A prescription drug linked to a rapidly growing number of deaths in England and Wales is being widely sold on the streets of Manchester for as little as 50p a tablet.
Pregabalin, normally used to treat nerve damage, epilepsy and anxiety, is being increasingly used among the city centre's rough sleepers and drug addicts.
One charity worker described the drug as 'absolutely rife'.
Last year pregabalin was linked to 344 deaths in England and Wales - 60 in the North West alone.
That's up from just one a decade earlier, figures from the Office for National Statistics show.
The abuse of the drug, and other prescription medications, cuts across society, rather than being specific to homeless people.
However, during the pandemic, pregabalin's use among Manchester's homeless population is thought to have increased dramatically.
'I just want a one bed flat': The faces and stories of Manchester's homeless as winter fast approachesThat's because a decline in the quality of heroin and the difficulty of begging or shoplifting during lockdown pushed addicts to seek cheaper alternatives.
During the pandemic heroin tested in Manchester has regularly been found to be below 10% purity, and on at least one occasion a batch was found to be just 2% pure, the Manchester Evening News understands.
Normally researchers would expect the levels to be between 20% and 40%.
That's led drug users - and dealers - to seek different products.
It's understood much of the pregabalin supply in Manchester is coming from the Bury New Road area of Strangeways where boxes of 60 tablets can be bought for as little as £35.
But it's feared many of the pills are counterfeit, either imported from China or made in back street labs using unknown chemicals, which greatly increases the risk of harm.
Taken alone, the effects of pregabalin, a central nervous system depressant which was made a class C drug in 2019, have been compared to being drunk.
But when combined, pregabalin increases the effect of drugs such as spice, heroin or crack.
And that's led to fears about a potential rise in overdoses.
Prof Robert Ralphs, a lecturer in criminology and social policy at Manchester Metropolitan University and one of the authors of the GM Trends annual report into drug taking in Greater Manchester, said the increase in pregabalin use among rough sleepers was 'deeply concerning'.
He said: "It's been around for the last few years, but it's kicked in a lot more recently.
"That's because users have been pushed towards cheaper drugs like pregabalin because they've not been able to make as much money from begging or shoplifting during lockdown to buy their usual drugs.
"And it's also because the purity levels of drugs such as heroin are much lower at the moment.
"A lot of people will use pre-gabs on top of heroin, crack, spice or alcohol.
"For instance if the quality of the heroin is only stopping them from withdrawing but not giving them a nod, they'll use pre-gabs as well.
"Or if someone is using heroin before they get their head down for the night, but because of the low quality they're waking up at 3am or 4am, they're taking pre-gabs to get through until morning.
"The issue is these are all central nervous system depressants. If you are mixing pre-gabs with other drugs then the risk of overdose increases.
"It's a growing issue. Not just locally but nationally as well."
One homeless person, who we are not naming, said pregabalin now rivalled Spice as one of Manchester's main street drugs.
They said: "Most of the Spice used to come from Chadderton, but the man got arrested.
"Since then there's still Spice, but it's not as strong as it used to be.
"Now most people are on the tablets from Bury New Road.
"It's £35 for a box of six strips, but then you can sell a strip for a tenner, so you can almost double your money if you sell them on.
"It makes you feel like you're p*****. Loads of people are getting addicted to them."
George Rigby is a recovering drug addict who now works for Strangeways-based charity On The Out, which helps former prisoners rebuild their lives.
He described the rise of pregabalin use among Manchester's homeless community as a 'recipe for disaster'.
He said: "A lot of people end up on pregabalin coming from heroin.
"If you wake up rattling you need to get at least £10 for a bag of heroin, but you only need a quid for a pregab and that gets them going in the morning.
"The snide ones are coming from China or are being made in factories round here and you've no idea what's in them.
"They can be five or six times as strong as the real ones.
"I took one once and it was so strong I was just falling on my face every few steps, I was falling into the road and everything.
"I could have been killed that night. That was from just one tablet - it felt like I'd had 10.
"And when people are taking them on top of spice or heroin it's a recipe for disaster.
"But the problem, without a doubt, is Bury New Road. It's such a short distance from town. It's literally so easy (to buy).
"It's easier to go to Bury New Road than it is to get a methadone script. It's a quick fix for people."
Michael Bradley, from On The Out, said pregabalin use was 'absolutely rife' in Manchester.
And he said drug users from across the North West were coming to Bury New Road to buy tablets.
He said: "I know a lad from Blackburn who comes here to buy it in bulk.
"And it's not just pregabs, it's diazepam, gocaine (a cocaine-style legal high) and fake heroin.
"It's all fake stuff and nobody knows what in it. It's like a pandemic and Bury New Road is the centre for everybody in the North West and the North.
"It absolutely rife at the minute."
Superintendent Helen Critchley, of GMP's Manchester division said: “The illegal use of prescription drugs can be extremely dangerous, and can have devastating consequences if used inappropriately.
“Across Greater Manchester, we have a dedicated, multi-agency operation known as ‘Op Cranium’ in response to the sale of counterfeit medication in Cheetham Hill, in which we work closely with partners to identify trends in drug use, ensure appropriate action is taken, and the correct support is available.
“Operation Cranium covers all aspects of our response to this issue, including proactive policing such as warrants, dedicated patrols and intelligence gathering, to identify those involved in the supply of drugs, and disrupt the criminal networks involved.
"In addition, multi-partnership work continues to take place, such as harm reduction visits to premises to offer appropriate advice, as well as harm reduction work, targeted at users and professionals who work with users.
“Dedicated patrols and a community plan remain in place across the Cheetham Hill and Strangeways area to target the sale of drugs, and we are working with our partners to tackle the deep-rooted issues around the area as part of the ongoing work around Op Cranium.
''A crucial part of our work to identify problematic areas and intelligence surrounding the supply of these drugs is through information from members of the public to help identify enforcement opportunities around individuals or vehicles.
"I would like to encourage anybody with information to come forwards, whether this is via the GMP website or anonymously through Crimestoppers.''