Despite having called pervasive opioid addiction in America “a national emergency”, Donald Trump has yet to formally unlock federal assistance by declaring the national emergency urged by a high-level commission.

Two weeks after Mr Trump told reporters “we’re going to spend a lot of time, a lot of effort, and a lot of money on the opioid crisis”, the administration is still undertaking “a legal review”, a White House spokesman said.

The apparent delay has frustrated health providers and advocates on the front line of an epidemic that, according to a report from the President's Commission on Combating Drug Addiction and the Opioid Crisis, contributes to 142 Americans dying each day from drug overdoses - more than from car crashes and gun violence combined.

“We’re a little mystified as to why it hasn't happened yet”, said Mark Dunn, director of public policy at the National Association of Addiction Treatment Providers. “It would be unusual for any president of the united states to make an announcement like that in front of the cameras and then not follow through, so we are still hopeful that he meant what he said.”

Declaring a national emergency could provide more money for treatment or dispatch healthcare providers to areas where they are most needed. Mr Trump could approve waivers allowing states to treat addiction through Medicaid, a health insurance program for low-income Americans.

World's 10 deadliest street drugs Show all 10 1 /10 World's 10 deadliest street drugs World's 10 deadliest street drugs Whoonga Whoonga is a combination of antiretroviral drugs, used to treat HIV, and various cutting agents such as detergents and poisons. The drug is widely available in South Africa due to South Africa’s high rate of HIV sufferers, and is believed to be popular due to how cheap it is when compared to prescribed antiretrovirals. The drug is highly addictive and can cause major health issues such as internal bleeding, stomach ulcers and ultimately death Getty World's 10 deadliest street drugs Scopolamine Scopolamine is a derivative from the nightshade plant found in the Northern Indian region of South America (Ecuador, Colombia and Venezuela). It is generally found in a refined powder form, but can also be found as a tea. The drug is more often used by criminals due its high toxicity level (one gram is believed to be able to kill up to 20 people) making it a strong poison. However, it is also believed that the drug is blown into the faces of unexpecting victims, later causing them to lose all sense of self-control and becoming incapable of forming memories during the time they are under the influence of the drug. This tactic has reportedly been used by gangs in Colombia where there have been reports of people using scopolamine as way to convince victims to rob their own homes World's 10 deadliest street drugs Heroin Founded in 1874 by C. R. Alder Wright, heroin is one of the world’s oldest drugs. Originally it was prescribed as a strong painkiller used to treat chronic pain and physical trauma. However in 1971 it was made illegal under the Misuse of Drugs Act. Since then it has become one of the most destructive substances in the world, tearing apart communities and destroying families. 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The side effects of crack cocaine include liver, kidney and lung damage, as well as permanent damage to blood vessels, which can often lead to heart attacks, strokes, and ultimately death World's 10 deadliest street drugs Crystal meth Not just famous because of a certain Walter H White, but also because it is one of the most destructive drugs in the world. First developed in 1887, it became widely used during the Second World War when both sides would give it to their troops to keep them awake. It is also believed that the Japanese gave it to their Kamikaze pilots before their suicide missions. After the war crystal meth was prescribed as a diet aid and remained legal until the 1970s. Since then it has fallen into the hands of Mexican gangs and has become a worldwide phenomenon, spreading throughout Europe and Asia. The effects of crystal meth are devastating. In the short-term users will become sleep depraved and anxious, and in the long-term it will cause their flesh to sink, as well as brain damage and damage of the blood vessels World's 10 deadliest street drugs AH-7921 AH-7921 is a synthetic opioid that was previously available to legally purchase online from vendors until it became a Class A in January 2015. The drug is believed to have 80% of the potency of morphine, and became known as the ‘legal heroin’. While there has only been one death related to AH-7921 in the UK, it is believed to be highly dangerous and capable of causing respiratory arrest and gangrene World's 10 deadliest street drugs Flakka Flakka is a stimulant with a similar chemical make-up to the amphetamine-like drug found in bath salts. While the drug was originally marketed as a legal high alternative to ecstasy, the effects are significantly different. The user will feel an elevated heart rate, enhanced emotions, and, if enough is digested, strong hallucinations. The drug can cause permanent psychological damage due to it affecting the mood regulating neurons that keep the mind’s serotonin and dopamine in check, as well as possibly causing heart failure World's 10 deadliest street drugs Bath salts Bath salts are a synthetic crystalline drug that is prevalent in the US. While they may sound harmless, they certainly aren’t the sort of salts you drop into a warm bath when having a relaxing night in, they are most similar to mephedrone, and have recently been featured throughout social media due to the ‘zombification’ of its. The name comes from the fact that the drug was originally sold online, and widely disguised as bath salts. The side effects include unusual psychiatric behaviour, psychosis, panic attacks and violent behaviour, as well as the possibility of a heart attack and an elevated body temperature World's 10 deadliest street drugs Purple Drank One of the more unusual drugs around at the moment, purple drank was popularised in 90s hip hop culture, with the likes of Jay Z and Big Moe all mentioning it in their songs. It is a concoction of soda water, sweets and cold medicine, and is drunk due to cold medicines high codeine content, which gives the user a woozy feeling. However it can also cause respiratory issues and heart failure World's 10 deadliest street drugs Krokodil Krokodil is Russia’s secret addiction. It is believed that over one million Russians are addicted to the drug. Users of krokodil are attracted to the drug due to its low price; it is sold at £20 a gram while heroin is sold for £60. However, krokodil is considered more dangerous than heroin because it is often homemade, with ingredients including painkillers, iodine, lighter fluid and industrial cleaning agents. This chemical make-up makes the drug highly dangerous and likely to cause gangrene, and eventually rotting of the flesh

In its report, the opioid crisis panel urged the president to authorize Medicaid waivers and to declare a national emergency as a way to “force Congress to focus on funding” and allow the White House to take a leading role in combatting the epidemic.

“It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will,” the report said. “You, Mr. President, are the only person who can bring this type of intensity to the emergency and we believe you have the will to do so and to do so immediately.”

Life as a teenage drug dealer

The White House spokesman said Mr Trump “is considering not just the emergency authorities outlined in the report, but other potential options as well, to ensure we’re doing all that we can to tackle this crisis head on”.

“The President recently instructed his administration to take all appropriate and emergency measures to confront the opioid crisis”, the spokesman said.

To Mark Brennan, who has watched a shifting rotation of drugs devastate communities - methamphetamine giving way to synthetic drugs, then opiods, then heroin - the need for more assistance is unambiguous.

“Is it a national emergency? Of course it is. We really have to attack this”, said Mr Brennan, who is executive director of the West Virginia Behavioral Healthcare Providers Association.

But Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness said he wasn’t sure “anyone’s holding their breath” awaiting a formal declaration given the president’s record of having “changed his thinking on a topic”.