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The U.S. criminal justice system seemed to intimately link the crack cocaine epidemic with the overrepresentation of African American men. National media reports described a "schism" within the African American community between a "wari-smoking, on the bottom" minority group and a "rapper-smokin', working class" majority [1]. These polarized political attitudes about crack and African Americans complicated safe access to health facilities and influenced debates about the appropriate drug use policies for different racial groups [4]. In the 1980 s, the definition of crack cocaine as a "new and potentially harmful epidemic form of cocaine" [5] intensified public interest in cracking down on the "new and growing crime wave" that crack cocaine generated within existing drug policy [5, 6]. Under the relaxed reforms of the Omnibus Crime Control and Safe Streets Act of 1968 [7], it became a federal offense to possess even trace amounts of crack cocaine; by the late 1980 s, a number of states had passed laws making crack cocaine possession a felony rather than a misdemeanor. From the mid-1980s to the early 1990 s, federal and state law enforcement agencies wagered their resources on deterrent strategies such as "enhanced" asset forfeitures and escalating sentences for drug trafficking [7]. Crack cocaine offenses impacted a large number of minority men and women as politicians and media portrayed crack incidents in the U.S. as a “new wave of violence" dominated by African American youth in the U.S. [8]. As U.S. law enforcement agencies increasingly went after small-scale distribution and possession crimes, crack cocaine use spread beyond inner-city settings and, in the process, contributed to the simultaneous upsurge of HIV infection [9].

Treatment facilities for crack cocaine addicts who used heroin were scarce and distribution remained illegal. This environment immunized addicts so severely that mortality rates for cocaine-addicted African American patients were disproportionately high [10]. Other characteristics of African American cocaine users were found to include a greater uptake of crack cocaine [11-13], a longer duration of cocaine use [14, 15], a higher prevalence of HIV infection [16] and a higher history of criminal arrest [7]. Furthermore, African Americans who were arrested for crack cocaine offences were more likely to be convicted and jailed than their white counterparts [7]. d2c66b5586

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