A lethal batch of heroin, trafficked under the name Hollywood, surfaced in New Hampshire in late January after claiming at least eight lives in western Massachusetts. For Granite State officials, it’s the latest in a steady dose of dire news that has seen overdose deaths linked to opioids double in the last two years; drug related overdose deaths are expected to surpass 400 in 2015. Deadly overdoses now outnumber traffic deaths in New Hampshire, one of dozens of states to feel the impact as heroin extends its reach to suburbs and rural areas across the country.

The epidemic has seen New Hampshire, the host of the nation’s first presidential primary next week, turn drug abuse into a contentious issue during the campaign. Several Republican candidates have responded to the crisis with an about-face rarely seen since Richard Nixon launched the so-called war on drugs 45 years ago: a mainstream conservative movement calling for treating low-level drug use with health services instead of prison time. Last month in New Hampshire, GOP contenders unveiled several ideas — although few with detailed plans — to treat heroin addiction via rehabilitation, from placing more emphasis on drug prevention and targeting drug dealers instead of users to expanding recovery programs.

The suggestions floated in the state reflect a budding yet guarded national conversation around drug policy and criminal justice reform. In December’s omnibus spending measure, Congress included a repeal of the ban on federal funding for state needle exchange programs. The decision, which overturned decades of federal opposition to these programs, was championed by House Appropriations Chairman Hal Rogers and Senate Majority Leader Mitch McConnell, both Republicans from Kentucky, one of the states hit hardest by opioid addiction. Their backing was seen as a reaction to the HIV/AIDS outbreak that struck nearby Indiana last year, forcing Gov. Mike Pence to declare a health emergency and grudgingly lift a law barring health officials from distributing needles to intravenous drug users.