Homeless shelters and substance misuse
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* Graham Pluck
* Kwang-Hyuk Lee
* Randolph Parks

*   © 2007 Canadian Medical Association or its licensors

We read with interest Wendy Muckle and Jeffrey Turnbull's guest editorial on homelessness.1 Although shelters are not perfect, they do protect people from some aspects of homelessness. For example, there is evidence of cognitive impairment in some homeless people,2 and this association is partially dependent on housing quality.3

We compared substance misuse in 31 homeless people staying in supportive shelters with that in 15 people who were literally roofless in Sheffield in the United Kingdom. Thirteen (87%) of the roofless people had injected drugs in the past month compared with only 4 (13%) of the people in shelters. All 15 (100%) of the roofless people had been using heroin or crack cocaine regularly in the past year compared with only 10 (32%) of the people living in shelters.

Homelessness is inevitably harmful and can become self-perpetuating. In our study, despite the lower level of drug use in people living in shelters, 18 (58%) of the people in this group had started taking at least 1 new drug since becoming homeless. If the homeless do not receive significant levels of help, the problems they experience can multiply. A public policy of increasing resources to address the problems of the homeless would likely be highly cost-effective over the longer term. Muckle and Turnbull are right to be concerned about the possibility of cutbacks by the current Canadian government to the homelessness funding program.

## REFERENCES

1.  1. Muckle W, Turnbull J. Sheltering the homeless [editorial]. CMAJ 2006;175(10):1177.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTc1LzEwLzExNzciO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTc2LzQvNDg5LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Spence S, Stevens R, Parks R. Cognitive dysfunction in homeless adults: a systematic review. J R Soc Med 2004;97:375-9.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToic3BqcnMiO3M6NToicmVzaWQiO3M6ODoiOTcvOC8zNzUiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTc2LzQvNDg5LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  3. Seidman LJ, Russell KS, Caplan B, et al. The effect of housing interventions on neuropsychological functioning among homeless persons with mental illness. Psychiatr Serv 2003;54:905-8.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1176/appi.ps.54.6.905&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=12773609&link_type=MED&atom=%2Fcmaj%2F176%2F4%2F489.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000222758300021&link_type=ISI)