June 24, 2020
The Black Lives Matter movement has forced people around the world to become more aware of ways that systemic racism affects minority communities and, in particular, the Black communities. For example, U.S. government data shows that among COVID-19 cases with known ethnicity, 55% of people are either Hispanic or Black. And while there is still uncertainty in the method of data collection for COVID-19, these numbers demonstrate one consequence of the social and economic disadvantages minority communities face due to institutional barriers1.
Yet Black people have been unfairly targeted by U.S. policies for many years. Since Nixon began the War on Drugs in 1971, the U.S. has wrongly tackled health issues with criminalisation. Whether intentional or not, the strategy has been the cause of unjust incarceration and oppression of Black communities that continues today. One specific example that shows the effects of this misguided strategy is the case of crack cocaine.
The introduction of crack cocaine
In the 1970s and 80s, crack cocaine was introduced to America. A massive increase of cocaine entering the U.S. caused prices to drop dramatically2. Crack cocaine was a much more profitable alternative created from powder cocaine. It’s unclear who invented crack cocaine, but it certainly has a troubled history3.
A concerning rise in crack use (and abuse) led to declaring a crack cocaine epidemic and the Anti-Drug Abuse Act of 1986. This made crack cocaine illegal and created the same penalties for possession or trafficking of 5g of crack cocaine as for 500g of cocaine powder, a 5-year mandatory minimum sentence4,5. A 100:1 difference in weight, for the same amount of time in jail. As a result of this crack vs. powder cocaine sentencing disparity, low-level crack dealers received more severe punishments than whole-sale cocaine dealers6.
What is crack cocaine?
Crack cocaine is classified as a stimulant, the same as powdered cocaine. Baking soda is mixed with cocaine powder and allowed to crystallise7. The resulting crack ‘rocks’ are smoked, rather than snorted, typically using a glass hand pipe or water pipe, and commonly mixed with heroin, marijuana or other drugs8. So why is it called “crack cocaine”? The name comes from the crackling sound that the rocks make when smoked. Even though crack contains the same substance as snorted powder cocaine, smoking crack results in higher levels of cocaine in the blood more rapidly and for a shorter period of time6,9, which makes crack more potent and addictive.
The crack-cocaine sentencing disparity
Because of the relatively cheap price of crack, this form of the drug was more concentrated in minority communities and urban areas. Crack users were more likely to be Black, “less” educated, and have lower income10. But when looking at powdered cocaine Black people represented a similar, if not smaller, percentage of offences to white people6. The vast majority of crack cocaine offenses were dealt to Black people, and by 1989 a quarter of Black males aged 20-29 were incarcerated or on probation3, a dire consequence of the sentencing disparity. It took decades – until 2010 – for politicians to finally change the ratio to 18:1 with the Fair Sentencing Act11. But, even then, is the ratio justified? Studies have indeed shown that there is a higher risk of dependence, but this is only 2-4 times higher compared to powdered cocaine12,13,14. Still far below 18, let alone 100….
Recognising this disparity highlights new problems in the drug policy anyway; injecting powder cocaine produces similar effects to smoking crack cocaine. Intravenous cocaine users have been found to become dependent on the drug at levels similar to, and even higher, than all other routes of administration6. Yet, even if it’s difficult to separate the form of drug from its typically used route(s) of administration, none of this is reflected in the laws.
Danger to society?
One other factor that needs to be accounted for is the damage to society that each form of the drug is causing. Much of the fear associated with crack (and to a degree with powder cocaine) is crime and violence. However, the majority of drug crimes (almost ¾) are associated with systemic violence – crime within the black market drug trade. Most crime arising from drug-taking is due to alcohol, not crack cocaine15. Besides, any difference in violent behaviours between crack users vs. powdered cocaine users disappears once sociodemographic factors – race, education, income, mood disorders - are taken into account10.
In other words, most of the perceived higher prevalence of crime related to crack is not due to the drug itself, but due to the same socioeconomic factors that underlie the racial disparity between use of crack and powder cocaine in the first place. To read more on this and other crack cocaine myths, click here.
Best Practices for Reducing Harm
Although there is only one way you can prevent any short- or long-term damage from using crack-cocaine - that is, to stop using the drug altogether - there are a few ways to keep yourself a little safer. If you follow these practices, you can at least avoid further harm to your body and mind. These will also restrict the spread of infectious diseases between yourself and others.
- Use crack pipes made from Pyrex or borosilicate. These will not break as easily due to heat, which will prevent cuts on your lips or other body parts. This reduces the risk of infections, such as HIV or HCV. For the same reason, do not use broken glass pipes16,17. Similarly, do NOT use plastic bottles or cans18.
- Avoid sharing equipment. If you do, use your personal mouthpiece. Make sure to clean the pipe and mouthpiece in between turns, for example using alcohol swabs18.
- Use steel or brass metal filters. Do NOT use filters made of copper or steel wool, such as brillo pads. They often contain harmful detergents and break off easily, after which they are either inhaled or can become lodged in your body. To properly place filters in the pipe, use sticks (i.e. chopsticks). Replace the filters regularly16,17.
- Use uncoated aluminium if you use foil to consume crack. You can find this at a needle exchange near you. Otherwise, burn your foil before using to smoke the crack. Use new foil for every use18.
- Do NOT mix with other drugs, including alcohol19.
- Most importantly, call an ambulance if your or a friend do not feel well or have overdosed. Find out more strategies to keep safe in case of an overdose.
Developing adequate drug policy is certainly not easy, especially considering the time pressure during drug scares. Nevertheless, U.S. policies still have a lot of ground to cover until they can be considered evidence-based. For crack vs. powder cocaine, a ratio of 4:1, at most, can be justified in the laws, based on the relative risks.
Lasting effects of drug policies
Even though we have seen improvements in the government’s policies on drug use, the regulations are still rooted in biased viewpoints rather than science and a healthcare perspective. Moreover, the consequences of the U.S. policies are still real today. Looking at today’s COVID-19 pandemic, for example, shows that jails and prisons are experiencing high rates of infections; these are facilities that contain a disproportionate population of Black people as a result of decades of criminalisation of already disadvantaged communities20. The image that the War on Drugs has painted of Black people is still afflicting lives today, such as when the “drug fiend” defence is used to absolve police brutality21.
Let’s use this time to educate ourselves. The Black Lives Matter movement officially started in 2013 following the acquittal of Trayvon Martin’s murderer. Before it was founded and ever since, there have been countless murders of Black people by police, continued systemic prejudice and discrimination on a day-to-day basis. You may not think you’re racist, but each one of us has had prejudiced thoughts and behaviors that we can begin to dismantle. This may begin internally by paying attention to your views or thoughts that are discriminatory. It should also include educating ourselves on Black history and White supremacy (for book recommendations, see below). Perhaps most importantly, let’s listen to each other and do our best to understand one another’s perspectives.
A few books to begin with:
- The New Jim Crow: Mass Incarceration in the Age of Colorblindness
- So you want to talk about race
- White Fragility: Why It’s So Hard for White People to Talk about Racism
- Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
- How To Be Antiracist
This post was created for informational purposes and is not a substitute for professional medical advice. If you plan on using cocaine check out our cocaine harm reduction guide to learn about the experience, dosage, legality and more. If you or anyone you know is experiencing problems with cocaine, seek help.
All drugs pose risks, and the best way to avoid them is not to take any, but we understand that people still choose to. Drugs and Me exists to provide you with information about drugs, based on the best evidence available, helping to reduce their harms. Our work is fuelled by volunteers and we’ve chosen to not have any ads, so we rely heavily on your support. Why not become a patron today, or if you prefer, make a one-off donation. If you like this post, please share it on social media using the buttons below!
If your organisation needs help dealing with issues related to recreational drugs, check out Neurosight. We offer evidence-based interventions as well as research and policy consultancy.
- Godoy M, Wood D. What Do Coronavirus Racial Disparities Look Like State By State? [Internet]. NPR. NPR; 2020 [cited 2020Jun23]. Available from: https://www.npr.org/sections/health-shots/2020/05/30/865413079/what-do-coronavirus-racial-disparities-look-like-state-by-state
- The Crack Epidemic - The History of Crack Cocaine [Internet]. Foundation for a Drug-Free World. [cited 2019 September 25]. Available from: https://www.drugfreeworld.org/drugfacts/crackcocaine/a-short-history.html
- Turner DS. Crack Epidemic [Internet]. Encyclopedia Britannica. 2016 [cited 2019 September 25]. Available from: https://www.britannica.com/topic/crack-epidemic
- Mandatory Minimums and Sentencing Reform [Internet]. Criminal Justice Policy Foundation. [cited 2019 September 25]. Available from: https://www.cjpf.org/mandatory-minimums
- H.R.5484 - 99th Congress (1985-1986): Anti-Drug Abuse Act of 1986 [Internet]. Congress.gov. 1985-1986. [cited 2019 September 25]. Available from: https://www.congress.gov/bill/99th-congress/house-bill/5484
- Hatsukami DK, Fischman MW. Crack cocaine and cocaine hydrochloride: Are the differences myth or reality?. Jama. 1996 Nov 20;276(19):1580-8.
- 10 Facts About Cocaine [Internet]. Drug Policy Alliance. [cited 2019 September 25]. Available from: http://www.drugpolicy.org/drug-facts/cocaine-and-crack-facts
- Crack Cocaine [Internet]. CESAR. 2013 [cited 2019 September 25]. Available from: http://www.cesar.umd.edu/cesar/drugs/crack.asp
- Fowler JS, Volkow ND, Wang GJ, Gatley SJ, Logan J.  Cocaine: PET studies of cocaine pharmacokinetics, dopamine transporter availability and dopamine transporter occupancy. Nuclear medicine and biology. 2001 Jul 1;28(5):561-72.
- Vaughn MG, Fu Q, Perron BE, Bohnert AS, Howard MO. Is crack cocaine use associated with greater violence than powdered cocaine use? Results from a national sample. The American journal of drug and alcohol abuse. 2010 Jul 1;36(4):181-6.
- Reuter P. Why has US drug policy changed so little over 30 years?. Crime and Justice. 2013 Aug 1;42(1):75-140.
- Chen CY, Anthony JC. Epidemiological estimates of risk in the process of becoming dependent upon cocaine: cocaine hydrochloride powder versus crack cocaine. Psychopharmacology. 2004 Feb 1;172(1):78-86.
- Reboussin BA, Anthony JC. Is there epidemiological evidence to support the idea that a cocaine dependence syndrome emerges soon after onset of cocaine use?. Neuropsychopharmacology. 2006 Sep;31(9):2055.
- Haasen C, Prinzleve M, Gossop M, Fischer G, Casas M, COCAINEEU-TEAM TH. Relationship between cocaine use and mental health problems in a sample of European cocaine powder or crack users. World Psychiatry. 2005 Oct;4(3):173.
- Gershon L. Rereading the Story of the Crack Epidemic [Internet]. JSTOR Daily. 2018 [cited 2019 September 25]. Available from: https://daily.jstor.org/rereading-the-story-of-the-crack-epidemic/
- Boyd S, Johnson JL, Moffat B. Opportunities to learn and barriers to change: crack cocaine use in the Downtown Eastside of Vancouver. Harm Reduction Journal. 2008 Dec;5(1):34.
- Small D, Drucker E. Return to Galileo? The inquisition of the international narcotic control board. Harm reduction journal. 2008 Dec;5(1):16.
- Crack [Internet]. Drugsandalcohol.ie. [cited 2019 September 25]. Available from: https://www.drugsandalcohol.ie/15565/1/Chrysalis_crack_booklet.pdf
- Safer crack smoking [Internet]. CATIE. 2011 [cited 2019 September 25]. Available from: https://www.catie.ca/en/practical-guides/hepc-in-depth/prevention-harm-reduction/safer-crack-smoking
- Sandoiu A. 'We don't have a health system:' Expert on prisons, race, and COVID-19 [Internet]. Medical News Today. MediLexicon International; 2020 [cited 2020Jun23]. Available from: https://www.medicalnewstoday.com/articles/we-dont-have-a-health-system-expert-on-prisons-race-and-covid-19
- Daly M. How the War on Drugs Enables Police Brutality Against Black People [Internet]. Vice. 2020 [cited 2020Jun23]. Available from: https://www.vice.com/en_uk/article/3azbek/how-war-on-drugs-enables-police-brutality