Qualitative data were deployed to explore the spatial needs of homeless drug users staying in hostels and night shelters. Findings indicated that Fitzpatrick and LaGory's four categories of spatial need (‘privacy’, ‘personal space’, ‘social interaction’, ‘safe and defensible spaces’) all had good analytical purchase. However, three further need categories (‘institutional support’, ‘amenities and standards’, ‘spatiotemporal structures and boundaries’) were identified. While hostels and night shelters met the spatial needs of some homeless drug users, there was considerable scope for improvement; indeed, failure to meet spatial needs could result in increased drug use, risky injecting practices, worsening health and a return to the streets. Our seven-fold categorisation of spatial needs requires further empirical study but could potentially inform other place-based approaches to health.