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Background Young drug misusers and the homeless both have a greater risk of death than their peers. This study sought to estimate the additional impact of homelessness on the risk of death for young drugs misusers. Methods From all admissions to NHS hospitals in Scotland between 1986 and 2001, those that were: drug misuse related, for people born between 1970 and 1986 and aged over 15 years (n=13 303), were selected. All subsequent admissions and registrations of death were linked to this dataset. Each admission was coded as homeless if the health board of residence was coded as 'no fixed abode'. 5-year survival after an admission was modelled using (1) life table and (2) proportional hazard models and then (3) differences in causes of deaths were explored. Results Immediately after a drugs-related hospital admission there was no difference in survival between the homeless and those with a 'fixed address'. However, over a 3-year period the risk for those who were homeless was 3.5 times greater (CI 95% 1.2 to 12.8). This elevated risk seemed to be particularly focused on the second year after an admission. The causes of death were similar for the two groups. Conclusion Although a homeless hospital admission is associated with a greater risk of death for young drug users, it is also a point in time when a young person is in contact with public services. An attempt to link their discharge with housing services would seem a potentially productive policy. [ABSTRACT FROM AUTHOR]

Prior to the 1970s, neither homelessness nor drug addiction was seen as issues of major concern in Europe. At most, they were of local interest and of particular importance only in some larger metropolitan centres. Over the last three decades they have come much more into public prominence and risen up in local and national policy agendas. At the level of the European Union (EU), however, while the use and abuse of drugs has attracted substantial financial resources and institutional involvement, homelessness, in comparison, has been relatively neglected and remains predominantly the concern of non-government and voluntary organisations. At all three levels-local, national, and European-it is only in recent years that the link between homelessness and problematic substance use has come to the fore as an issue of singular concern. This paper examines the recent emergence of policies and programmes which seek to tackle and prevent homelessness among substance users. Our investigation suggests that although new initiatives at the EU level are limited, at the national and especially sub-national level, effective programmes addressing both treatment and prevention are being designed and implemented.