Sydney Fishman is a graduate student in Reporting the Nation/NY in Multimedia.

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Jim and Jeanne Moser couldn’t have imagined such a simple solution could have saved their son’s life in 2015. Five years later, the East Kingston, New Hampshire couple is working tirelessly to keep others from making the mistake they did, and educating others worldwide on the importance of disposing of excess prescription opioids through their national campaign, Zero Left for the Medicine Cabinet. 

According to the American Society of Addiction,  four out of five people who develop an opioid addiction start with legally prescribed pills, whether it be pills prescribed for themselves, a friend, or family member. This was ultimately Adam’s fate, and what makes his death the most painful. Now with the New Hampshire primaries looming, the parents of four, like many other New Hampshire residents, are still pondering who the best candidate to tackle the important issues like the opioid crisis is. 

On September 19, 2015, 27-year old Adam Moser died of a fentanyl overdose, after four years of secretly struggling with an addiction to opioids. Moser was one of four to die of an opioid overdose that weekend, and one of 444 opioid overdose deaths that year in New Hampshire, which has consistently been in the top five states with the highest rates for opioid deaths for the last four years.  “Unbeknownst to us, he was helping himself to opioids we had left over from our joint replacement surgeries,” Jeanne Moser said. “ We were prescribed these and neither of us really liked them, so we put them in our kitchen cabinet. By the time that we found out he had a drug problem, it was the night that the police officer told us he was dead.” 

Just days after Adam’s funeral, Jeanne headed to the pharmacy to pick up pain medication for Jim, who had just had knee surgery which had been previously scheduled before Adam’s death. 

She was shocked at the contents of the bottle.

“I was like, ‘Here we go again, ” she said, recalling the devastation of seeing 150 Percocet and Oxycontins being prescribed, and bursting into tears as she drove away.  “The doctor came to the funeral. Didn’t he know? Why would he do this?”

Per doctor’s orders, he only needed 30 pills, which were to be taken over the course of seven days.

“I was disgusted,” Jim Moser, who works as a surgical scrub deck, said.  “I ended up flushing the rest down the toilet.”

 When Jim Moser was cleared to return to work, this was when the Mosers realized the gravity of the drug problem not only facing New Hampshire, but the country as whole, pushing them to begin brainstorming the ways they could join the fight against addiction.

“I was going down the road of how to get medication prescribed more accurately,” Jim Moser said. “No one asks you when you have surgery ‘How many pills did you actually use?’ Surgeons usually give you the maximum prescription so that they get less calls from patients asking for more.”  

 In 2017, the pair began building the campaign with flyers, PSAs, and public addresses around the country about the dangers of unprescribed opioid use, even getting recognized by President Trump during a March 2018 speech about his $6 billion plan for fighting the opioid crisis at Manchester Community College. Most notably, the couple was able to join forces with doctor and fellow friend, Thomas McGovern, to distribute Deterra, a disposable drug deactivation system that uses water and deactivated charcoal to dilute pills when mixed together in a plastic pouch. The campaign’s launch was on January 1, 2019 and as of March 2019, the couple has helped healthcare facilities throughout the country to distribute over 175,000 Deterra packages.  In addition to the implementation of the Deterra packages, New Hampshire law now requires an informed consent form be given to patients needing opioids. In addition to detailing the possible risks and side effects of opioids, the form also asks patients to do a risk assesment where they are asked about family or personal history of substance abuse, sexual abuse, and psychological disease such as ADD or OCD.

The Mosers recognize that because a national crisis can’t be solved by one person, leaving them unsure who would be the best candidate to handle such a national, and personal, crisis, as the nation’s next President.

“The problem is so big. The DEA will tell you they can’t arrest their way out of this problem. When I hear a political candidate speak about the opioid crisis, it doesn’t matter what side they are on, or if I personally like them or not, they can’t really promise anything,” Jeanne said. “Maybe through the healthcare funding avenue that it could get fixed. Getting folks the mental health they need may help in not leading them down that path.”

In the eyes of recovering addict and author Timothy Macmahan King, who became addicted to prescribed opioids meant to treat acute necrotizing pancreatitis, the policies that the presidential candidates have proposed for addressing the opioid crisis are much better than that of Trump’s, who he believes is only talking about the opioid crisis for political gain.

“There are candidates that you connect with because of policy issues and there are candidates you connect with because you believe the stories they are telling about the world,” said King,  a storyteller himself, recently writing a book called “Addiction Nation: What the Opioid Crisis Reveals About Us”  where he talks about his journey to recovery, as he questioned and explored the things that fuel addiction in a society. 

“Donald Trump has named an issue that resonates with his base, while not following through with good policy. I’m watching what he is doing and how effective it is and I’m shocked that the Democrats don’t see it and find a way to counter it.” 

In order to be able to pick the right candidate, King said he needs a candidate who presents a healthy balance of relating to the people on a personal level, and a policy level when it comes to important issues. For him, that candidate would be Andrew Yang. 

“I think he is doing the best job at creating a narrative that connects with what people are experiencing in their day to day lives through his big policy ideas. It’s a long shot for him to become president but I’m really glad his voice is in the mix but I hope other Democrats keep listening to what he had to say.”

Nik Orestis, retired paramedic and firefighter for the city of Manchester, also feels like the role mental health has in drug addiction really needs to be addressed, remembering the horrors he saw while working in emergency services, which he worked in from 1992 to 2017.

“I worked two 24 hour days and had four days off, “ Orestis said. “It was a great career, but we got overwhelmed with drug and mental health cases. It was brutal. When I would see people in the back of the ambulance, the older generation would say that it started because of their prescription medication. For the younger kids, the mental illness had a lot to do with it. They just wanted to get away and it [using opioids] was a way for them to handle depression, suicidal thoughts, schizophrenia, and things like that.”

Despite starting in 1992 when the opioid crisis was really just beginning, Orestis actually saw some of the worst cases around 2017.

“I was seeing five to seven overdoses a day in the city of Manchester alone. Some of them were repeats,” Orestis said. “They overdose, you give them a dose of Narcan, they come back, and you would pick them up later that night for the same thing. From my colleagues that I’m still friendly with today, it’s still pretty bad.” 

Orestis looks forward to candidates providing better access to mental health as a means to combating the opioid crisis and believes that Bernie Sanders is the best man for the job because of his Medicare for All plan.

“I agree with him 100% that medical care for everyone should be a right so I’m aligning myself with Bernie Sanders,” he said. “How far that will go, I don’t know but I like his platform. The biggest thing I hear from people is ‘How is he going to pay for it?’ Hopefully we all find out.”

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Video by Bessie Liu

Story by Amanda Perez Pintado

Blankets of snow covered the desolate sidewalks on Main Street in Nashua, New Hampshire. The sun was out, but the chilly air prickled the skin. Nearby, residents sought refuge from the bitter 20 degree cold in Nashua Public Library. 

In the library’s basement, an area designated for activities, Martha Alvarado spoke to a group of about a dozen Latin American immigrants like herself. On Saturdays, she dictates a citizenship preparation class. 

“I started to get people motivated to become American citizens, teaching them also why voting is important, why it’s important to have the blue United States passport,” said Alvarado, 53, in Spanish. “Because with that one has more commitment with our nation, more commitment with oneself.”

Alvarado migrated from Colombia to the U.S. 20 years ago and moved to Nashua in 2010. She became a U.S. citizen in 2009, and she believes it is important for immigrants to make their vote count during Tuesday’s Democratic presidential primaries. Her vote will go to billionaire activist Tom Steyer. 

“What is more beautiful than becoming an American citizen and voting?” she said. “Voting is very important. If we stay in this country it’s because we like the democratic system, we like politics here, the possibility of working.”

New Hampshire’s primaries are decisive for the Democratic Party’s battle for the presidential nomination. The primaries in the north-eastern state follow the polemic Iowa causes, whose official results were announced late Sunday night. 

The voters in the last midterm elections were the most ethnically and racially diverse ever, according to Pew Research Center. In 2018, the number of naturalized-citizen voters nearly reached 10 million, almost equaling the 10.8 million naturalized citizens that voted in the 2016 presidential elections. 

Among the 11 Democratic presidential hopefuls, Steyer is Alvarado’s first choice because of his policies on education and climate, particularly his promise of declaring state of emergency to tackle climate change if elected. 

She hopes whoever prevails in November will make immigration his or her priority and propell reforms that will protect DACA recipients and provide an easier path for undocumented immigrants to become citizens. 

 Eva Castillo, director of New Hampshire Alliance for Immigrants and Refugees, has dedicated most of her life to advocating for immigrants. She arrived in the U.S. from Venezuela in 1975 and moved to New Hampshire in the early 1980s. 

Sitting at a table in a Mexican restaurant in downtown Manchester, Castillo said there were few Latinos when she first moved to the Granite State, but has noticed that the Latino population has grown in the past years.

Those who identify as Hispanic or Latino makeup 3.9 percent of New Hampshire’s 1,359,711 citizens, according to the U.S. Census Bureau. White residents make up 93 percent of the population, making it the least racially diverse of the early caucuses and primary states. 

Castillo, 63, said the Democratic Party has taken Latino voters for granted. 

“They don’t really put much of an effort to reach out to the Latinos, and they feel like we’re going to vote for them because what is the alternative?” she said. “But I am tired of voting for the lesser of two evils because evil is still evil. And they’re really not doing much for us as it is.”

She said the Democratic candidates have not made immigration a priority during their campaigns. In fact, the issue was absent from the debate stage in New Hampshire last Friday. 

“They have the policies, but nobody has made it a special subject in their campaigns,” said Castillo. “They will answer questions if we ask them, but both in the debates they don’t really make an issue out of immigration, which is really frustrating and pretty sad to leave so many millions of people out of the picture.” 

To get Latin American immigrants involved in the elections, Castillo argued, campaigns should hire bilingual staff and people of color, the campaigns’ literature should be available in Spanish. 

No matter who wins the nomination, Castillo said, the aim for the upcoming presidential elections should be to vote out Trump. 

“I hope everybody supports the winning candidate and that the Democratic Party realizes that the goal is to eventually defeat Trump and that we cannot start bickering about whose candidate is better,” said Castillo. “I don’t want to repeat what happened in the previous election.”

Michael Zhang and Suhu Liu attended last Saturday’s Democratic Party dinner in an arena in downtown Manchester to see which candidate has what it takes to beat Trump. The couple and their children walked through a swarm of potential voters and candidates’ supporters and stopped at a table with tech entrepreneur Andrew Yang’s campaign.

Zhang and Liu migrated from China in 2006, and their two children were born in the U.S. 

For Zhang, 45, policies and personal character are a determining factor in winning the presidential election. The family’s top pick is Yang. 

“We like Andrew Yang very much,” said Liu, 44. “We feel like we will vote for someone who most likely has a chance.” 

Sandra Almonte, owner of the restaurant Don Quijote in Manchester, said Trump has helped improve the economy and her business has flourished since he took office. She does not agree, however, with his stance on issues such as immigration and hopes he gets voted out.  

Sandra Almonte, 48, immigrated to the U.S. from the Dominican Republic. Her top Democratic presidential candidates are Joe Biden and Sen. Elizabeth Warren. Photo by Bessie Liu

Almonte arrived in the U.S. from the Dominican Republic in 1998 and she has owned the restaurant for almost 20 years. She employs 12 people, all of whom are immigrants too. 

Speaking over the sounds of bachata and merengue coming from a jukebox, Almonte, 48, said her favorite candidates are Joe Biden and Sen. Elizabeth Warren.

“I like Joe Biden’s experience when he was with the Obama administration,” she said. “I really don’t follow politics much so I don’t know all the different details that they have, but I like for what Elizabeth Warren stands for, and I’d love to see a combination of them run our country.” 

Deepa Mangalat, 55, is a volunteer and community worker in Nashua, New Hampshire. She will vote to get President Donald Trump out of office. Photo by Amanda Perez Pintado

Deepa Mangalat refused to say Trump’s name. She was terrified when he became the Republican nominee in 2016, and she fears that he will remain in office four more years if Democrats “don’t get their act together.”

“It’s voter apathy that got us to this place,” said Mangalat, 55. “It’s because people did not vote.” 

Mangalat migrated from India and has lived in Nashua for 30 years. She has worked in the city as a volunteer and community worker. 

During the last Democratic primaries, her candidate was Sen. Bernie Sanders, but this time around she is undecided. She said, however, that she would like to see a woman in the White House. 

One thing is for certain: Mangalat will vote for the eventual nominee to get Trump out of office. 

“Nobody can be as bad as the one sitting in the White House, nobody,” she said.

 Bessie Liu and Amanda Perez Pintado are students in the Reporting the Nation/NY in Multimedia concentration

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New Hampshire native Timothy McMahan King was there and approached the Massachusetts senator. He handed her a copy of his book, “Addiction Nation”, published in 2019, which details the story of his past opioid abuse.

“Elizabeth Warren has a great plan [for solving the opioid crisis],” King said. “Love it. On paper.”

But in reality, he has serious doubts about whether it could be put in place. In fact, as an undecided Democratic voter, from one of the top states most affected by the opioid crisis, King believes that every single front runner in the primary election has laid out effective proposals to deal with one of the most serious health crisis plaguing the country.

“But they aren’t campaigning on it like they need to,” King said.

Timothy McMahan King, a New Hampshire native, published “Addiction Nation” in 2019, detailing his stuggle with opioid abuse. He stands in front of the Restoration Cafe, where a few hours earlier he briefly met senator Elizabeth Warren. Photo by Catarina Lamelas Moura

While the opioid crisis typically doesn’t make it into the top ten issues in democratic candidate’s stump speeches, it is currently listed in the top five in the White House’s official website, the author pointed out.

“There’s something that they’re looking at that the Democrats aren’t,” he said. “You call up a normal person and you ask them what their top issues are, drug policy is not going to be up there. But it’s not a policy issue. It’s a narrative issue. And Trump knows how to win on narrative.”

A total of 67,367  people died from drug overdoses in 2018, according to the Center For Disease Control And Prevention. That same year, New Hampshire had an age-adjusted rate of 35.8 deaths per 100,000 persons, close to double the national average of 20.7.

That year’s numbers also show the first decrease in drug overdose in the past 28 years (4.1% decline from 2017) — a fact Trump took credit for in his latest State of the Union Address.

“So Trump comes to New Hampshire and he taps into that,” King said. “But he’s not there to talk about the policy. He’s there to have a very deep visceral connection with the ways that people have lost family.”

The author argued that the only candidate who has been able to appeal to people on this level has been Andrew Yang.

“He goes to people and he’s like ‘what’s different in your town,’” King said. “But none of the other Democrats are integrating it that way, because it doesn’t show up as the policy issue that people care about. Where Trump’s campaign has identified ‘oh, this is a story we can tell that justifies our other policies.’”

At the recent McIntyre-Shaheen 100 Club Dinner,  which gives the Democratic candidates a platform to speak to funders and supporters, Lisa Klaud, 42, from Hooksett, New Hampshire, still hadn’t decided on who to vote for in the upcoming primary, but said she was leaning towards Andrew Yang.

“I think he has a tremendous amount of energy and intuition in terms of reading what the American public is experiencing,” she said. “He’s the only candidate that really understands what’s going on if you’re dealing with extreme poverty or your middle class. New Hampshire has its set of very specific challenges, and he’s been able to speak to all of them.”

Klaud also praised Yang’s Freedom dividend as something that would greatly impact the lives of people impacted by the opioid crisis.

“[It] would make a huge difference for anybody who’s raising children who are their children’s children, which in the state of New Hampshire happens a lot,” Laud said. “The foster care system doesn’t have sufficient beds for all of the people who are impacted. So that would really help struggling families to be able to make due when they’re doing parenting the second time around.”

Some Democratic voters who attended events over the weekend leading up to the primary looked at the opioid crisis as part of a larger issue. Cara Flynn, 19, a student currently living in Boston, has seen many people around her impacted by this problem.

“It’s more of a human rights issue,” Flynn said. “I believe that without Medicare for all, or without a universal health care plan, that it’s just going to keep happening. People are going to be taken advantage of and that includes not having access to health products that they need. And because of that, they turned to something more accessible, like drugs, alcohol.”

Samantha Spiers, 29, attended the McIntyre-Shaheen 100 Club Dinner, while still undecided on who to vote for in the primaries. Photo by Catarina Lamelas Moura

Samantha Spiers, 29, of New Hampshire, is leaning towards voting for Bernie Sanders. Although “it’s hard to meet someone who hasn’t been affected” by the opioid crisis, Spiers said that everyone is divided on how to address it. 

“People still don’t even see substance abuse as a mental health issue and as a health issue,” she said, stressing the importance of universal health care.

On the moderate side, John McSheffrey, 52, from Newbury, New Hampshire, wants to see big government hold big pharma accountable — a position he has seen on opposite sides of the political spectrum, both from Bernie Sanders and Donald Trump’s republican challenger Bill Weld.

“I think that [the opioid crisis] goes hand in hand with the importance of caring for the working class,” McSheffrey said. “You protect the middle class with Social Security, you’re protecting the middle class with jobs, you’re protecting the middle class with protecting their education and their healthcare, and protecting them from the exposure the big pharma pharmaceuticals.”

Whoever is elected has to be able to bring people together, he said.

“We’re not polarized. We’re not,” he said. “Our politicians are polarized. We’re a country in the middle. But the primary process takes us to the left and right, right, and we end up having extreme candidates. We need to have moderate candidates, because most of us are moderates. Most of us are in the middle.”

Surviving in Manchester

Hope for NH Recovery, in Manchester, is a community center where people with an addiction can find safe haven. Keith Howard, 61, its executive director is looking for a politician who can address the challenges of living in the 21st century. 

Hope for NH Recovery is a community center in Manchester, New Hampshire, for people recovering from addiction. Some of the art made there is displayed along the halls. Photo by Catarina Lamelas Moura

“As I am making my decision, It’s very unlikely that a politician’s position on increasing funding for opioid treatment or recovery is going to play much into my decision,” Howard said. “I think that politicians can have a much more direct hand in then fighting what I see as being an existential, philosophical issue of the emptiness of modern life. I don’t think that there’s a Senate bill that is going to bring meaning to people who need drugs just to get up the courage to live.”

As someone who has been in recovery for 12 years, Howard’s views stem from his beliefs on the underlying cause of addiction.

Keith Howard, 61, is the executive director of Hope for NH Recovery. He has been in recovery himself for about 12 years. Photo by Catarina Lamelas Moura

“I think that addiction is caused by alienation from humanity and alienation from the world,” he said. “If a person is alienated drugs make you feel better. If you are having your human needs met, then you don’t need drugs as much.”

Carlos Zemban, 57, a recovering addict,  spends a big part of his week attending meetings and hanging out at Hope for NH Recovery. About 30 years ago he left Santa Catarina, Brazil, for New Hampshire and hasn’t been back since. In 2016, Zemban was one of the 46,5% people in New Hampshire who voted for Trump. Hilary Clinton won the state by a very slim margin.

Carlos Zemban, 57, is recovering from substance abuse and spends a big part of his week attending meetings and hanging out at Hope for NH Recovery. Photo by Catarina Lamelas Moura

Zemban, is currently homeless and looking for a job, having been laid off from his previous position in construction three months ago. As a single parent to a 12 year old daughter, he sees Trump as the candidate who can better address his concerns.

“Being a single father, looking for assistance is a big deal. Every time you go to get assistance or anything, it’s like a barrier they have. That’s a policy that has to be changed around,” he said. “This year I have to find a way to advocate for a single father, with a kid, to find a place to live. Because a woman with a kid can get anywhere she wants to, but a guy with a kid, it’s very hard to get help. It’s a lot of barriers.”

Having used everything from alcohol, to cocaine, prescription pills and heroin throughout most of his life, Zemban has been in recovery since September of 2018. His substance abuse started back in Brazil, at the young age of 11.

“When I left Brazil I thought I could come here and start fresh,” he said. “But I ended up going the same way really.”

Now he said he is turning his life around.

“I can see myself sitting on the porch, my own house. You know, it happened before so why not?,” he said.

For the moment, he is focused on staying clean. And come November he will once again cast his vote for President Trump.

Catarina Lamelas  Moura is a graduate student in Reporting the Nation/NY in Multimedia concentration

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Felipe is not that lucky. Living in a small town that borders New Hampshire, he gets up at 7 am every Saturday to catch a van that takes him to Manchester. The 18-year-old will then work at a food stand in the Southern   New Hampshire University Arena for 10 hours, and head back home in the midnight with $100 in hand.

Both Vanessa and Felipe are looking forward to a higher minimum wage being implemented in New Hampshire. The current rate of $7.25 an hour is the lowest in New England but the cost of living is among the highest in the nation.    These teens are not  alone.

In May 2019, a survey  by Public Policy Polling showed that more than 60% of New Hampshire residents strongly supported raising the minimum wage to $12 by 2022. It would affect more than 150,000 employees who make up 24% of New Hampshire’s labor force, according to a research by the Economic Policy Institute.

 The Democratic Presidential candidates want to push it further. They  want to raise the minimum wage to $15 an hour.  Of the seven candidates who qualified for the February debates in the 2020 election cycle, five support a federal minimum wage of $15, including Pete Buttigieg and Bernie Sanders, the two forerunners in the Iowa caucus. A $15 minimum wage would benefit even more New Hampshire workers – some  225,000 people in New Hampshire, representing 36% of the state’s labor force, according to a report by the National Employment Project.

Calls to double the minimum wage in New Hampshire have garnered  tremendous support from local unions. SEA/SEIU Local 1984, a New Hampshire branch of the Service Employees International Union, announced on January 12 that it would endorse Bernie Sanders for the Democratic presidential nomination. The endorsement decision distanced the local branch from its national affiliate, which has so far remained neutral in the presidential race.

Yet economists do not think minimum wage alone would do much to New Hampshire’s economy, which already has one of the lowest poverty rates in the nation. A classical economic theory suggests that a higher minimum wage could lead to a higher unemployment rate as companies lay off workers when they cannot afford to pay higher wages,  according to Guido Menzio, professor of labor economics at New York University.

The theory does seem to be on display in New Hampshire where the state’s $7.25 minimum wage law is accompanied by a 2.6% unemployment rate, the third-lowest in the nation.

Menzio also points out that an increase in the minimum wage might improve the efficiency of the economy by weeding out unproductive employers. But, he said, it does not necessarily improve workers’ living conditions.

“Workers may be paid $15 rather than $10 an hour but required to have their own transportation, work longer effective hours, or work more intense hours,” said Menzio.

C.J., who used to work as a pastry chef in New Hampshire for 20 years, agreed with Menzio on the point that a simple increase in wage did not make his life easier. “I used to live on minimum wage for years,” said C.J. who spoke anonymously because he did not want to be seen being critical of his employer.  “when I got promoted to the management level, I started working 60, 70, or even 80 hours per week. If you divide the pay by the hours I work, I was paid even less than the minimum wage.”

What C.J. really likes about his  current job is that his employer provides him with a solid benefit package. “Now I have insurance, and can take a paid-leave — these are more important factors than a simple rise in wage,” said C.J.

Ethan, a first-year student at Manchester Community College who works 1o hours at an  ice-cream stand and 20 hours as a construction worker, says he gets paid $300 per week and needs more money. “But I don’t think $15 would do much to my life,” said Ethan, “I think the inflation will ultimately offset such little increase in my hourly wage.”

Karen Conway, economist at the University of New Hampshire, is a strong opponent of a $15 minimum wage for the state. “The cost of living varies dramatically across the country and even within New Hampshire,” said Conway. “The northern part of the state is more rural and hence has more small firms, which are more likely to lay off people if the minimum wage rises.”

Jacob Vigdor, an expert on minimum wage who teaches at the University of Washington, thinks the effect of a rise of minimum wage on unemployment depends on the economy’s condition. “If the minimum wage is raised rapidly in the middle of a recession, employers may face greater difficulty in making payroll. If the wage is phased in slowly in a strong labor market, it may have no impact at all as wages tend to rise naturally in a strong labor market.”

Bruce Sacerdote, a labor economist at Dartmouth College, thinks that the labor market in New Hampshire is strong enough to afford some layoff. “I am in favor [of a $15 minimum wage] given recent studies on the minimum wage law that suggest that this does put a floor on wages for low-income folks, and the reductions in employment are not severe,” said Sacerdote.

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