A heroin epidemic is ensnaring thousands of people and overdoses are rising exponentially in the New Hampshire.
The small state may conjure up images of pristine winter skiing, crystal-clear lakes and summer hiking, but scratch the surface and there is a deadly war at the heart of the US presidential campaign.
‘The rate of heroin overdose deaths between 2002 and 2013 nearly quadrupled, claiming more than 8,000 lives in 2013, according to the Centers for Disease Control.’
Across New Hampshire there were around 450 overdose deaths in 2015, up from 380 the previous year, say officials. While other US states are fighting the same curse, treatment in New Hampshire lags almost everywhere else in the country.
In Manchester, the largest city, there were 726 suspected heroin and fentanyl overdoses and 83 deaths in 2015, up from 320 in 2014. Five people died in the first six days of February alone.
Paramedics are called out to overdoses in public restrooms, restaurants and cars in affluent homes and in low-income neighborhoods.
"It's everywhere," says Christopher Hickey, a paramedic from the Manchester fire department. "We probably only see a fraction of the actual users."
Democrat and Republican presidential candidates canvassing for votes have all spoken about the need to combat the epidemic -- thanks in no small part to one woman.
Kriss Blevens is one of America's top political make-up artists. She has worked with every US president since Jimmy Carter and is managing, for a sixth New Hampshire primary, the make-up of the candidates.
She lost her step-daughter to a heroin overdose in 2014.
Taking advantage of her unique one-on-one access, she has spent the last year telling the candidates Amber's story and raising awareness about the need to expand recovery treatment.
In a sign of how prevalent drug addiction has become, Republican candidate Jeb Bush's daughter was jailed for drugs, Carly Fiorina lost a step-daughter to addiction and Ted Cruz's sister died of an overdose.
Amber's addiction started with over-the-counter sedatives to treat what Blevens believes were undiagnosed mental health issues, before moving onto marijuana, opiate pills and heroin.
She was her husband Mark's only child.
"He kept saying to me, she's going to die, she's going to die," Blevens told AFP. "The roller coaster of being parents of a child that is addicted is so incredibly painful because it's just filled with fear."
Blevens has set up Amber's Place to offer emergency recovery for overdose patients, giving them a rooming house for up to two weeks as coaches help to find them a detox program or a safe place.
She is now raising funds to staff it around the clock.
In Manchester, the youngest overdose patient was 16 and the oldest 74, but those most at risk are aged 18-35, officials say.
"It's a soul sickness. It's almost like people aren't ok in their soul and they need to escape through any number of addictions, instead of just learning to be comfortable in their skin," Blevens said.
Dennis Dutra, 43, knows first hand the misery of heroin. It took him to prison 31 times and he spent 13 years homeless.
He is now a trained recovery coach who moved to New Hampshire late last year to take a job to help patients overcome addiction.
Dutra smoked marijuana at 12, before getting hooked on prescription pain killers after an injury. By 15 he was using cocaine. He turned to heroin at 25, using the drug until he was 39.
It costs as little as $7 to buy a hit. You can buy opioids across the country in probably almost every neighborhood, Dutra says.
"My life has become pretty damn good. I was living under a bridge behind Providence Place Mall several years ago," he tells AFP.
Tuesday is his first New Hampshire primary. An independent voter and undecided, the most important issue for him is solving the epidemic and getting more access to treatment.
"It's a war," he said. "If a candidate is not talking about solving that problem then that candidate is not getting my vote."
Tim Soucy, public health director for Manchester, says the numbers are astronomical.
"Whoever becomes president I think they have to understand the magnitude of the problem, they have to be willing to work in a bipartisan way with Congress to allocate funding," he said.
"We need money for treatment, we need money for recovery, our law enforcement folks need money to help get this drug off the streets."
The paramedic Hickey says money is starting to come in to expand rehabilitation and attributes some of the success to the profile raised by Blevens.
"I get worried that come February 10, when the primary's over, that it's going to kind of fall by the wayside and go back to how it was, which isn't going to do anything to help the problem," he said.