On a recent evening, Ryan Hampton stood in front of a crowd of people in Spokane, Wash., urging them to see drugs and addiction as a key issue in the midterm elections.
"We see these overdose numbers hitting new historic highs," Hampton said, referring to the 107,622 Americans who died after using illicit drugs last year.
"How many in this room are voters? If you're a voter, raise your hand," he said, drawing cheers and applause. "Alright, good, good, good."
Hampton is an activist who was himself addicted to opioids for years, surviving repeated overdoses. He's traveled the country in a big bus, holding rallies like that one, trying to put the drug crisis back in the political spotlight.
Studies show tens of millions of Americans live with addiction and roughly 22 million people in this country are now in recovery. Hampton believes those people could make up a key voting bloc.
But in an interview with NPR, he voiced concern that the debate over drug policy has tilted in a dangerous new direction, with increasingly partisan attack ads focusing on the powerful synthetic opioid fentanyl.
Many Republicans are talking about opioids not as a public health problem, but as symptom of what they describe as a crime and border crisis. That worries some drug policy experts.
"Some of the rhetoric that we're hearing is not helpful," Hampton said. "It actually endangers us."
Republicans frame fentanyl in partisan attacks
Drug deaths have surged dramatically in recent years, and public health experts say these fatal overdoses have been fueled by the rapid spread of fentanyl and by social disruptions caused by the COVID pandemic.
Fentanyl has emerged as one of the top killers of young Americans, hitting Black and Native Americans especially hard.
Until recently, the public response to the opioid crisis has been remarkably bipartisan, de-emphasizing drug war-era strategies like police and prisons and focusing more on treatment and housing.
But through the late summer and fall, Republicans in close campaigns began hitting Democrats hard on the drug issue, linking fentanyl deaths with rising crime and fears about border security.
"John Fetterman supports decriminalizing dangerous drugs like fentanyl and heroin," declares one of Republican Mehmet Oz's attack ads in the Pennsylvania U.S. Senate race. "Fetterman's ideas are radical, deadly and wrong."
Some of the attacks reflect real policy differences. Oz has blasted Fetterman for the Democrat's support for creating supervised drug injection sites, an idea Oz opposes.
Fetterman, by contrast, has called in the past for drug decriminalization, though he's backed away from that proposal during this campaign. He's also supported more medical services for people who actively use street drugs, arguing it could help reduce fatal overdoses.
"I think it's important that we as a society have all the options on the table," Fetterman said in a 2018 interview, "including needle exchanges ... and even safe injection sites that are being considered like, say, in Philadelphia."
This idea remains controversial in the U.S., but has been endorsed by a wide range of mainstream health care experts, including the American Society of Addiction Medicine.
Conspiracy theories and culture war jabs
Other Republican attacks are completely divorced from the facts.
In Ohio, Republican Senate candidate J.D. Vance echoed a right-wing conspiracy theory that Democrats are deliberately allowing Mexican drug cartels to smuggle fentanyl into the U.S.
"If you wanted to kill a bunch of MAGA voters in the middle of the heartland, how better than to target them and their kids with this deadly fentanyl ... and it does look intentional," Vance said in an April interview with the right-wing media outlet Gateway Pundit.
In fact, efforts to target the drug cartels inside Mexico collapsed in 2020 during the final months of the Trump administration. Over the last two years the Biden administration has scrambled — without much success, according to most experts — to reduce the flow of fentanyl into the U.S.
In one of the Ohio Senate debates this fall, Democrat Tim Ryan counter-punched Vance on the drug issue, arguing that by embracing a conspiracy theory, the Republican had aligned himself with an "extremist movement."
"Who says that the president of the United States is intentionally trying to kill people with fentanyl?" Ryan asked.
Still, Democrats clearly worry about looking soft on this issue. In a later Senate debate, Ryan echoed GOP ideas about stopping fentanyl traffickers with tougher border security.
"A stronger border, more border patrol, I disagree with President Biden when he's talking about relaxing some of the regulations down on the border," Ryan said.
Some Democrats have also embraced a Republican proposal that fentanyl be officially designated a weapon of mass destruction, an idea the Biden administration has rejected.
A Republican advantage and a fentanyl crackdown
Jessica Taylor, who analyzes Senate races for the Cook Political Report, thinks public fear over fentanyl may give the GOP an advantage.
She noted that polls seem to have shifted toward Republican candidates after the GOP began focusing on drugs, crime and the border.
"It's certainly a rising issue and I think it's one Republicans believe they have an advantage on and that may well bear out," said Taylor, who added that fears about security and drugs could eclipse voter concerns about more Democrat-friendly issues like abortion.
"I think this is really aimed at sort of getting back wayward suburban voters the [Republican] party saw eroding, particularly women," she said.
Hampton, the addiction activist who's been traveling the country, worries the GOP's reframing of the drug debate will continue beyond the midterms.
He said some state legislatures are already moving to toughen fentanyl laws, an approach that means more focus on police, arrests and lengthy prison sentences.
"When we start to weaponize one particular drug such as fentanyl, we also weaponize the response and militarize the response," he said.
Hampton predicted a return to drug war-era policies would lead to more stigma for people living with opioid addiction, with less focus and money for treatment, housing and health care.
"We have seen this playbook before with crack cocaine and we saw the devastating results of that," he said.