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In response to the public health crisis following crack cocaine use [3], the U.S. Congress enacted the Anti-Drug Abuse Act of 1986, which among other things mandated a minimum sentence of 5 years for possession or distribution of 5 grams or more of crack cocaine [5]. This legislative action lead to the emergence of treatment options for patients with crack cocaine use problems. The U.S. drug war that began in the 1980s transformed into a war on drugs and subsequently a drug policy [2]. The focus of the U.S. drug policy efforts shifted from management of the crack cocaine crisis to law enforcement, especially with the progression of the 1990s, from the combined efforts of the U.S. Office of National Drug Control Policy (ONDCP) and the United States Drug Enforcement Administration (DEA). Between 1992 and 1995, the U.S. government significantly increased spending on drug policy, with $29.5 billion allocated to build and expand prisons and other institutions of incarceration in response to the perceived “crack cocaine epidemic” in the U.S. Since the late 1980s, the U.S. Congress has been engaged in a massive expansion of the federal prison system which passed a bill increasing the prison population by over 400% [6]. At the same time, the U.S. Congress also granted the Federal Bureau of Prisons (BOP) the responsibility for providing medical care in federal prisons [7]. The U.S. Congress later reaffirmed by reauthorization the Voting Rights Act of 1975 which provided for the harshest punitive measures for crack cocaine, as well as other drug-related crimes, such as crack cocaine in the 29th section of the Act entitled “severe penalties” [8].

The Anti-Drug Abuse Act of 1988 (also known as the Drug Abuse Amendments Act of 1988) also brought sweeping revisions to federal drug sentencing statutes. The new law mandated life imprisonment for individuals convicted of distributing 25 grams or more of crack cocaine or its equivalent over the course of a ten-year period; mandating a sentence of 40 years to life for distributing 5 grams or more of crack cocaine over a five-year period; and creating a 100-1 ratio of crack cocaine sentences relative to powder cocaine sentences. The law made crack possession offenses a felony while powder drug possession offenses were reduced to a misdemeanor. d2c66b5586