It is an epidemic many may associate more with the 1980s than 2018.

But as the sleeping bags have multiplied in Manchester's doorways, heroin is once more making its gruesome mark on the city centre.

For as rough sleepers have turned to Spice, heroin dealers have slashed their prices and sharpened their tactics.

Now a new wave of heroin addicts is spilling out of the shadows and into the daylight, trapped in an endless cycle of scoring, begging, injecting, bedding down and scoring again, leaving their needles behind them.

It has reached such levels that charities, academics and a senior city councillor have even suggested giving them their own safe space in which to shoot up.

Charities all agree heroin has been there in the background throughout Manchester's growing homelessness crisis, although the shock rise of a strong strain of Spice last year may have distracted from it. But of late, visible heroin use has soared even further.

Hendrix Lancaster, of the city centre charity Coffee 4 Craig, has been working with rough sleepers in Manchester for over a decade.

“It’s been awful,” he says of the current heroin trend, adding that in the last few weeks alone he has helped four addicts who have ‘gone over with needles in their arms’.

The problem goes ‘hand-in-hand with homelessness’, he says, but has got worse as dealers have cleverly adapted to the emergence of spice.

(Image: Manchester Evening News)

“There had been a massive decline in heroin and opiates use when Spice was legal, because spice was cheap and you could walk into a shop and get it,” he says.

“And it did get you off your face.

“Then Spice became illegal and they cut it with all sorts of nasty crap - plus it changed totally depending on where you got it from.

“What’s happened now is that a lot of people have reverted back to heroin. All the heroin dealers were losing so many customers that they cut it down to a fiver a bag.”

It is a picture echoed by several other homeless charities spoken to by the M.E.N. over the last six months.

Jonathan Billings, of Stockport’s Wellspring homeless centre, does outreach work in the city centre. He says the price of a ‘one and one’ - a hit of heroin and a hit of crack - has fallen from around £25 or £30 to as low as £5 since Spice was outlawed.

(Image: M.E.N.)

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“The prices have definitely become cheaper since Spice was banned," he says. Spice has become cheaper too, he points out, with dealers handing out freebies to the homeless to get them hooked.

Hendrix agrees heroin dealers haven't just changed their prices, but also their methods.

“As a rough sleeper, you now have dealers coming to you," he says.

“They are coming out in the morning, giving you the drugs and then coming back two or three hours later - when you’ve begged enough money - and claiming the debt.

“It’s changed so much. It used to be that you’d nip to Ancoats to your dealer’s flat, buy some, go down the side of the canal and inject and bugger off.

“You’d have to go looking for drug paraphernalia if you wanted to find it. Now we’re falling over it.”

He’s not wrong.

One lunchtime this week we find, on Lever Street’s busy thoroughfare between Piccadilly Gardens and the Northern Quarter, heroin needles, cooking-up spoons and an unidentifiable pile of large red and white pills, all discarded inches from passers-by.

Some are in a planter overlooked by a trendy coffee shop and others have simply been left next to the pavement.

Doorways on the back-street behind Mosley Street, a favoured shooting-up spot, are littered with human excrement, a tell-tale sign of both heroin and Spice use due to the way drugs affect addicts ahead of their next fix.

“There are now many areas of Manchester that are full of faeces. It’s absolutely horrendous,” notes Hendrix, adding that before the council street-cleaners come out early in the morning, doorways are also littered with the plastic spoons handed out for cooking up by needle exchanges.

Further afield, in the up-and-coming residential neighbourhoods across the inner ring-road, we find an empty needle packet in the litter gathered against New Islington primary school’s fence.

At the car park next to New Islington tram stop - at the heart of an area being redeveloped for housing by the council’s £1bn partnership with Abu Dhabi United - there is a substantial smattering of needles, elastic bands and spoons, along with the stench of excrement.

Inevitably complaints to the council have increased as a result. A Freedom of Information request made by the M.E.N. last year reveals reports of discarded needles tripled in the city centre between 2014 and the start of 2017, while those in the ward that covers Ancoats and New Islington doubled.

On Wednesday night the first meeting of Ancoats and New Islington’s new neighbourhood forum put the issue top of the agenda, raising drug taking, drug dealing and needles as major local concerns.

(Image: Manchester Evening News)

Residents complain of blatant dealing in Cutting Room Square, at the heart of the freshly regenerated Ancoats mills, and of heroin use around the nearby primary school, outside the Chips building and around Pollard Street.

Ben Amponsah, 49, has been living in Islington Wharf for a decade. He says the heroin problem has got visibly worse in the last two years, especially in 2017, and particularly on the walk through Piccadilly Basin to New Islington.

“It was actually quite a shock when I saw people using - it wasn’t particularly late at night,” he says.

“I’m not a sort of reactionary, I work as a psychotherapist and I firmly believe the government has got it all wrong on drug use. It’s directly related to our homelessness crisis, which we’re all aware of.

(Image: Manchester Evening News)

“But I was really shocked, because they were just creating and taking heroin right where people were walking past.

“So it does seem like there’s a problem and it has become more visible and more prevalent. I live in Ancoats and I walk down to Ardwick Green for work and there, as well, I don’t think there’s a month goes past that I don’t see used needles.”

Conscious of the growing needle problem in the area, Manchester council is currently reviewing the location of needle exchanges - of which there are two in the city centre, one in Ancoats and the other in Strangeways - but admits discarded needles are a ‘challenge’ it takes ‘very seriously’.

“If anyone is concerned about discarded needles or other hazardous waste we would urge them to report it to us and we will remove it urgently within a day,” says Nigel Murphy, executive member in charge of neighbourhood services.

(Image: Manchester Evening News)

“Where it is on private land, we will also do all we can to ensure landlords act. And of course if anyone is aware of illegal drug-taking activity taking place we would encourage them to report it to the police.”

Police too have seen a rise in complaints from residents in the city centre, particularly in the Northern Quarter, where people have reported evidence of drug use in the back-streets, tow-paths and open public spaces.

The M.E.N. has witnessed heroin users injecting in the middle of the day on a surface car park off Ducie Street, while lock-keepers on the Ashton canal say a large part of their job involves clearing floating needles from the water.

City centre PC Andy Costello believes last April’s sudden rush of shocking Spice episodes may have been due to manufacturers mistakenly making their batch more potent than intended - but since then it has become significantly weaker, potentially driving users to seek a bigger hit through injecting heroin.

(Image: Manchester Evening News)

But he points out many street homeless people are caught in a ‘triumvirate’ of drugs: Spice, heroin and crack. The three, along with rough sleeping, are all intertwined.

“We know there’s issues and we have recently been getting multiple complaints from residents regarding drug use increasing,” he says, adding that the police have an ongoing operation targeting street dealing and have upped patrols in the Northern Quarter in response to reports.

“It could be attributed to the potency of Spice falling, leading some users from Spice back towards heroin.

“But it’s hard to confirm because polydrug users will go anywhere they can to get what that need.”

As street heroin use resurfaces, some are looking abroad - and to other parts of the country - for solutions.

'We need to have a radical look at our drug policy'

Coun Rosa Battle, who set up the new Ancoats and New Islington forum this month, argues a radical new policy is now needed - not only help to users, but to resolve the public health problems associated with discarded needles.

That could, she believes, include the opening of ‘drug consumption rooms’: safe spaces similar to those in Holland and Germany, where addicts can shoot up and dispose of paraphernalia.

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“Users are obviously very vulnerable and need support which they’re not getting,” she says.

“That’s also causing distress to residents and children in the area. So we need to have a radical look at our drug policy and perhaps look for other cities that have dealt with this in different ways.

“At the moment, we are investing a lot of public money but getting the same results we’ve had for years. We need to have a grown up conversation about whether it’s decriminalisation or introducing drug user rooms and how we target intervention, policing and neighbourhood services.

“These are some of the most vulnerable people in our society and they deserve us to take another look at how we help them away from drug abuse.”

(Image: Manchester Evening News)

The debate around so-called ‘fix rooms’ has been growing for a while, as other UK cities battle similar problems. Last year Glasgow put forward the same idea, but was told it would need Westminster approval for such a move, despite Scotland’s devolved government.

Earlier this month the West Midlands police and crime commissioner, David Jamieson, also proposed the move, despite it being at odds with the government’s drugs policy.

“If we are to cut crime and save lives there’s one thing we can all agree on: we need fresh ideas,” he said on launching the policy, arguing that it would also reduce spending, crime and ‘the terrible harm caused by drugs’. In response, the Home Office said it had no plans to allow such a proposal, suggesting it would lead to a rise in crime.

(Image: Manchester evening news)

However Dr Tim Millar, a drugs specialist at Manchester university’s division of psychology and mental health, has spent his career studying opiate use and believes the rooms are worth looking at.

He points out the latest estimates - which only go up to 2014/15 - show the overall use of heroin and similar drugs in Manchester has stayed relatively static. The current problems are specifically linked to the city’s growing rough sleeping crisis, he says.

“This is about a visibility of a specific of homeless heroin users, which has increased because homelessness is increasing,” he says.

“I think there’s evidence that suggests drug consumption rooms can reduce risks and the associated effects on the surrounding community, so long as they are targeted at a specific group of vulnerable people who haven’t got anywhere else to use.

“If they are using in a safe space, their injecting paraphernalia will be safely disposed of and they can be observed periodically and action taken if they show signs of overdose - which may not happen if they are heading somewhere outside where they won’t be found if they OD.

“I certainly think it’s worth having that conversation about whether user rooms might help in our particular context.”

Manchester council does not rule out proposing the move, but stresses any new drugs policy would need to be evidence-based.

Coun Bev Craig, executive member for adult health and wellbeing, points out opiate misuse is ‘complex and rooted in social factors’ that are being played out in cities and towns across the country.

“Locally, we are working hard to help people to come off such substances wherever possible but also to minimise the risk to those who do continue injecting them,” she says.

“We are aware of concerns in the city centre and are working to address them. This includes commissioning Manchester Metropolitan University to carry out a review into the issue of drug-related litter in Manchester and recommend how this can best be tackled. This research includes a review of needle exchange provision across the city.”

Manchester was one of the first places to introduce needle exchanges back in the 1980s, she points out, and the city has a ‘strong tradition of developing new and innovative approaches to tackling the harm caused by drugs’.

“We are always willing to consider any evidence-based approaches but would need to agree any new service developments with our partners in the NHS, Greater Manchester Police and our service providers,” she adds.

For Hendrix Lancaster, the idea of drug user rooms is ‘brilliant’.

Many homeless people currently fall in and out of shelters and hostels, he points out, because they are addicts and have to go onto the streets to get their fix.

(Image: Manchester Evening News)

“User rooms are exactly what we need,” he says. “People use all night long. They go out, use, come back in. It’s a constant cycle.

“They choose to say on the streets because they can do that on the streets and they can’t do that in a hostel or a B&B.

“So it’s a real need now - to provide a safe space you can go and use in. If you had a six month trial of it the results would be astounding.”

In common with a great many veteran homelessness workers in the city, he approaches addicts with a deep sympathy, but the overall situation - the needles, the excrement, the endless cycle - with a blunt reality.

“We don’t want to demonise users,” he says.

“But also you don’t want to fluff it up and make it pretty. Because it’s not.”