MANCHESTER, N.H. (AP) — Sitting among hospital leaders, law enforcement and recovering addicts in New Hampshire's largest city Wednesday, Jeb Bush heard a sobering statistic: In the past 30 days, 102 people overdosed on drugs in Manchester alone. Ten died.
"It is all over the place, it is something extraordinary, it's heartbreaking," Bush said in the round-table meeting.
In town halls and meet-and-greets in Iowa and New Hampshire, voters are using their access to presidential hopefuls to raise painful and often deeply personal concerns about drug abuse. Often, it's about heroin and prescription drug abuse.
Unexpectedly confronted by the issue in such early voting states, several candidates are now incorporating policies on substance abuse into their campaigns.
"This is an epidemic," Manchester Mayor Ted Gatsas said. "If there was anything out there that was killing this many people, we'd call it a serial killer and we'd be doing something about it."
More than 320 people died from drug overdoses in New Hampshire last year, a sharp spike from the year before. The state has far fewer treatment beds than are needed and drug-related emergency room visits are up 76 percent from last year, according to state data.
Casey Currivan, 31, told Bush and others at the meeting that he came to the Hope for New Hampshire Recovery Center for treatment from drug addiction 42 days ago, because "life was not good."
He now volunteers there and said one of the biggest struggles is finding treatment beds in New Hampshire so people seeking help don't have to go out of state.
A treatment bed, he said, "is like a unicorn in the state of New Hampshire."
Few candidates have laid out specifics on what they would do about substance abuse as president.
But Democrat Hillary Rodham Clinton was one of the first to raise the issue, and she's laid out a $10 billion plan that promotes treatment over incarceration and gives law enforcement better access to overdose reversal drugs.
During her first trip to the state of the campaign, a participant at an event in Keene recounted her struggle with a family member suffering from addiction. Clinton called drug abuse a "quiet epidemic," and the stories she's heard on the trail led Clinton advisers to talk to advocates and experts in New Hampshire to develop her campaign's policies on combating addiction.
"As a presidential issue, I certainly did not foresee it," said Mike Vlacich, who runs Clinton's campaign here. "It just organically started coming up."
At Wednesday's meeting about substance abuse, Bush pressed the group to do more to strengthen the state's prescription drug monitoring program and enact harsher penalties for people who cut drugs with fentanyl, a painkiller that is far more powerful than heroin it is often mixed with. He's also visited a treatment center in Manchester.
Vermont Sen. Bernie Sanders, a Democratic candidate, has visited the same recovery center. The issue is deeply personal to Republican Carly Fiorina, who lost a stepdaughter to drug addiction, and she speaks about that in the campaign.
New Jersey Gov. Chris Christie has made drug treatment a centerpiece of his agenda, both in his state and in the campaign.
He has paid several visits to drug treatment centers, meeting recovering and former addicts and talking about his efforts in New Jersey to establish drug courts that mandate treatment over incarceration for non-violent offenders. He proposes to replicate such policies nationally.
Christie, who lost a close law school friend to addiction several years ago, often talks about the need to end the stigma against drug abusers, portraying addiction as a deadly disease that can affect anyone.
That approach reflects a wider shift in the way politicians and policymakers talk about substance abuse and drug addiction.
"In the past, addiction was often viewed by policymakers as a moral failing," said Linda Paquette, executive director for New Futures, a New Hampshire non-profit focused on drug prevention and treatment. But as more recovering addicts speak out and share their stories, she said, "minds are being changed."
Tym Rourke, chairman of a state commission on prevention, treatment and recovery, called the candidates' discussion of substance abuse a "profound step forward."
Of New Hampshire, he said, "we played a pivotal role in that."
Associated Press writer Jill Colvin contributed to this report from Keene.