’s editorial standards.”

“We want the public to know that there is bad activist reporting happening in New Hampshire and will use all the channels that we can, all the channels we have at our disposal, to get the truth out,” he said.

With the NHGOP’s fundraising email claiming the story is fake news and the conservative national publications picking up the story, it’s becoming fodder for a GOP narrative that the press is biased and can’t be trusted.

A known right-wing blogger in the state dedicated an entire post to the controversy, claiming that the New Hampshire Democratic Party “conned” the reporter into writing a negative article about Trump.

“The reporter is an anti-Trumper who seems to have written that specifically for the Democrats so they could make false claims about the event and Trump’s support in New Hampshire,” the post read. “Because Democrats are trying to paint the picture that Trump is losing support and therefore Republicans are losing support. It appears they are lying, as usual. Rather than try to push their ideas of why they are a better choice than Republicans, they simply keep trying to paint a false picture of Trump and his supporters.”

Trump has criticized the mainstream media for months about being “unfair” and “biased.” It’s what he built his presidential campaign on and what his supporters believe.

According to Gallup, Republicans who say they have trust in the media has plummeted to 14 percent from 32 percent just a year ago. It’s the lowest confidence among Republicans in 20 years.

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New Hampshire Secretary of State William ‘Bill’ Gardner is widely revered as a bipartisan state official. He has to be since he’s the longest-running secretary of state in the nation and is reelected to his post by an overwhelming majority of Republicans and Democrats alike.

And he takes his job very seriously. He’s in charge of the state department that oversees all general elections, primary elections, voter registration, and recounts within the state, including the First-in-the-Nation primary. With claims of voter fraud in the 2016 election being discussed often by President Donald Trump, Gardner has played a more active role in politics than simply overseeing elections. He’s become a fierce advocate for keeping New Hampshire’s primary status and for tightening voter laws to make sure Granite State voters are the only people voting in the state’s elections.

With that last issue, he’s siding with Republicans who are trying to get a bill passed this legislative session that would define the differences between “residency” and “domicile.” Yet, Gardner is actually a Democrat. He began his career in New Hampshire politics as a Democratic state representative before he was elected secretary of state in 1976 by the Legislature, and he has shown over the years that he’s not afraid to stand up to members of his own party for what he believes is right.

“We’re not denying anyone who shows up at the polls to be able to vote; we’re just saying we want to be able to let everyone know these votes are valid and true,” Gardner told lawmakers when Senate Bill 3, a voting reform bill, was introduced in March.

Democrats and outside groups are pushing the narrative that the GOP bill is a form of voter suppression and would especially discourage college students from voting. But Gardner said he would not support legislation if he thought it would hurt voter turnout.

In fact, he’s so serious about voter integrity that he agreed to join Trump’s national commission to review voting registration and voting processes used in federal elections. Trump ordered the creation of the Commission on Election Integrity that will be chaired by Vice President Mike Pence and co-chaired by Kansas Secretary of State Kris Kobach.

“There is a reason I’m doing this,” he told WMUR. “I care a lot about this. I’ve spent my whole life dealing with it, and it’s too bad that over half of the people in the country feel that there is vote fraud. Let’s find out why.”

Earlier this year, Trump claimed he lost the popular vote in the November election because “millions” of people voted illegally. He said that he lost New Hampshire’s four electoral votes because “thousands” of people crossed the Massachusetts border “on buses” to vote illegally.

Gardner disagreed with the president, saying there was no widespread election fraud in the state, but there were a few cases of people voting in New Hampshire who shouldn’t have in previous elections.

In 2014, Gardner said he saw illegal voting with his own eyes.

“We have drive-by voting,” he told the New Hampshire Union Leader. “The people that ran the polling place called me over, and said they had three people who didn’t know whether they could vote, and they wanted me to answer the questions. So I go over, there were two young men and a young woman, and they were AmeriCorps [volunteers].”

The woman was from Washington state and said she missed the deadline, but “really wanted to vote.”

“She said she was going back to Washington state the first of December. I said, well that should answer it for yourself as to whether this is now your home,” Gardner said.

She did not ultimately vote, but the two men did. He said he is essentially powerless in these situations unless the Legislature decides to act.

Under SB 3, they allow the secretary of state’s office to investigate a voter registrant’s information if local supervisors are unable to verify a voter’s domicile.

Looking at voter fraud or voter integrity (depending on who you’re talking to) is something Gardner has been wanting to look into for a while. When Republicans introduced a similar bill in the Legislature  in 2015, former Democratic Gov. Maggie Hassan vetoed it, even though Gardner gave it his approval. He was also in favor of instituting a photo ID law when casting a ballot.

Democrats in the state are unhappy with Trump’s new commission, and are surprised that Gardner would agree to participate. The American Civil Liberties Union of New Hampshire called it a “sham” and a “kangaroo commission.”

“Signing this piece of paper will not make Mr. Trump’s false statements about voter fraud true,” said ACLU-NH Executive Director Devon Chaffee. “Our expectation is that, while on this commission, Secretary Gardner will only join conclusions in the commission’s final report that support voting rights and are based on actual proven facts, not unsupported speculation.”

House Democratic Leader Steve Shurtleff is calling on Gardner to assure that New Hampshire taxpayers are not paying for his travel or accommodation when he works on the commission.

“In addition, I would hope that your state time is not used in the pursuit of your work for the commission,” he wrote in a Friday letter. “As you are well aware, many Democrats and Republicans in New Hampshire believe that there is no validity to President Trump’s claims that there was voter fraud in NH. It is my hope that you will bear this in mind when presenting information or otherwise engaging your time on this commission.”

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The latest stop in Tom Price’s opioid crisis listening tour brought the health and human services secretary to the New Hampshire State House on Wednesday. He wasn’t alone, though. Always near him was Kellyanne Conway, counselor to President Donald Trump. They were joined by Gov. Chris Sununu, state Health and Human Services Commissioner Jeffrey Meyers, and Democratic U.S. Rep. Annie Kuster of New Hampshire, among other treatment providers, law enforcement, first responders, and families who have been impacted by the substance abuse crisis.

The meeting in Concord only lasted about an hour and members of the press were not allowed to be in the Executive Council chambers where the listening session took place. Afterwards, Price and Conway went to Manchester Fire Department to learn about the city’s Safe Station program. Press were also kicked out at first, but were then invited back in.

At a press conference after the listening session, Price said solving the opioid crisis is a priority for the Trump administration and his visit was a chance to see how states are dealing with it at the ground level.

“The Department is all in, the President is all in,” he said. “He has such passion for this issue, because he knows the misery and the suffering that has occurred across this land, and wants to help, help solve it.”

Price points to the recent $3.1 million in funds — with more money on the way — being sent to New Hampshire as evidence of the administration’s commitment to getting more resources out into the field.

Yet, more funds are needed for the Granite State, which has the second-highest overdose deaths per capita in the country. Nearly 500 people have overdosed on drugs in 2016. New Futures, a nonprofit focused on the opioid crisis, released a report Monday that found substance misuse costs the state’s economy about $2.36 billion each year.

Sununu praised the White House for its “tremendous” effort in reaching out to the states to see what they think of certain policies and solutions to combat opioid misuse.

“This administration has provided a great philosophy in that they want to set a foundation and a platform for good policy out of Washington but they look to the states to implement it,” he said. “Unlike the previous administration where Washington was going to implement and control everything, they want the states to be the implementers.”

However, Democrats are blasting the U.S. House of Representatives’ passage of the American Health Care Act, which would make major changes to Medicaid expansion. Democrats argue that the bill would weaken funding for federal programs to battle the drug epidemic.

Just before Price and Conway’s arrival, protesters staged a “die-in,” laying on the floor in the hallways of the State House, holding up signs that said, “Trump lied, I died” and “I died for a billionaire’s caviar.”

Protestors at the #DieIn today ready to welcome @HHSGov Sec Tom Price & reject the #AHCA #nhpolitics #thisisnotnormal #handsoffourhealthcare pic.twitter.com/Gy6w1cYe7c

— Ashley Marcoux (@ashmarx9) May 10, 2017

Democrats held their own press conference while Price and Conway met with New Hampshire leaders, criticizing Sununu for holding a closed-door meeting.

“New Hampshire won’t stand for a plan where premiums skyrocket, benefits shrink, and thousands are booted off [health care] coverage,” said Senate Minority Leader Jeff Woodburn.

Price said Trump is committed “to make certain that every individual has access to the kind of coverage that they want for themselves and for their family.”

“I think it’s important to step back and say is the Medicaid program the most appropriate program for every individual in that economic setting,” he added. “Is there a better way to provide coverage? Is there a better way to provide services? Whatever the answer to that is the president is committed and we’re committed to making certain every single American has a seamless transition.”

He vowed “that nobody falls through the cracks. That no rug is pulled out from anybody and that we make certain that the coverage and the care is available to every single American.”

Sununu said he had “some severe reservations” about the House’s health care bill, but he appreciates “the progress the House made.”

“We have to move that ball forward,” he said. I do have reservations in some areas when you look at the details. But people have to understand this is simply one part of the process. The Senate is going to go through their process. It shows that Congress isn’t stalled, not stagnated. They’re not going to do nothing. I think we’ve had eight years of a lot of do nothing. They’re doing something and they’re standing up for the American people.”

Conway said the opioid epidemic should be a bipartisan issue that Democrats and Republicans solve together.

“We look at this as a non-partisan issue in need of a bipartisan solution,” she said. “And we are working with people on both sides of the aisle in Washington and within each of the states to do exactly that.”

However, there are instances of disagreement between Republicans, especially on the American Health Care Act. It also appears that New Hampshire leaders and the White House aren’t always on the same page.

Several media outlets reported that the Trump administration was contemplating a 95 percent cut for the White House Office of National Drug Control Policy (ONDCP), which houses the agency’s high-intensity drug trafficking program and drug-free communities support program. Officials dismissed the claims and reaffirmed Trump’s support for ending the opioid crisis. Sununu called the reports “very disconcerting.”

Price and Conway did not mention the national drug czar’s office during their visit. While New Hampshire is one of the hardest hit states of the drug epidemic, it appears an official from the state has not been invited to sit on the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, leaving many to question how committed Trump is to fulfilling his campaign promise.

New Jersey Gov. Chris Christie is chairing the commission, and it was announced Wednesday that Democratic Gov. Roy Cooper of North Carolina, Republican Gov. Charlie Baker of Massachusetts, and former Democratic Rep. Patrick Kennedy of Rhode Island will also serve on the commission. Bertha Madras, a former deputy director of the Office of National Drug Control Policy, will also work on the commission, but no one from the Granite State.

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New Hampshire became the latest state to have three residents die of overdoses from one of the most deadly opioid drugs in the world, adding to the growing list of communities nationwide trying to handle the crisis. Gov. Chris Sununu and public health officials announced last week that for the first time in the Granite State, the synthetic opioid carfentanil was found in the bloodstream of three people who died from overdoses in March.

Two of the deaths were in Manchester, and the third was in Meredith. The substance is so potent that it’s not intended for human consumption. It’s 100 times more potent than fentanyl and is commonly used to tranquilize elephants.

“Unfortunately, today is the first day that we’ve been able to confirm this,” Sununu said at a Tuesday press conference. “And worse yet, I think we all understand that it is likely not the last day that we talk about this issue.”

New Hampshire is the first New England state to have confirmed deaths from carfentanil and its effects are being felt by many key players in the opioid crisis, including public health officials, first responders, and treatment and recovery providers.

While these are the first confirmed cases in New Hampshire, the rise in carfentanil overdoses has been happening throughout the United States over the last few months. At least 96 heroin users overdosed in one devastating week in August in just one Ohio county, with several of the overdoses linked to carfentanil. In September, the Drug Enforcement Administration issued a nationwide warning about the powerful opioid.

Tom Pifer, forensic lab director for the N.H. State Police, said the drug was developed in the mid-1970s by a pharmaceutical company, but was never made public due to its high potency.

It takes just two milligrams of carfentanil to knock out a 2,000-pound African elephant. When veterinarians or zookeepers do that, they wear gloves and face masks to prevent exposure to the drug because a dose the size of a grain of salt could kill a person. A dose may even be lethal when absorbed through the skin or potentially through inhalation. That’s why the state asked law enforcement and first responders to stop field testing drugs. The problem is that users might not know they are even taking the drug since dealers have been cutting heroin with fentanyl or carfentanil to give it a boost and stretch their supply further.

“You cannot tell the difference between heroin and fentanyl and certainly not fentanyl and carfentanil,” Pifer told New Hampshire Public Radio. “You are literally rolling the dice with any sort of dosage unit you’re purchasing on the street.”

It’s not only incredibly powerful, but it’s also incredibly resistant to naloxone — also known as Narcan, the opioid antidote that can save someone’s life from a heroin overdose. A typical overdose requires one or two shots to work, but when a dosage is laced with carfentanil, it could require six or more shots to be effective — if it works at all.

Even though there is an abundant supply of Narcan in states battling the opioid crisis, an increase in carfentanil overdoses could deplete the antidote supply fairly quickly and drain money from states who need to purchase more. With drug overdose deaths rising, state crime labs could also see a backlog of cases to investigate. In New Hampshire, there are thousands of cases dating back from 2015 that have yet to be investigated.

A criticism in New Hampshire of government officials is that funding from the state and federal government to tackle the crisis has been slow to come out.

Congress signed the 21st Century Act in December, which would provide more funding to states for the opioid crisis. In April, U.S. Sen. Jeanne Shaheen, D-N.H., said $485 million in grants would soon be administered to states. It’s not clear exactly when that would happen.

New Hampshire is ranked as the second hardest hit state in the opioid crisis based on per capita deaths. Yet, it’s only supposed to receive $3 million out of the $485 million promised to states since the formula is based on total mortality. Shaheen is urging Trump’s administration to revise the funding formula for next year.

The other Democratic senator from New Hampshire, Maggie Hassan, and Shaheen wrote in a letter last week to U.S. Health and Human Services Secretary Tom Price that the formula should be re-tooled. Officials have indicated that they will review the formula and the two senators were optimistic after their meeting with New Jersey Gov. Chris Christie, who is heading President Donald Trump’s national opioid commission.

In March, Trump created The President’s Commission on Combating Drug Addiction and the Opioid Crisis with Christie at its helm to start fulfilling his campaign promise to end the opioid crisis.

Trump promised the people of New Hampshire that he would build a wall between the U.S.-Mexico border to curb the opioid crisis and stop the flow of drugs into the area.

“New Hampshire has a tremendous drug epidemic,” he said in October. “I am going to create borders. No drugs are coming in. We’re going to build a wall. You know what I’m talking about. You have confidence in me. Believe me, I will solve the problem. They will stop coming to New Hampshire. They will stop coming to our country.”

While heroin supplies mostly come from Mexico, synthetic opioids, like fentanyl and carfentanil, are believed to originate in China. Even though it’s illegal there, secret labs in the country manufacture the drug before shipping it to the United States. People can order it online, and it’s shipped through the U.S. Postal Service before it makes its way into the local heroin supply.

It’s still not immediately clear how the drug made it into New Hampshire. It’s likely that either someone bought it online, or it was purchased in another state and then followed the traditional route of heroin and fentanyl into the Granite State, which is from major distribution centers like Philadelphia and New York and then through Massachusetts.

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The flurry of activity in the Granite State this week has some calling it the start of the 2020 New Hampshire primary. Former Democratic presidential candidate Martin O’Malley held some meet-and-greets and a town hall meeting on Sunday, and former Vice President Joe Biden is headlining the state Democratic Party’s fundraising dinner on April 30. Smack dab in the middle of the two Democrats is Republican Gov. John Kasich, who visited the state on Thursday to promote his new book.

It felt like a reunion of sorts for Kasich, his team, and over 200 supporters who came to hear him speak at the New Hampshire Institute of Politics at Saint Anselm College. In a small gathering before his speech, he thanked key allies for their help during the 2016 Republican presidential primary. Even though Kasich was in the state in August to campaign for Gov. Chris Sununu in his gubernatorial bid, it’s his first foray back to New Hampshire since Trump won the White House.

Of course, there was an elephant in the room (and not just because the room was chock full of Republicans): is Kasich going to run for president again in 2020? Those waiting with bated breath will have to wait a bit longer.

“People ask why I am back,” Kasich said. “I am back to sell books.”

His new book, “Two Paths: America Divided or United,” came out on Tuesday and one of his first stops in his book tour was New Hampshire, so it’s easy to see where the 2020 speculation comes from.

He mostly talked about his 2016 campaign and national politics, with some advice to his followers who are unhappy with President Donald Trump.

“In course of running for president, something happened to me that never happened before,” he said. “I was, like, so boring, you know, and boring didn’t cut it.”

Kasich finished second in last year’s first-in-the-nation presidential primary, far behind Trump (35 percent to 16 percent). Yet, Kasich spent more time in the state than any other candidate, holding more than 100 town halls during the primary.

He took note of Trump not following through on some of his campaign promises, like ripping up the Iran nuclear deal and deporting “13 million Muslims out of the country.”

“You notice all that promise? It’s all been taken back,” he said.

Ohio Gov. John Kasich speaks at the New Hampshire Institute of Politics at Saint Anselm College to promote his new book, “Two Paths: America United or Divided” on Thursday, April 27, 2017. (Photo Credit: John Kasich Facebook page)

He also encouraged unity, bemoaning the wide political divide in the United States.

“We all ought to spend about 10 minutes a day reading something we don’t agree with. All of us are absorbing only that that we agree with and getting rid of those things that we don’t agree with,” Kasich said. “Over time, I think things are going to settle down and people are going to realize that the difficulties that we face cannot be solved without unity. Difficulties cannot be solved unless we have deliberate and steady solutions to the problem.”

Out of the three “potential candidates” visiting New Hampshire this week, Kasich is probably getting asked the most if he is going to run again in 2020.

“He hasn’t been president for 100 days, yet,” Kasich told reporters. “I mean, everybody needs to take a deep breath. We’ll see how it runs out. He’s the president. Give him a chance. We’ll see how it goes.”

Why is he getting the question more? Well, it’s good political theatre. If there’s still #NeverTrump sentiment in a few years, Kasich is a good person they can rally behind, since he’s one of the few 2016 Republican presidential candidates who did not endorse Trump after he secured the party’s nomination.

That’s not to say O’Malley and Biden aren’t getting asked (both of whom have also skirted the question). The 2020 Democratic primary should be an exciting one, with 20 or so candidates expected to enter the race, but political pundits and the media love the idea of an incumbent president getting a primary challenger.

Challenges to White House incumbents aren’t as rare as people think. Five of the six presidents who served between 1968 and 1992 faced insurrections. When they do — like Ronald Reagan’s challenge of Gerald Ford in 1976, Ted Kennedy’s race against Jimmy Carter in 1980, and Pat Buchanan’s bid to unseat George H.W. Bush in 1992 — it’s usually because they were viewed as unsuccessful or unpopular, especially within their party’s base.

It’s very possible that Trump’s base could leave him in the next three years, but after his first 100 days in office, it appears they are still with him.

A University of Virginia Center for Politics poll of Trump voters released Thursday shows his approval rating at 93 percent with his base.

The most recent poll in New Hampshire shows that a majority of Republicans approve of the president, although not as high as the national average. About 80 percent of New Hampshire Republicans approve of the job Trump is doing as president, according to a University of New Hampshire Survey Center poll from February.

Those percentages would need to decrease for anyone to seriously consider mounting a GOP primary challenge. What does this mean for Kasich? It looks like he’s playing the “sitting-and-waiting game.” If the opportunity presents itself, don’t be surprised to see him be one of the first Republicans to declare their candidacy. For now, he told NH1 News that he will “see how things develop in the future.”

Kasich is still popular in the Granite State, and he said he had a feeling he would return often because he has many friends here, so he could become a regular face in these parts over the next three years.

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Three months into Republican Gov. Chris Sununu’s term it already looks like he’s got a couple challengers in 2018. The first to announce in March was Jilletta Jarvis for the Libertarian ticket. Now, Steve Marchand, former Democratic mayor of Portsmouth is throwing his hat into the ring too.

Do these names sound familiar? Well, they both ran for governor in 2016. Jarvis was an Independent and Marchand came in second in the Democratic gubernatorial primary, finishing behind eventual nominee Colin Van Ostern.

“We can make New Hampshire the best place in America to start and raise a family, and the best place to start and grow a business,” Marchand wrote in a Monday email to supporters. “We will aspire to be the example of what America, at our best, can be. That’s why I’m running for governor.”

Last year, Marchand trailed behind his Democratic challengers in campaign fundraising and the polls, often coming in behind businessman Mark Connolly and Van Ostern, the former executive councilor. However, he managed a surprising second place finish, garnering 25 percent of the vote. Van Ostern received about 52 percent and Connolly took 20 percent.

On a Tuesday press call, Marchand chalked up his difficulty in fundraising to his timing and to entering the race late, but told reporters he enjoyed the experience.

“Keep in mind, last year, I got to second place in our primary despite very little time and consequently very little money,” he said.

Now, he’s not going to make the mistake of entering late again, and while it is definitely early to announce a run for the Corner Office in 2018 (more than a year-and-a-half out), Marchand said he couldn’t sit idly by under the leadership of President Donald Trump and Sununu.

“I realized there was an unprecedented passion unprecedented due to a lot of circumstances at the state and national level,” he said. “These are unusual times.”

Marchand has been quietly campaigning for the past few months, attending various Democratic meetings and doing meet-and-greets with his base. Already, he’s criticizing Trump’s and Sununu’s agendas. He pointed to Sununu’s first bill signing, which repealed required permits for concealed weapons.

“That’s not the direction we need to go in as a state,” he said. He also accused Sunnunu of wanting to weaken unions, suppress voter turnout, and privatize public education.

So what makes this campaign different than his last one?

He’s taking his job of fundraising more seriously, by hiring Nick Daggers of the CFO Consulting Group. Daggers specializes in fundraising for political campaigns.

Marchand only raised about $30,000 during his campaign last year, according to campaign filings with the secretary of state’s office. Van Ostern raised $1.1 million in just the primary election.

Daggers even wrote a blog post on his company’s website discussing the importance of early campaign fundraising.

“An early fundraising start will give the opportunity to build a solid infrastructure, allow the candidate more time to campaign, and most importantly give you the greatest chance at victory,” he wrote in 2013.

If Marchand can drum up a solid war chest before other candidates jump into the race, he could be a serious contender before he actually starts spending any of it.

Don’t expect too many changes in his platform, though. Marchand still supports legalizing and taxing marijuana and increasing the state’s business profits tax, which would supply millions of dollars to support state aid for full-day kindergarten and improve the state’s infrastructure, among other policies.

Yet, his record is already being criticized by the Republican Governors Association.

“From property taxes, to the gas tax, to the business profits tax cut, Marchand has consistently supported increasing the tax burden on New Hampshire families,” the group said in a statement. “While Steve Marchand may claim to be the most fiscally responsible candidate for governor, his campaign won’t be able to rewrite his record of supporting higher taxation on Granite State voters.”

Besides entering the race early, Marchand said he’s more committed to expanding his “knowledge base” and getting out to interact with voters on a grassroots level statewide.

“The more you go out and speak to groups and to people, the more you learn,” he said.

With this early momentum, Marchand also seeks to improve upon some mistakes his Democratic challenger made in the general election.

Van Ostern’s biggest struggle in his race was name recognition. A poll before the election found that only 10 percent of respondents did not recognize Sununu’s name, but about 28 percent never heard of Van Ostern. While Van Ostern benefited from a strong ground game from the New Hampshire Democratic Party and a bigger war chest than Sununu, the voters didn’t turn out for the Democratic nominee like they did at the top of the ticket.

By getting out of the gate early and meeting with voters now, Marchand is increasing his chances that come Election Day next year, the voters will remember who he is.

Yet, Democratic voters might also recognize Connolly’s name on the ballot. The former gubernatorial candidate is also mulling another run. He stirred some intrigue when he had a paid “sponsored post” on Facebook last week.

Connolly said Marchand’s announcement was too soon and that now is the “time to governor” and the “focus should be on the budget.”

“We should be working with our leadership in the Senate and House to get our best possible budget for the state,” he told NH1 News. “After the budget plays out… I’ll consider running again if the ideas I offered in 2016 aren’t being fully addressed. But certainly at this stage you don’t say if you’re in or you’re out.”

Marchand’s focus is on Trump and Sununu. He believes Sununu’s “full-throated” support for Trump during the campaign and still in his term, will ultimately be his downfall.

“It’s never too early to begin what’s going to be a long and difficult process,” he said. “It is difficult to defeat a first-term incumbent governor. I’m under no illusions. I will be a happy warrior. I will not be outworked. I know the magnitude it will take.”

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There’s a new presidential opioid commission in town, but drug policy experts remain skeptical about its mission and effectiveness. It also appears that New Hampshire does not have a seat at the table, for now at least.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis was announced Wednesday when President Donald Trump signed the executive order laying out its blueprint. It will be chaired by New Jersey Gov. Chris Christie, who has made the opioid crisis a priority as governor, and will study appropriate steps for lawmakers and federal officials to take to combat the epidemic.

“This is an epidemic that knows no boundaries and shows no mercy, and we will show great compassion and resolve as we work together on this important issue,” Trump said.

The panel’s mission would be to identify federal funding streams that could be directed to address the crisis, determine the best practices for prevention and recovery, evaluate federal programs and the U.S. health system to identify regulatory barriers or ineffective initiatives like prescribing practices, and consider changes to the criminal justice system.

More than 52,000 Americans died from a drug overdose in 2015 — up from 47,000 in the previous year — according to the U.S. Centers for Disease Control, and nearly two-thirds of those deaths involved an opioid.

The commission would make interim recommendations within 90 days of its establishment along with a final report in October. The agencies involved would be expected to take actions implementing those policies.

The commission would be composed of Attorney General Jeff Sessions, Health and Human Services (HHS) Secretary Tom Price, Veterans Affairs Secretary David Shulkin, and Defense Secretary James Mattis. Another five members from state governments, law enforcement, and other groups would finish it. Massachusetts Republican Gov. Charlie Baker and North Carolina Democratic Gov. Roy Cooper are reportedly set to sit on the panel.

When the commission was announced, a spokesman for New Hampshire Republican Gov. Chris Sununu told NH1 News that he “doesn’t have a formal role with the commission.”

If that stands, it would be an interesting position from the White House. The Granite State has the second-highest overdose deaths in the country. While Massachusetts has also been devastated by the opioid crisis, Baker did not support Trump in the 2016 presidential election and Governor John Sununu never once wavered from his support for Trump.

There was also no one from New Hampshire taking part in the listening session at the White House when they announced the commission. None of New Hampshire’s Democratic congressional delegation took part in the session.

That’s worth noting because Trump and Christie as presidential candidates often discussed the opioid crisis during their campaign visits in New Hampshire.

“A wall will not only keep out dangerous cartels and criminals, but it will also keep out the drugs and heroin poisoning our youth,” Trump said in a stop in the Granite State in October.

However, drug policy experts are concerned that Trump is focusing on just the criminal justice side of the crisis, and not enough on treatment and prevention.

“We don’t yet fully know what the Trump policy towards the opioid crisis will be,” said Leo Beletsky,a law professor at Northeastern University who specializes in health and drug policy, in an interview with NH Journal.

“During the campaign, he made statements supporting treatment access and focusing on interdiction at the US-Mexico border,” he added. ‘Since the election, we have heard much about the ‘Wall,’ other interdiction efforts, and criminal justice tools to combat the crisis, but not so much about the treatment issue.”

Other advocates are frustrated with actions the Trump administration has already taken that could actually worsen the crisis.

The Office for National Drug Control Policy (ONDCP) would support the commission, and the office’s director — known as the “drug czar” — would represent the president. Yet, the ONDCP post is still unfilled, despite reports that former U.S. Rep. Frank Guinta of New Hampshire was being considered for the job.

A new spending plan reported last week would cut the Substance Abuse and Mental Health Services Administration’s mental health block grant by $100 million in 2017. Trump’s proposed 2018 budget for HHS would cut the agency’s funding by nearly 20 percent.

Beletsky was also concerned about Sessions being involved in the commission due his skepticism about treatment and favoring a punishment system to handle the opioid crisis.

“Further, Jeff Sessions is a long-time adherent to the idea that we can arrest and punish our way out of substance misuse in this country — an idea that has been a demonstrable failure and one that has frankly brought us to where we are today,” he said.

Several experts also question the value of the commission and how its efforts could be duplicative of actions and groups already in existence.

In November, Surgeon General Vivek Murthy released the office’s first-ever report on opioids and addiction, which included tools and recommendations to combat substance abuse.

There’s also the Bipartisan Task Force for Combating the Heroin Epidemic, which was created in 2015 by Guinta and New Hampshire’s other delegate, Democrat U.S. Rep. Annie Kuster. It’s mission has transformed as the crisis evolved from just heroin to include opioids and fentanyl, but it remains a legislative approach to handling the epidemic.

“The Presidential Commission…appears to be weighed heavily towards a more partisan and more criminal justice-focused approach, in a tone set by the AG,” Beletsky said. “As far as I know, there is not one public health expert on the Commission, which is as clear signal as any that Obama Administration’s mantras of ‘public health approach’ and ‘we can’t arrest our way out of this problem’ will not find much support in this group.”

Kuster appeared supportive of Trump’s efforts to tackle the opioid crisis and create a presidential commission, but cautioned against repealing parts of the Affordable Care Act that provide support for individuals seeking substance abuse treatment.

“We also know that there is not enough capacity for those seeking treatment, and I was pleased to see that part of the Commission’s mission will be to assess the availability of substance use treatment and recovery services,” she said in a statement. “I look forward to working with the Commission and discussing how the Bipartisan Heroin Task Force can be a productive partner in the House of Representatives to advance policies to address the opioid addiction crisis.”

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