At least 20,000 people are likely to die this year by overdosing on heroin or another opioid.

The number of times the crisis came up in last week’s Republican presidential debate? Zero.

On Tuesday, Democratic frontrunner Hillary Clinton will participate in a community forum on substance abuse and opiate addiction at Keene Middle School in New Hampshire. Back in April, at a roundtable discussion with New Hampshire voters, she promised to make the “quiet epidemic’’ of substance abuse and mental health issues a big part of her campaign.

It’s a surprising move, given that hardly anyone running for president — or current leader of the free world President Barack Obama — is saying much about heroin at all.


The situation echoes the AIDS crisis in the 1980s, said Dr. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing and the chief medical officer for Phoenix House, a nonprofit addiction treatment agency. A stigmatized group of people are dying — 220,000 since 1999 — and few leaders want to touch the issue.

Prescription painkillers killed 16,000 people in 2013, according to the CDC, and another 8,200 died from heroin.

Massachusetts is on track for more than 1,200 deaths from opiates this year. In New Hampshire, which famously hosts the nation’s first primary, officials recorded more than 300 overdoses last year and expect at least that many deaths in 2015. Ohio, a presidential battleground state, had more than 1,500 deaths from opioids in 2013.

“If we were talking about any other disease, any other medical condition killing this many people, of course you’d be hearing more talk about it,’’ Kolodny said. “It’s people with addictions who are dying, which is why I believe we haven’t been hearing about the problem.’’

Locally, though, voters care. New Hampshire residents surveyed in a poll last month said that drug abuse is the second-most important issue in the state, behind jobs and the economy.

Kendall Lane, the mayor of Keene, which is hosting Clinton’s visit on Tuesday, hasn’t decided yet who he’ll support in 2016. He’s waiting to see how the candidates talk about the crisis that’s debilitating his town.


“We’re creating as much public attention on the issue as we possibly can,’’ he said. “We’re dealing with it ourselves, but quite frankly, if we’re going to have a meaningful impact on it, we need the cooperation of both state and federal officials. We can’t solve it ourselves.’’

Tym Rourke, chair of the New Hampshire Governor’s Substance Abuse Commission, said candidates have seemed blindsided when voters ask them about addiction.

“You aren’t going to get far in New Hampshire unless you talk about this issue,’’ said Rourke, who is also the director of substance abuse grant making at the New Hampshire Charitable Foundation.

Some candidates have touched on opiate addiction, though not as much as they have spoken about the economy, immigration or foreign affairs.

In a May interview with The Boston Globe, Gov. Chris Christie of New Jersey vowed to make drug addiction one of his top “five or six’’ issues. He also visited a Manchester drug treatment facility to talk about the opiate crisis. That was before he announced that he was running for president on June 30.

During Thursday’s prime time Republican presidential debate, however, the words “heroin’’ or “opiate’’ were not mentioned once by the 10 candidates on stage.

Ohio Gov. John Kasich, answering a question about why he chose to expand Medicaid in his state, said that the expansion helped addicts.

“Everybody across this country knows that the tsunami of drugs … is threatening their very families,’’ he said.

At the St. Anslem College Voters First Forum earlier this month in Manchester, New Hampshire, Sen. Marco Rubio said what many people in the state already know: that people addicted to heroin start with prescription opiates.


He didn’t say what he’d do about that, other than not legalize any other drugs, like marijuana.

At the same event, Christie was specifically asked about New Hampshire’s heroin crisis, and what he might do to help addicts and their families. In New Jersey, non-violent drug offenders go to treatment, not prison, he said.

Clinton’s Democratic rivals — Sen. Bernie Sanders and former Maryland Gov. Martin O’Malley — have been mostly silent on the issue.

“Part of this is about stigma,’’ Rourke said. “This is something that people haven’t wanted to talk about, that’s lived in the shadows. I think in our state, we’re overcoming the stigma and people are talking about it.’’

Candidates might also gain politically by addressing the crisis.

“It shows that these campaigns have an ear to the ground and that they know what’s going on locally,’’ said Fred Van Magness, a Republican political consultant.

For governors — like Kasich, Christie, Louisiana’s Bobby Jindal, Wisconsin’s Scott Walker, and others — talking about opiates is an opportunity to describe their states’ battles against addiction, Van Magness said. There are also opportunities for Ben Carson and Sen. Rand Paul, the two doctors running for president.

It can seem like the opiate crisis is just a state or local issue. But the federal government can also make a real difference. It could require health-care companies to provide treatment, devote more money to treating addiction, or lift treatment restrictions now in place.

“It’s the expectation of New Hampshire voters that they hear from candidates about how they can ensure that those struggling with addiction can get help immediately,’’ Rourke said, “so we can stave off what we see as a public health disaster that’s been 30 years in the making.’’