Middletown, Ohio – The speech was JD Vance’s chance to introduce himself to a national audience.

A freshman senator from Ohio, Vance had only 18 months of experience in Congress when Republican presidential candidate Donald Trump picked him to be his 2024 running mate.

It was a Monday in July when the announcement about Vance’s selection was made. By that Wednesday, Vance was on stage at the Republican National Convention, preparing to address voters across the United States.

What he decided to share was a glimpse at his family’s history with opioid addiction.

“Our movement is about single moms like mine who struggled with money and addiction but never gave up. I’m proud to say that tonight my mom is here, 10 years clean and sober. I love you, mom,” he said, as his mother, Bev Vance, blew him a kiss from the crowd.

The audience erupted in chants of “JD’s mom! JD’s mom!” Vance has made tackling the opioid crisis a mainstay of his campaign appearances ever since.

This month, when he rallied in Byron Center, Michigan, he outlined a vision in which he and Trump would close US borders to “stop the drugs”. Then, a few days later in Kenosha, Wisconsin, he called for drug dealers to receive the death penalty.

But in Vance’s home state of Ohio, addiction experts and advocates say they have yet to hear policy proposals in this year’s presidential race that would adequately address the complex nature of the opioid crisis.

Jackie Phillips Carter, the health commissioner for the city of Middletown, Vance’s hometown, said neither Democrats nor Republicans have put forward viable solutions.

“There are so many obstacles and roadblocks,” she said, “that I don’t think anybody is serious about addressing the issue.”

Barriers to access

When advocate Dennis Cauchon reflects on the hurdles to confronting the opioid crisis, he thinks of his colleague Dylan Stanley.

Cauchon serves as president of Harm Reduction Ohio, a drug policy nonprofit based east of the state capital, Columbus. In 2018, he hired Stanley to lead community outreach.

She excelled at the role. Cauchon credits her with saving countless lives.

“Dylan was one of our earliest and best distributors of naloxone,” Cauchon said, referring to the nasal spray used to reverse the effects of an opioid overdose.

But Stanley herself struggled with addiction, and she relied on methadone to treat her opioid use disorder.

Getting the medication, though, required her to criss-cross Columbus by bus: Only certified treatment programmes can dispense the tightly regulated drug. And there was regularly a line at the door by the time she arrived.

Four years ago this month, Stanley died of a probable overdose at age 30, Cauchon said. She left behind a two-year-old daughter, Ruby.

While Cauchon said he respects Vance’s personal story, he feels it is unlikely the Republican’s hard-knuckle proposals will move the needle when it comes to helping those struggling with addiction, like Stanley.

“I don’t think he has a good understanding of what needs to be done. A lot of people are well-meaning but do the opposite of what’s needed because it’s a complex issue,” said Cauchon.

“His policies — increasing the drug war and prison sentences and arrests — do the opposite. I don’t think that’s his intent, but I do think that’s the result.”

A chronicle of decline

Since the mid-2010s, Ohio has consistently had one of the steepest proportions of overdose deaths in the country.

While the number of deaths has fallen significantly in recent years, the state still averages 45.6 deaths for every 100,000 people — the 10th highest rate in the country.

The crisis hit Vance’s hometown of Middletown particularly hard. In the five years from 2017 to 2022, Middletown’s Butler County saw one of the most elevated rates of overdose-related deaths in the state.

Vance captured the crisis in his best-selling memoir, Hillbilly Elegy. It painted a portrait of Middletown as a Rust Belt city in decline, full of shuttered shops and fading parks.

It also relayed the story of his mother’s struggles with heroin and OxyContin, a prescription opioid.

The book’s publication in 2016 propelled Vance to national stardom, and that same year, he established Our Ohio Renewal, a nonprofit formed to “combat Ohio’s opioid epidemic”.

Vance explained that the organisation’s focus was to assist “the grandparents and aunts and uncles taking care of a lot of the kids who had been orphaned by the epidemic”.

It even pushed the state legislature to support the “caregivers” who help family members affected by opioid addiction.

But in 2021, Our Ohio Renewal closed down. It had faced criticism for employing an addiction specialist with ties to Purdue Pharma, a now-bankrupt pharmaceutical company accused of aggressively pushing highly addictive opioids like OxyContin to consumers.

And the experts who spoke to Al Jazeera questioned whether the nonprofit amounted to much.

“It really didn’t do anything. I deal with this issue every day across the whole state, and we had no contact with it,” said Cauchon. “It didn’t do any good, but it didn’t do any harm.”

Feeding stereotypes?

Some critics, however, argue that Vance’s depiction of the region did indeed cause harm, by feeding into stereotypes about the root causes of addiction.

In Hillbilly Elegy, for instance, Vance credits a “culture in crisis” with creating the situation in Middletown.

“You can walk through a town where 30 percent of the young men work fewer than twenty hours a week and find not a single person aware of his own laziness,” Vance writes.

Scotty Robertson, a pastor in Middletown who grew up in West Virginia’s Appalachian coalfields, found Vance’s airing of his family’s addiction struggles problematic for several reasons.

The book, Robertson explained, allowed Vance to present himself as a paragon of success, while those around him are often depicted as uneducated and drug-addicted.

“I think the context in which the story is told actually reinforces the stereotype, in light of how he uses the story to elevate himself,” he said.

Robertson believes Vance’s current political stance is another reflection of those stereotypes.

Vance, for example, has opposed “housing-first” policies that would offer lodging to those facing homelessness, for fear they would introduce “people with serious drug problems” into communities.

“It’s a political agenda that dehumanises,” Robertson said. “If [his] story was told for Vance to achieve the right kinds of outcomes, then I think the story very much could have been used for the purpose of humanising.”

Phillips Carter, the Middletown health commissioner, also believes part of the difficulty in addressing addiction lies in breaking down stereotypes about who is vulnerable. She wants the public to understand that those struggling with addiction are simply everyday people.

“The biggest challenge now is always bringing the human component,” she said. “So often the biggest challenge is trying to bring the humanity and education that addiction is a disease.”

Turning the tide

There are also significant hurdles to getting treatment for addiction and related conditions, Phillips Carter added.

“Mental health treatment is very difficult to get,” she explained. “There is insurance. There is red tape. People can’t go into multiple programming. Sometimes women can’t get treatment where men go. Sometimes a family will lose its kids if [a parent] goes into treatment.”

But she and other experts believe there is reason to be hopeful. Overdose deaths in Ohio are down 34 percent so far in 2024, compared to the same period last year.

Nationally, deaths fell in 2023 for the first time in five years. New federal regulations easing restrictions on methadone were also announced in April.

Ohio itself invests nearly $100m a year in prevention, harm reduction, treatment and recovery responses.

Cauchon, the president of Harm Reduction Ohio, credits local and state leaders like Governor Mike DeWine with working across party lines to lower the number of deaths.

“Is the response everything it could be?” Cauchon asked. “No, but it’s much better than five or 10 years ago.”