- Video report by ITV News Correspondent Martin Geissler
The US is in the grip of an opioid epidemic, with the drugs killing tens of thousands of Americans each year.
The drug problem is so extreme in Manchester, New Hampshire, that in a city with a population of 100,000, the synthetic heroin is killing almost 100 users per year.
Attending opioid cases in the US city has become a familiar routine for the emergency services, with firefighters now attending more overdoses than fires and trained in administering Narcan, the antidote to opioids.
"When we were dealing with just heroin, you know, people were overdosing, but, I hate to say it, it was almost manageable," Danny Goonan, the city's fire chief explained.
He continued: "But once synthetic opioids came in, it was out of control and that's when we hit the crisis, because we were just dealing with death all the time."
In a bid to help tackle the crisis, all of Manchester's fire stations have been declared "safe spaces", meaning addicts can walk-in, register for help, and enrol with a rehab programme.
And they do.
ITV News met Sandra Griffin, a mother who described herself as being at her "wits' end", but who wanted help for her 34-year-old son who she was "watching die".
She recalled one day in May 2017 when she had the emergency services at her house three or four times to help her son who has survived multiple overdoses.
"I've seen him die and be revived," Ms Griffin recalled.
She described the effect of opioids on users as "the death of the spirit, the death of the person you know.
"The addiction takes over and the behaviour is not the person you knew since before they were born, and loved, since before they were born.
"It is death."
Opioids are not just an urban problem.
Barely any county in any state in the US has escaped their grim influence.
At the Dartmouth-Hitchcock Medical Centre in Lebanon, New Hampshire, just 70 miles away from Manchester, a doctor explains that one in 10 babies born there have been exposed to opioids in the womb.
Just hours after birth, the babies begin to experience withdrawal symptoms, shaking and crying uncontrollably, and unable to sleep.
In the state which Donald Trump described as a "drug infested den", doctors say that despite the President's promises, there are no quick fixes.
They explain that addicts are never totally cured and so the crisis could haunt America for two generations or more.
"Their [addicts'] brains become rewired," Dr Alison Holmes, a paediatrician at Dartmouth-Hitchcock Medical Centre explained.
"So it's something they're going to battle for their lifetime, and I think we as a society need to be really aware of that and figure out what we need to do to help people manage this chronic disease for the next 60 years."
President Trump's first steps in tackling the epidemic include harsher punishments for drug traffickers, including the death penalty, in plans he unveiled on Monday.
The 71-year-old also called on Congress to pass legislation reducing the amount of drugs needed to trigger mandatory minimum sentences for traffickers who knowingly distribute certain illicit opioids, according to his domestic policy director.
Other parts of the plan include broadening education and awareness, and expanding access to proven treatment and recovery efforts.
However, in America's war against opioids, victory still seems a long way away.