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implications: there is a need for research on the full range of health outcomes with crack-cocaine use, to inform effective public health strategies. further analysis of the relationship between crack use and other underlying mechanisms is needed. these may include behavioral factors, access to care, and environmental impact, as well as factors related to the quality and availability of interventions.

impact: crack-cocaine use is associated with a range of health outcomes, yet rigorous epidemiological studies are needed to thoroughly assess the impact of crack-cocaine use on public health, especially among key groups (e.g., african americans). rigorous epidemiological studies are also needed to investigate the relationship between crack use and other biological and non-biological risk factors.

limitations: crack use was generally assessed as a secondary covariate in relevant studies. conclusive evidence on many of the health outcomes of interest was missing, including an association between crack-cocaine use and mortality. we were not able to include any environmental health outcomes, which are known to be linked with crack-cocaine use.

conclusions: crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.


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