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Down and out of it: high levels of drug-related risk and harm among homeless IDUs in Manchester
Russell Newcombe, Senior Researcher, Lifeline, Liverpool

Abstract
Annual statistics since 1995 show that levels of needle-sharing and infectious diseases among injecting drug users (IDUs) in Manchester and North-West England have risen to record levels. To investigate these trends, 100 IDUs attending Lifeline Needle Exchange Scheme (NES) in Manchester city were surveyed in 2006. The average client was male, white, single, unqualified, unemployed, homeless, and aged 35 years - with a criminal record based on around three dozen convictions and a dozen prison sentences. Most clients attended the NES daily or weekly, and about half were also attending treatment agencies. Risky injecting practices were reported by about a quarter to half of the sample, including using 'shooting galleries', groin injecting, public injecting, re-using syringes, and indirect sharing - with eight in ten reporting regular speedballing. The main harm to health, reported by about a quarter to half over the past year, included abscesses, bad hits, hitting arteries and nerves, and HCV infection.

Eight in ten respondents were homeless - about half roofless and half in temporary housing.  Compared with housed IDUs, homeless IDUs were significantly more likely to be male and unemployed; to inject daily, inject speedballs, and inject in derelict houses; to report higher spending on drugs, and to fund their habit by shoplifting; to attend the NES daily; and to be HCV-positive. Compared with other respondents, roofless IDUs spent significantly more on heroin, were less likely to be in treatment, and were more likely to beg, shoplift, and inject in public places and derelict houses.

Using interval estimation, it was hypothesised that the number of roofless IDUs in manchester over 2006 was at least 650 - far greater than the city council's one-night 'count' of five (which contributed to the mid-year 'count' of 502 rough sleepers for England overall). It was concluded that (1) drug agencies should routinely monitor clients' housing situation and multi-drug use practices; (2) NESs should develop special interventions and kits/boxes for homeless IDUs; and (3) the government's method of estimating rough sleeper numbers is invalid and unreliable, and should be urgently replaced by a more scientific technique (like capture-recapture).

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Biography
RN is a social psychologist, and has been a specialist researcher in the drugs field since 1984. From 1987 to 1995 he helped pioneer harm reduction approaches to drug use in both Merseyside and Manchester, and from 1998 to 2005 was joint programme leader of the MSc. in Drug Use & Addiction at Liverpool John Moores University. He has published many reports and papers on drugs issues, and is co-author of 'Living with Heroin' (1988), 'Tripology' (2004), and 'The Big Blue Book of Cannabis' (2006).  He is presently Senior Researcher for Lifeline in Manchester.