A recent article from The Atlantic draws an analogy between the current opioid epidemic and the crack epidemic of the 1980s and early 1990s, and the political reaction to the respective crises.

[M]any conservatives demanded harsher sentencing during the largely African American crack epidemic, yet now show far less enthusiasm for imprisoning opioid addicts—most of whom are white.

My question is whether the two drug epidemics are analogous, at least for purposes of a public policy response. I confess knowing almost nothing about this, but I imagine significant factors might be:

  • Number of deaths or hospitalization associated with drug use
  • Any rise in violent crime associated with drug use
  • Other social problems associated with drug use (drop-outs, unemployment, etc.)

I am not interested in the motivations of particular politicians (it is possible, though perhaps not likely, that a given conservative's mind has changed on the effectiveness of incarceration). I'm just trying to understand whether it's ‘fair’ to compare the two situations.

  • 3
    There are similarities (rapidly growing numbers of people are using an illegal drug in certain communities with negative effects for the individuals and communities as a result), and there are important differences. For example, crack was a revenue source for violent gangs, collateral distribution network related harms haven't been as important in the current epidemic as they were in previous heroin use surges. And, legal prescriptions were not a gateway to illegal crack use in the way it is for opiods. Some comparisons are valid, others are not. It isn't a simple question of fair or not fair.
    – ohwilleke
    Commented Nov 27, 2017 at 3:45
  • Many of the deaths are from prescription drugs with no middle-man. Pain clinics in particular are a huge source. Politicians simply don't want to lockup doctors for legal (yet questionable) prescriptions.
    – dandavis
    Commented Nov 27, 2017 at 19:58
  • The cliche is that history never repeats itself but it rhymes.
    – ohwilleke
    Commented Nov 27, 2017 at 22:57
  • Let's not forget about the _War on Drugs which only exasperated the Crack Epidemic
    – Noah
    Commented Nov 28, 2017 at 4:37

1 Answer 1


Broadly speaking they are comparable from a public policy response in that an effective policy response would be centered around rehabilitating offenders instead of imprisoning them.

The epidemics themselves have some stark differences including demographics of the userbase, the source of the drugs, and the culture surrounding the drug. To address your points specifically, the sharp increase in opiate deaths recently which eclipses the overdose deaths of all other drugs has been due to an influx of incredibly strong synthetic opiates such as Fentanyl which provides the double whammy of being hard to dose because of the very small dosage and also the pervasive issue in unregulated drug use of not knowing how pure any given dose is, both of which heavily contribute to accidental overdosing. There is a lot to be said on the violent crime part, but the most important facet is that opiates have been a largely rural issue whereas crack was largely urban, which in the crack epidemic had dealers pit against each other for market share in geographically small but lucrative markets, whereas the users of opiates are spread out in such a way that there is going to be less fighting for a particular block or similar.

tl;dr the situations themselves are not really comparable, but an effective policy response to both would be similar. You're never going to be able to stop drugs from coming into your country and stop people from selling or using them, the best you can do is help users quit and try and remove the driving reasons people began using or selling in the first place (mental health, unemployment, etc.)

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