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Researchers interviewed people with crack, opioid, and alcohol dependency in two towns, one in the North and one in the South, all had been out of treatment for over a year. Many in the Northern town said crack was so easy to get that avoiding it felt “impossible,” with some moving directly from powder cocaine to crack.��

Nearly half (49%) of untreated participants in the Northern town used crack, compared to just 4% of those in treatment—highlighting a major gap in support. Among those not in treatment, 85% had serious mental health issues and 74% were in urgent need of housing.��

Dr Bina Bhardwa from the , University of London, said: “Our empirical research across the two study sites has highlighted that those who are dependent on crack, opioids and alcohol face a myriad of complex and multifaceted needs: substance use being one unmet need among many others. This has led us to question - both conceptually and practically – ultimately, how we understand and respond to those with unmet needs in this area”.��

Professor Charlie Lloyd from the University of York: “Violence, poor physical and mental health, severed relationships, bereavement and homelessness were common among the participants we interviewed in both locations. Crack and opioid use were part of their extreme marginalisation and formal drug treatment meant little in this context, when the fundamentals of safety and warmth were in such short supply.”��

Crack users reported spending £100–£500 a day on the drug, often relying on benefits, begging, or shoplifting. Service providers across England confirmed high numbers of untreated users and the challenges of supporting them.��

The study highlights the urgent need for targeted interventions and increased support for crack cocaine users, particularly in the North of England. Researchers are calling for a comprehensive approach that addresses not only addiction but also the underlying social and economic factors contributing to this crisis.�� ��