Crack was first reported in Liverpool in 1987. By mid 1998 crack use was prevalent among the city’s prostitutes. An outreach worker describes how by the end of 1988 there was concern that the women accepted higher risk sex to buy crack and were the victims of crack-related violence. By 1990 the entire community was affected. Working with inner city crack users requires first the nurturing of a relationship of trust with a group suspicious of authority and prone to cocaine induced paranoia.