Sen. Kelly Ayotte of New Hampshire speaks at the 2013 Conservative Political Action Conference in National Harbor, Maryland, on March 15, 2013. Ayotte is one of many Republican politicians up for election whose campaign is being bolstered by dark money-funded attack ads. (Photo: Gage Skidmore)

Political attack ads are known for crude sensationalism, but a recent TV ad attacking New Hampshire Gov. Maggie Hassan goes beyond the usual jabs and exaggerations. Capitalizing on a spike in drug overdoses that has rocked the state, the ad juxtaposes Hassan with shots of a wailing ambulance and an overdose victim being rushed into the emergency room on a stretcher. Hassan’s decision to veto a budget bill last year is blamed for delaying funding for drug-treatment programs.

The ad provoked harsh backlash in a state at the center of the media frenzy over the so-called “opioid epidemic,” with both sides accusing the other of politicizing the issue while families continue to grieve the deaths of loved ones. It’s true that drug treatment programs in New Hampshire have long waiting lists, and last year the state suffered a record number of overdose deaths. This occurred on Hassan’s watch, but the Democratic governor spent much of 2015 locked in budget battles with a state legislature dominated by Republicans; the partisan finger of blame could point in either direction.

The overdose ad, of course, isn’t just an effort to put pressure on Hassan. It is a strategic move in the larger battle to maintain a Republican majority in the United States Senate. All but 10 of the 34 senators defending their seats this election season are Republicans, including Kelly Ayotte of New Hampshire. Ayotte’s challenger is none other than Gov. Hassan, and observers consider the race to be a toss-up.

The attack ad is part of a $4.6 million ad buy in New Hampshire by an out-of-state group called One Nation. This “social welfare organization” features an opaque mission statement about pursuing “the Founders’ vision of America,” but One Nation is simply a reincarnation of Alliance for America’s Future, a longstanding group in Karl Rove’s Crossroads network of super PACs and dark money nonprofits.

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Alliance for America’s Future has been largely idle since 2010, and operatives have dusted the group off and given it a new name, likely in order to take advantage of a tax exemption that the IRS granted the Alliance six years ago, according to the Center for Responsive Politics. Rove’s other dark money group, Crossroads GPS, has been waiting on such an exemption for years. One Nation is now spending millions of dollars on ads in states across the country, and we may never know who is paying for them because nonprofit “social welfare organizations” are not required to disclose their donors.

Groups like One Nation and its sister super PAC, the Senate Leadership Fund, are not a strictly conservative phenomenon. In fact, they began as a Democratic strategy. The Center for Responsive Politics reports that in starting both groups, Rove’s camp ripped a page from the playbook “developed by Harry Reid and the Democratic operatives” behind the liberal dark money group Patriot Majority USA and its sister super PAC. These groups spent millions of dollars attacking Republican congressional candidates in 2014, just like One Nation is spending millions to fend off a Democratic take-over of the Senate today.

Dulling the Trump Effect

Republicans hold 54 seats in the Senate, while the Democrats currently have 46 seats plus two independents that caucus with the party. Races for Senate seats held by Ayotte and six other Republicans are currently considered “competitive” or “toss-ups” that could go either way, according to the Cook Political Report and other analysts. At the moment, Democrats are only in real danger of losing the seat currently held by minority leader Harry Reid of Nevada, who announced this week that he is not seeking reelection and will retire after this year.

The Republicans in “toss-up” races are all running in states that President Obama won in 2012, including Illinois, Wisconsin, Ohio, Florida and Pennsylvania. With the controversial Donald Trump presumably topping its ticket, the GOP is wringing its hands over the possibility that Democrats could win control of both the Senate and the White House if the Trump campaign goes down in flames.

While polls show that Democratic front-runner Hillary Clinton is not exactly popular, she is not as unpopular as Trump, whose racist comments and outbursts have alienated moderates and other voters that the GOP needs to win close races and stay relevant. A recent Quinnipiac poll found that only 23 percent of voters ages 18 to 34 support Trump, along with 33 percent of Latinos and 1 percent of Blacks. Another recent poll found that 66 percent of all voters think Trump is unfairly biased against “women, minorities and Muslims.”

These voters don’t need to love Clinton to punish Trump in the polling booth, and they could take other Republicans down with him, a fact that vulnerable GOP senators are well aware of. Sen. Pat Toomey’s campaign in Pennsylvania has said he will probably be too “busy” to attend the Republican convention in Cleveland where Trump is expected to receive the presidential nomination. Ohio Sen. Rob Portman, who is facing a tough electoral challenge from a former governor, has criticized Trump’s racially charged remarks and dismissed the idea that he could be his running mate.

The “Trump effect” has also made its way to the New Hampshire race. Hassan has been eager to play on anti-Trump outrage, and Ayotte has demanded that Trump retract his comments about Muslims and a certain judge’s Mexican heritage. In an effort to straddle the fence of controversy, Ayotte maintains that while she plans to vote for Trump she is not endorsing him or any candidate for president.

The Politics of Painkillers

Meanwhile, One Nation’s attack ad against Hassan has backfired. A state association of firefighters and paramedics who credit Hassan with increasing the availability of naloxone, the lifesaving overdose reversal drug often carried by first responders, called the ad “false and disgusting.” Hassan’s supporters in law enforcement and public health lined up to demand that the ad be taken off the air.

Even Ayotte tweeted that “no one should be playing politics with the heroin epidemic” and asked One Nation to take down the ad, but so far the group has refused. In fact, playing politics with the nation’s painkiller problem is exactly what One Nation has been doing for months, to Ayotte’s benefit.

In March, One Nation launched a $1.1 million ad campaign praising Ayotte for her role in passing the Comprehensive Addiction and Recovery Act (CARA), which has been heralded as a feat of bipartisanship and an important step toward treating the nation’s rising rates of opioid and heroin misuse more like a public health challenge than a criminal problem.

Star players behind the bill included Portman and Toomey, who represent states hit hard by the uptick in painkiller overdoses and have been campaigning on the issue. Both senators are also supported by One Nation, which has made multimillion-dollar ad buys in their favor, although those ads were focused on other issues.

CARA may have given these Republicans something to brag about that has nothing to do with Muslim immigrants or Donald Trump, but the legislation only authorizes the use of federal funds to pay for addiction treatment and prevention; it does not actually allocate any funds. Moreover, since the passage of CARA, bipartisan cooperation on painkiller issues has since disintegrated. The White House and allied Democrats are calling for $1.1 billion in new funding to combat the “epidemic,” but most Republicans in Congress refuse to dig into the federal purse for even a dime, providing the Democrats with their own cannon fodder to use on the campaign trail.

These are the political details you won’t find in attack ads and campaign rhetoric.

Consider Ayotte, who was a darling among drug reformers until a couple of weeks ago, when she proposed expanding mandatory minimum sentencing for people convicted of possessing fentanyl, a powerful opioid that is increasingly cut into heroin and is responsible for an increasing number of overdoses in New Hampshire and elsewhere.

Such a crackdown may sound good in a campaign commercial, but policy experts say Ayotte’s proposal is poorly designed and lumps low-level users in with international drug traffickers. That means people in need of medical treatment would be locked away in prison for years, contributing to mass incarceration and doing little, if anything, to stop the cycles of drug misuse and addiction.

It seems like everyone is playing politics with painkillers these days, even the masterminds behind Karl Rove’s attack ads. Meanwhile, opiate addiction and misuse continue to be very real problems that the nation’s public health systems have not been able to effectively address.