Two Epidemics, Two Americas
In 1986, Congress passed the Anti-Drug Abuse Act with overwhelming bipartisan support. The legislation established a 100-to-1 sentencing disparity between crack and powder cocaine, meaning a person caught with 5 grams of crack receives the same mandatory minimum sentence as someone caught with 500 grams of powder cocaine. Chemically, the two substances are nearly identical. Demographically, their users were not.
Approximately 15 years later, OxyContin became the next big thing on the market. Purdue Pharma sales representatives visited doctors at rates that correlated directly with subsequent overdose deaths. The company trained its representatives to dismiss addiction concerns and misrepresent the drug’s duration of effect. However, when internal documentation later surfaced in litigation, it showed that this strategy was deliberate. Purdue was ordered to pay over $600 million in fines by 2007 after admitting to misrepresenting and skewing public perception of OxyContin. Not a single representative received any form of criminal punishment. The demographic affected most by overdose deaths was white, rural, and suburban Americans. Congress's response was to provide treatment funding for those who had formed an addiction to OxyContin. The vast discrepancy in outcome between these two epidemics was largely determined by the racial identity of those affected.
The language society uses to describe addiction reveals what society has decided about the addicts themselves. During the crack epidemic, criminalizing vocabulary dominated mainstream media coverage and legislation. Users were described as morally compromised, communities as pathological, and policy as incarceration. The New York Times ran stories about “crack babies” that have since been substantially discredited by neonatologists. The influence of crack cocaine on fetal development was a large overstatement. Rather, the damage to fetal development was more likely to be attributed to poverty itself, which is a far stronger predictor of the developmental outcomes that researchers at the time were observing. However, the retraction of this statement never achieved the same cultural saturation as the false original claim that commanded public perception.
When opioid addiction became a national crisis in the 2010s, the New York Times ran long-form profiles on families in Ohio and West Virginia. Photographers accompanied by journalists walked through living rooms and church basements, humanizing the subjects. They were rendered with interiority, their love for their children, their economic precarity, their regret. They were, in the language of those pieces, victims of pharmaceutical industries that had lied to them. That framing is not inherently wrong. Purdue Pharma did lie to them. The Sackler family did profit from engineered addiction. But that framing was not applied universally because it had not been applied before to the people who looked different, suffering in the exact same way, due to the exact same industry.
Craig Reinarman and Harry Levine, writing in Crack in America: Demon Drugs and Social Justice (1997), documented how the crack epidemic was constructed as a media and political event that bore only a partial relationship to the actual scale of the crisis. Crack use, while devastating to communities affected, never approached the prevalence suggested by coverage. What coverage did attach was a face to the crisis: Black, urban, poor, and that face determined the policy response. The opioid epidemic has also been subject to selective framing, but that selectivity ran in the opposite direction. It was met with sympathy rather than condemnation.
The 100-to-1 sentencing disparity created by the 1986 act was not corrected for 24 years. The Fair Sentencing Act of 2010 reduced it to 18-to-1. This disparity, though smaller, is still without any scientific justification. The United States Sentencing Commission had recommended eliminating the disparity entirely on multiple occasions before Congress even began to consider acting. During those 24 years, tens of thousands of people, disproportionately minorities, served sentences calibrated to racial geography that were never publicly acknowledged. Comparing this to the federal response to opioids demonstrates clearly who is victimized and who is criminalized.
The Comprehensive Addiction and Recovery Act passed in 2016 with near-unanimous Senate support. It authorized different treatment programs, expanded access to naloxone, and framed addiction as a medical condition requiring clinical intervention rather than a moral personal failing. Positioning addiction as a medical disease rather than deviance had existed in medical literature since at least the 1950s, when E.M. Jellinek published The Disease Concept of Alcoholism. It had been available as a policy frame during the crack epidemic. It was simply not used.
The Substance Abuse and Mental Health Services Administration's own data show that Black Americans with substance disorders are less likely to receive treatment than white Americans with the same diagnoses. A 2020 study published in the Journal of Substance Abuse Treatment found that Black patients were significantly less likely than white patients to be prescribed buprenorphine, which is considered the most effective medication-assisted treatment for opioid addiction. The compassion coated in the policy response is not evenly distributed, and that’s not an accident.
American political culture has a specific demanding concept of victimhood. To “deserve” sympathy, a victim must be innocent. They must be acted upon rather than committing the act, meaning their suffering must arrive externally rather than internally. The concept does enormous work in determining who receives public compassion and who receives prosecution.
The opioid crisis successfully narrated a story of innocence, the kind that everyday Americans were enamored with. Patients trusted their doctors. Doctors trusted pharmaceutical representatives. Pharmaceutical representatives were trained to lie. The narrative had a clear wrongdoer, Purdue Pharma, and the Sackler family. The victims were those who had been deceived. The narrative unlocked the perfect sympathetic frame.
The crack epidemic was narrated as a failure of self-control. The structural conditions that made crack appealing and accessible in Black urban communities in the 1980s were deindustrialization, disinvestment, and the deliberate dismantling of social programs under the Reagan administration, all of which were largely, if not completely, absent from mainstream media coverage. What remained within coverage was individual behaviors, stripped of context, evaluated against a standard of personal responsibility that was selectively applied. As Michelle Alexander argues in The New Jim Crow (2010), the War on Drugs functions as a system of racialized social control precisely because it operates through ostensibly race-neutral mechanisms. Embedded into the system were drug laws, sentencing guidelines, and prosecution discretion that produced racially stratified outcomes. The racial intent was never explicitly stated because it didn't need to be; the effect was consistent enough. Using innocence as a framework is not incidental to racism; it determines whose suffering is legible, whose death counts as preventable, and what warrants a congressional hearing.
Purdue Pharma filed for bankruptcy in 2019 as part of a settlement that would direct roughly $4.5 billion toward opioid abatement programs. Members of the Sackler family were granted immunity from civil suits in the original settlement terms, a provision the Supreme Court struck down in Harrington v. Purdue Pharma in 2024. The family has paid and will pay substantial sums. However, not a single one of them has faced criminal prosecution.
The architects of the marketing campaigns that flooded American communities with addictive opioids faced civil liability. The people caught selling crack on corners, often entrenched in economies of addiction and desperation, faced mandatory minimums that removed judicial discretion entirely. The 1986 Act did not allow a judge to consider the context, history, or conditions under which someone had arrived at that corner. Though for the pharmaceutical executives, those guidelines didn't apply. They retained counsel and negotiated settlements.
Bryan Stevenson, in Just Mercy (2014), writes about the way the American criminal justice system reserves its harshest penalties for the poor and racialized while providing the wealthy with procedural protections that function as buffers against real consequence. The opioid and crack epidemic illustrates this in parallel. The supply chain for crack was criminalized at its most street-level nodes. The supply chain for opioids was permitted to operate openly for decades, and was penalized in civil rather than criminal terms when it was finally penalized at all.
The compassion for the opioid epidemic is not wrong. Nor is treatment, or the congressional, media, and public response. Addressing addiction as a public health crisis rather than a moral failure is correct. Those things were always and have always been true; however, the variable that determined when they became policy was the race of the people dying. Progress that requires whiteness is not progress.
Genuine corrective action would be retroactive application of a public health framework, expungement of crack convictions, reinvestment in the communities the epidemic and the subsequent incarceration wave destroyed, equitable distribution of treatment, and infrastructure built around opioids. The First Step Act of 2018 made the Fair Sentencing Act crack powder reforms retroactive, allowing some people to petition for a reduced sentence. As of 2020, roughly 3,000 people have received sentence reductions. This is not enough when the crack epidemic incarcerated hundreds of thousands of individuals.
Fentanyl is currently the leading cause of overdose death in the United States, and it is killing people across racial lines in a way that neither crack nor prescription opioids did. It is imperative that we watch policy responses and the language used to describe the epidemic. The degree to which compassion extends to Black and brown communities dying of fentanyl rather than contracting again around criminalization will indicate whether anything has actually changed, or rather, the opioid sympathy was always contingent on the demographic that produced it.