Purpose: The purpose of this paper is to review the research evidence on recent British trends in the use of heroin and/or crack-cocaine by young people in order to appraise the scale and nature of the contemporary health problem they pose. Design/methodology/approach: The approach consists of a narrative review of the main current data sources on young people's drug use. Findings: Use of heroin or crack-cocaine is rare in Britain in the general population of young people and is concentrated more amongst young adults than adolescents. There is some evidence for associations between use of these drugs and socio-economic disadvantages, although the links are complex. There may be fruitful connections to be made between drug policy and public health strategies for tackling health inequalities. Practical implications: Embedding responses to young people's heroin/crack use within mainstream strategies to tackle health inequalities may be mutually beneficial to both policy agendas. Originality/value: Situating in its proper evidential context the emotive issue of young people's use of what are believed to be the most dangerous illicit drugs, and appraising these data from a public health perspective, may lead to a more realistic and appropriate research and policy response. (Contains 2 tables.)