ROCHESTER, N.H. (AP) — Kristina Amyot’s life has drastically improved since the last New Hampshire primary, but she isn’t confident the current candidates will help others achieve the same success.

Amyot, 36, spent more than half her life struggling with addiction, mainly to heroin, before joining Hope on Haven Hill, a comprehensive program for pregnant women and mothers that includes residential treatment, transitional housing and a wide array of support services. Today, she’s financially independent with a job, apartment and family she loves.

“I will never put myself through that again,” she said in an interview last week. “I have self-worth now.”

New Hampshire, a small state with an outsized role in presidential politics, has heard from candidates promising action on the opioid crisis for several presidential elections now. And some of those closest to the problem here say they’re dissatisfied with how the Republicans competing in Tuesday’s primary have focused on the border and law enforcement instead of treatment and recovery.

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Amyot isn’t sure whether she will vote in the presidential primary on Tuesday, in part because she’s skeptical that anything will change.

“I feel like every four years it gets talked about, and then it gets lost. We don’t really do much with it, and that’s something that needs to change because this should be one of the top priorities,” she said. “To think that these people don’t care about us is really sad.”

Starting in the late 1990s with the overprescribing of opioid painkillers, the nation’s drug crisis evolved to encompass heroin and then fentanyl, which in recent years often has been cut into other street drugs, often without the users’ knowledge. More than 80,000 people died of opioid overdoses in 2022, according to the U.S. Centers for Disease Control and Prevention.

In 2015, New Hampshire’s drug overdose death rate was the second highest in the nation. And while the state has made progress since then, the numbers have gone back up. The final tally for 2022 — 486 deaths — was only four short of the all-time high for New Hampshire, a state of about 1.4 million people.

“In New Hampshire, we are losing more than a person a day,” said Kerry Norton, who co-founded Hope on Haven Hill in Rochester in 2016. “It’s so easy for everyone to forget that it’s still killing generations of people, and it’s still making communities and states and families and friends lose their loved ones.”

Republicans who will be on the New Hampshire campaign trail this week have primarily focused on stopping the influx of illegal drugs at the southern U.S. border.

Former President Donald Trump, who once described New Hampshire as a “drug-infested den, ” has proposed using the military against foreign drug cartels, a view echoed by Florida Gov. Ron DeSantis and former U.N. Ambassador Nikki Haley. DeSantis also has said drug smugglers should be shot “stone cold dead,” while Haley has proposed cutting off trade with China “until they stop murdering Americans with fentanyl.” China is accused by many experts of allowing the export of precursor chemicals used to make synthetic opioids like fentanyl.

But that’s only part of the equation, argues Jay Ruais, a Republican who was sworn in this month as mayor of Manchester, New Hampshire’s largest city.

“I think we also have to address it on the demand side as well. What are we doing for prevention for kids in schools? What are we doing for those who need more treatment? What are we doing for people who are outside of treatment? And on the recovery side, housing is a big component as well,” said Ruais. “It requires a systemic response where we’re dealing with everything from A to Z.”

During his own campaign, Ruais described how completing a court-ordered rehabilitation program in 2010 after a second drunk driving arrest deepened his sense of empathy for those struggling with addiction.

“It’s a deeply personal issue to me. It’s why I ran for mayor to begin with,” he said. “But I certainly think that any candidate coming to speak in New Hampshire should be talking about this issue.”

After two big leaps at the beginning of the COVD-19 pandemic, drug overdose deaths nationally rose 2% in 2022 to nearly 110,000. In New Hampshire, overdose deaths declined significantly before the pandemic and held steady in 2020, in part thanks to the creation of a hub-and-spoke model called “The Doorway,” in which hospitals work with local providers to connect patients with services close to home. But the state’s 486 deaths in 2022 marked an 11% increase from the previous year.

Norton said above all, she wants a president who recognizes that substance use disorder is a disease and will treat the crisis as a public health emergency. Punitive policies don’t help people who end up in the program due to trauma, abuse and lack of connection, she said.

“I’m not an expert in any way on how controlling the border is going to help,” she said. “What I do know is helping people have affordable health care, affordable housing, and basic rights and support is what will help here in New Hampshire.”

Former New Jersey Gov. Chris Christie, who led a bipartisan White House commission on opioid misuse during the Trump administration, echoed that approach when he unveiled his national drug policy plan at Hope on Haven Hill’s wellness center in December, a few weeks before dropping out of the race.

“We need an approach that remembers and reflects on the very basic humanity of every single one of those 100,000 victims, as well as the treasures each one of them could have brought to this country,” he said.

That message resonated with Amyot, who was in the audience that day and plans to be there when Haley visits the center on Wednesday. Putting a woman in the White House might make a difference, she said.

“The next four years cannot continue the way it has been, because it’s going to be so bad,” she said. “It’s so bad right now, and we’re not doing much about it.”