Exposure to physical and sexual violence reached extreme levels among street-based subpopulations. Treatment-seeking behavior, particularly after severe sexual violence, was limited. The association of mental health and substance abuse symptoms with exposure to violence could lead to further victimization. Medical and psychological treatments targeting these groups are needed and could help decrease their vulnerability.

Commentary on Salmon et al. (2010):The case for safer inhalation facilities-waiting to inhalea dd_2917 684..685 In recent years, a flurry of scholarly reports have demonstrated the effectiveness of supervised injection facilities (SIFs) as a strategy to reduce physical and social harms associated with injection drug use. Empirical data on SIFs lagged well behind their scale-up, but SIFs have now been shown to decrease HIV risk behaviors [1], overdose deaths [2] and public disorder [3], and increase uptake of detoxification services [4]. In this issue, Salmon and colleagues [5] demonstrate dramatic decreases in ambulance attendances at opioid-related overdoses in the period following the opening of the Sydney SIF, a finding that supports program cost-effectiveness [6]. While SIFs remain controversial, there are at least 90 SIFs in 40 cities globally. To this end, SIFs are becoming increasingly viewed as a necessary component of a comprehensive strategy to reduce drug-related harms and facilitate uptake of medical care and drug treatment among streetbased drug users [3,7].A logical extension of SIFs are supervised inhalation rooms (SIRs), intended for individuals who smoke or snort drugs such as crack cocaine, heroin and methamphetamine; yet most supervised drug consumption programs target drug injectors exclusively. In fact, SIRs operate in only a few countries (e.g. Germany, Holland, Switzerland and Spain) [8][9][10][11], and none have been evaluated formally.The rationale for SIRs may be less obvious than that for SIFs, but is no less important. Sharing of crack pipesparticularly among individuals with sores on their lips as a result of burns and cuts-may contribute to infectious disease transmission [12,13]. Inhalation of methamphetamine has been associated independently with human immunodeficiency virus (HIV) infection among female sex workers, even after accounting for injection drug use [14]. A recent laboratory study suggests that methamphetamine accelerates HIV replication [15]. Furthermore, police crackdowns often drive drug users into clandestine spaces (e.g. abandoned buildings, etc.), where their health is placed at risk [16]. Displacement of drug users contributes to their low uptake of public health and social services [17]. Because many drug smokers are stimulant users who are historically very difficult to engage in drug treatment, SIRs represent a pivotal entrypoint where they can begin to be reached. In Vancouver, willingness to use an inhalation room was associated independently with working in the sex trade, sharing crack pipes, having crack pipes confiscated by police, smoking crack in public places and having burns from hurried drug consumption [9]. As many cities are witnessing decreasing numbers of drug injectors but increasing numbers of people who smoke/snort drugs [18], SIRs warrant a close second look.A powerful case can be made in support of SIRs based upon the personal experience of one of the authors of this commentary (J.R.N.), who helped to coordinate a drug consumption facilit...