What the pharmaceutical, tobacco, and narcotics trade have in common

 Keynote address for AMSA's 43rd Annual Convention:
"A Prescription for Action: Use, Misuse & Abuse of Drugs"
Miami, Florida, March 25-28, 1993

The American Medical Students Association has chosen a daunting theme for this year's annual convention. The rampant misuse of drugs -- both legal and illicit -- has become a major and growing threat to health: of individuals, of communities, and of society as a whole. Official campaigns to combat substance abuse have largely failed because professionals and politicians tend to "blame the victims" rather than to confront the systemic root of the problem.

To tie together the threads of this year's convention, I would argue that the current pandemic of drug misuse has its roots in the unfair economic and sociopolitical structures of our society. This implies that meaningful attempts to acheive more limited and rational use of drugs must be linked to a grassroots struggle for liberation from unjust social. economic, and political structures. In short, it means working toward a more people-friendly, more truly democratic social order. Thus all of us, as health workers, are faced with an enormous challenge.

In looking at the patterns of drug misuse in today's world, we must consider three major categories: illegal drugs such as heroin and cocaine, legal but equally addictive drugs such as tobacco and alcohol, and pharmaceuticals, or drugs used as medicine.

The market for all of these drugs -- pharmaceuticals, alcohol, tobacco, and illicit drugs -- is controlled by giant multinational industries. Each of these powerful industries, in unscrupulous pursuit of maximum profits, causes immeasurable damage to the health and well-being of hundreds of millions of people.

To better understand today's high levels of abuse, it is essential to consider the close ties between big government and big business. To the casual observer, it may seem ironic that the US government blatantly subsidizes some of the most unnecessary and dangerous drugs, fastidiously regulates others, and appears to wage an all-out war on yet others. But if we look more closely at the role of government in relation to each category of drugs, we find that it consistently puts the interests of powerful industries before the well-being of ordinary people. In last analysis, the War on Drugs is as phoney a facade as the Surgeon General's warning on cigarette packages. Just as the US government continues to subsidize and protect the tobacco industry, so its covert operations have spurred the traffick of heroin and cocaine into the United States. And, likewise, many governments' policies on pharmaceuticals do more to defend the profits of industry than the health of consumers.

Let us look at each of these three categories of drugs.
First, pharmaceuticals. World wide, but especially in poor countries, modern Western medicines are a two-edged sword. When used well and made available at prices people can afford, they can save many lives. But when overused and misused, or sold at prices that make them inaccessible or further impoverish those in greatest need, they can become yet another way of capitalizing on the suffering and powerlessness of disadvantaged people.

Multinational drug companies have flooded the world market with overpriced, irrational, dangerous, useless, and redundant medicines. More than 50,000 pharmaceutical products are peddled in most countries, of which the World Health Organization (WHO) states that only about 270 are really needed. Over a decade ago, WHO published a list of "Essential Drugs", largely as a guide for procurement. This list is important because many Third World countries spend up to half their health budgets on pharmaceuticals, many of which are either totally inappropriate or more highly priced than safer, more effective equivalents.

Part of the problem is the double-standard of multinational drug companies. Time and again, medications that have been banned or restricted in the North are "dumped" on poor countries, sometimes with the help of under-the-table bribes paid to health officers. Toxic and potentially dangerous drugs are routinely promoted in the South for everyday ailments. Warnings about their risks and precautions are often incomplete or omitted. Earnings from the world trade of prohibitted pharmaceuticals is increasing at an alarming rate, and now exceeds $20 billion per year.

The persistently high child mortality rate in poor countries is in part due to the unethical practices of multinational industries.

As all of you know, the biggest killer of children in the world today is diarrheal disease, which drains the life out of at least 4 million children annually. Studies have shown that in some poor countries the death rate from diarrhea in babies who are bottle fed is up to 25 times as high as in babies who are breast fed. ,

The multinationals that produce infant formula are partly to blame. UNICEF calculates that the continuing violations of the International Baby Milk Code by multinational producers of infant formula contribute to one million children's deaths annually.

But the multinational drug companies also contribute to high child mortality through the promotion of irrational and often harmful anti-diarrheal medications. These include every conceivable presentation and combination of antibiotics, stool-thickeners, and anti-motility drugs. Many of theses products cause dangerous side effects, mask signs of dehydration, or actually prolong the infection and aggravate the diarrhea. WHO has issued a strong condemnation of these "anti-diarrheals". But the drug companies continue to rake in $150 million per year from them, most of it from the pockets of the poor.

Although untoward side-effects are a problem, the biggest danger of these unnecessary medicines to children of poor families is their cost . Such costs are often substantial. In Lima, Peru, for example, medications and visits to the doctor for childhood diarrhea cost many poor families more than one third of their monthlly wage.

To quote the Director of Mexico's National Nutrition Institute, "The child who dies from diarrhea dies from malnutrition." When a poor family spends its limited money on useless medicines instead of food, the risk of death from diarrhea or other diseases of poverty increases. Thus the unscrupulous promotion of needless medicines for child diarrhea may be as deadly as that of baby milk products.

The United States government -- despite its claims of being for and by the people -- has a long history of defending the interests of big business, whatever the human and environmental costs. Remember that the US was the only country which refused to endorse the International Baby Milk Code. It has also aggressively protected the interests of the pharmaceutical companies at the expense of people's health.

In 1982, the health ministry of Bangladesh adopted a National Drug Policy compatible with WHO guidelines. Its stated aim was "to ensure that the common people get the essential and necessary drugs easily and at a cheap rate, and to ensure that such drugs are good quality and are useful, effective, and safe." It prohibited import of over 1600 useless, harmful, or ineffective products. In angry response, multinational drug companies warned that it might stop shipment of life-saving medicines. The US government -- backing the multinationals -- threatened to halt foreign aid to Bangladesh if it did not revoke its policy. Amazingly, with relatively few compromises, Bangladesh has so far stood its ground.

But recently Bangladesh's National Drug Policy has been under renewed attack, this time by the World Bank. The Bank's structural adjustment policies have already forced Bangladesh -- like other debt-burdened countries -- to make devastating cut-backs on health care, education, and food subsidies for the poor. And now the Bank -- according to Lancet -- has "suggested" that Bangladesh make "detailed changes" in its National Drug Policy to emphasize the importance of a "free market" approach to medicines control.

Second, let us look at the tobacco industry. (In our discussion of legal but dangerously addictive drugs we should, of course, also include alcoholic beverages. But for the sake of brevity, let us stick to tobacco.)

Tobacco -- as you know -- is as addictive as cocaine, and in terms of diseases and death, much more dangerous. Tobacco causes far more deaths than all illicit drugs combined. In the United States cigarette smoking is a contributory cause in one out of every 5 deaths. Unfortunately, smoking not only damages the health of active smokers, but also the health of those around them. Of nearly half a million smoking-related deaths in the US every year, more than 50,000 -- or one in ten -- are passive smokers. Secretary Sullivan says that 10%of infant mortality in the US can be traced to tobacco use by prgnant mothers. In addition to its high death toll, smoking also causes a wide range of permanent disability, ranging from developmental delay in fetuses of mothers who smoke, to cerebrovascular accidents and other circulatory disease. In England it is reported that 80% of leg amputations are related to smoking.

Joe Camel and the Marlboro Man have made it clear that children are a primary target of cigarette advertising. The tobacco companies must work hard to replace the 1200 smokers who die every day in the US. With the gradual decline of smokers in the North, tobacco companies are more aggressively targeting the Third World. Data shows that for every person who quits smoking in the industrialized countries, two persons start smoking in the Third World.

As with unnecessary medicines and infant milk products, it is the money that poor families spend on the tobacco habit that often presents its biggest threat to health. For the hundreds of millions of workers who earn less than one dollar a day, buying cigarettes means less food. A recent study in Bangladesh shows that child malnutrition and mortality are higher in families with father's who smoke.

Some countries have passed laws prohibiting import of tobacco, or have banned advertising. But the US government, claiming that such restrictions are a violation of the free market, has threatened these countries with trade sanctions. Yielding to this pressure, Japan, Taiwan, South Korea, and Thailand -- have opened up their markets to American tobacco. As a result, cigarette consumption in these countries has increased substantially. Inevitably, so will the rate of smoking-related disease.

The World Health Organization warns that if the present trend of increased smoking in poor countries continues, tobacco related deaths will soon reach pandemic proportions. In India nearly a million people a year now die from smoking.

It has become clear that in the United States more deaths are related to cigarette smoking than to any other single factor. From a purely economic view, tobacco now costs the US 52 billion dollars a year in medical costs, lost wages, and other losses.

Then why does the US government -- which criminalizes much less lethal, less addictive substances like marijuana -- not only tolerate over-the-counter sale of tobacco but continue to subsidize and under-tax the industry? Most other industrialized countries place a very high tax on cigarettes. This discourages use -- especially among teenagers -- and generates revenue for public services. Yet the United States has the lowest cigarette tax of all the industrialized countries. But why?

The answer lies, in part, in the powerful lobby of the tobacco companies. Government officials want to get re-elected, so they cater to the "political action committees" of big business. High ranking leaders in the presidential election campaigns of both Ronald Reagan and George Bush just happened to be important functionaries in US tobacco companies. After elections these tobacco potentates were given high ranking government posts where they could play key roles in policy-making. And don't think it is just the Republicans. Bill Clinton's campaign manager for this last election was a top-ranking lawyer with a tobacco company. However, such allegiances with the vested interests of corporate power -- which make a sham of democracy -- are not exclusive to the United States. When Margaret Thatcher left her position as prime minister of Britain, she reportedly moved into a million dollar a year consult job with a major British tobacco company.

In the words of former US Surgeon General, Dr. C. Everett Koop, "The support of politicians and political parties by those associated with the tobacco industry is unconscionable. How can Americans believe political promises for health care reform when both parties seem to be associated with an industry that disseminates disease, disability, and death."

We are faced with this disturbing reality. In today's so-called "New World Order" (which is in fact an entrenchment of the Old) the giant killer industries -- ranging from baby milk products to tobacco, to alcohol, to the entire military-industrial complex -- have more power in the decision-making process of so-called democratic nations than do the people themselves. Big business is no longer within the law. Rather, it reshapess the laws to fit its needs and greed.

Third, let us look at illegal drugs. Of course, the apparent hard line between legal and illegal drugs historically shifts back and forth; it is determined more by power games and politics than by rational concerns about personal health or social well-being. Some drugs that are legal today have been illegal in the past, such as alcohol during prohibition. And some drugs that are illegal today were quite legal in the past, such as marijuana, opium products, and cocaine. Recall that Coca Cola gets its name from the early formula, which actually contained coca, the unrefined base of cocaine.

In fact, looking back, the distinction between pharmaceutical drugs and illicit drugs becomes blurred. Heroine, a derivative of morphine, was for a time widely used in medical practice. Marijuana, too, has a wide range of medicinal uses, ranging from treatment of arthritis and glaucoma to the severe nausea of chemotherapy. And conversely, many modern pharmaceuticals such as amphetamines and diazepam (Valium) are often misused for kicks.

The question of decriminalization of illicit drugs -- together with greater investment in education and treatment facilities -- needs to be seriously considered. It seems to have worked reasonably well in Holland.

Certainly, the criminalization of the narcotics trade has inflated its price tag and helped turn it into the giant, ruthless and corrupting multinational industry it is today. As with many other powerful multinationals , the relationship and clandestine agreements between drug cartels and big government have become a major obstacle to a healthy and democratic social order.

During the last 40 years, covert operations of the US government have utilized international narcotics trade to help finance the destabilization of liberation movements and national democratic struggles that resist the dominant free-market paradigm. Here we cannot explore in depth the links between the US government, corporate powers, and the international narcotics trade, in their attempt to dominate global politics and economics. Lots of well-documented investigative research has been done on this subject -- some of it by congressional committees -- but very little has penetrated the mainstream media. Indeed, cover-up and disinformation have become the most effective weapon of social control.

Nevertheless, numerous observers -- including a number of official investigators, disillusioned drug enforcement officers, and CIA drop-outs -- concur that the US government's so-called War on Drugs is in large part a sham. Indeed, many critics allege that the US government itself, through its covert actions and arms-for-drugs deals, has done more to increase the flow of illicit narcotics into the United States than any other factor.

During the carefully staged Iran-Contra Investigations, great care was taken in the carefully staged public hearings to cover-up the arms for drugs deals. Yet a wealth of evidence indicates that various branches of the US government collaborated with drug traffickers to bring tons of heroine and cocaine into the US. To sidestep US Customs, some drug shipments were unloaded at the US air force base in Homestead, Florida. The airplanes that brought drugs into the US were reloaded with weapons and explosives and flown back to Central America to resupply the Contras in their terrorist war against the Sandinista government of Nicaragua. This was during the years when the Boland Amendment had outlawed miliary assistance to the Contras. Hence many of the arms shipments and land mines paid for by peddling drugs on the streets of America were disguised under the label of "humanitarian aid." In fact, the arms shipments, like the drug shipments, violated both national and international law.

Tragically, these abuses are not a bizarre exception to a system of governing which is essentially honest and benign. They are par for the course. When occasionally national scandal break out, mock investigations are conducted. A few rotten apples may be fingered to distract attention from the rotten barrel.

But if we want to get at the roots of the drug problem, and of the widespread deterioration of the economic and social fabric of our nation and our world, we must look at the structure of the barrel itself. Drug growing, drug trafficking, and drug use are symptoms, not the cause, of the social, economic, and political imbalance in our society.

With the advent of our so-called "New World Order", the US government has amplified its role as global policeman and power-broker. But too often, policemen are bullies. And in fact, the US has a long history of heavy-handed intervention, especially in the Third World. Over the years, through overt and covert actions, it has displaced or neutralized many of the most popular and more egalitarian leaders, and has replaced them with some of the most corrupt and authoritarian rulers. The number of lives lost, human rights violations committed, and children starved through these high and low intensity operations adds up to many millions.

In recent decades, the US Central Intelligence Agency (CIA) has been central to these global power plays designed to protect the interests of America's ruling elite. And as history has borne out, where the CIA is involved, the underworld of organized crime and drug trafficking often becomes entwined in the plot.

Consider the events surrounding the US invasion of Panama to depose Manuel Noriega, who was accused of narcotrafficking. But how did Noriega rise to power? And who supported him? Those of you who have read Graham Green's Getting to Know the General are aware of the allegations that the CIA was involved in the mysterious death of General Torrijos, which left Noriega as de facto Chief of State. When George Bush was Director of the CIA, Noriega was on the Agency's payroll. During this same time -- with full knowledge of the CIA -- Noriega helped Panama become a major transit point for South American drugs destined for the US. With his earnings from the laundering of drug money, and allegedly under pressure from the US government, he helped to finance the Contra insurgency in Nicaragua. Noriega was neutralized not because he was a drug trafficker, but because he was a loose cannon, and had become too feisty. (Before the invasion he had bragged that he had George Bush "by the balls".)

The irony is that the puppet president who replaced Noriega, and whom the US government has backed so strongly through its continued military occupation of Panama, has just as dark a history in drug dealing and as close ties with the Colombian cartels as did Noriega. No wonder, therefore, the US Drug Enforcement Agency ( DEA) reports that "Cocaine shipments through Panama have jumped since Noriega's capture in 1989."

Throughout Latin America, the US sponsored War on Drugs rings just as hollow. In Peru, the US government has poured millions of dollars into its military, despite the evidence that large sectors of the Peruvian military are deeply involved in drug trafficking. And curiously, President Fujimori's former election campaign director -- who currently heads Peru's anti-drug initiative -- allegedly has a long history of ties to the South American drug mafia as well as links to the CIA.

In Bolivia in 1980 a gang of drug lords headed by general Garcia Meza and Colonel Arce Gomez took over the Bolivian government and, with direct cooperation of the Army, boosted the drug trade. There is evidence that this notorious "coca coup" was carried out with collaboration of the CIA and Argentinean intelligence.

A similar pattern can be seen in various countries in Latin America and South East Asia, where the US government provides weapons and assistance to local armies, ostensibly to combat the growing, processing, and trafficking of drugs, in spite of evidence that these military units are themselves deeply embroiled in the drug trade.

It has become increasingly clear that the so-called War on Drugs is promoted for other reasons than its stated objective. In the United States it has been used to justify forceful intervention in other countries, as well as to provide an excuse for continued our high military expenditures. Now that the Soviet Union has disintegrated and the Cold War has come to an end, new enemies are needed. A fearsome one has been created through the War on Drugs.

But is it a war the US government really wants to win? Probably not. The illegal drug trade -- like tobacco, pharmaceuticals, and weapons -- is a lucrative multinational enterprise tied into the global economy. Export earnings from drug trafficking into the United States are what have enabled many destitute countries to keep servicing their huge foreign debt to the Northern Banks. For example, several years ago the US State Department declared that 75% of Mexico and Columbia's export earnings come from drug trafficking.

In the current economic recession -- for impoverished nations in the South just as for the growing ranks of impoverished people in the USA -- drug dealing often seems to be the only viable option.

In Mexico, where I have worked with a villager-run health program for the last 27 years, I have seen how this happens. I have witnessed how poverty and exploitation drive poor farmers to risk growing drugs in order to feed their children. I have seen how the phoney War on Drugs has led to destruction of families, corruption of officials, and brutal violence. Narcotics control soldiers, armed and assisted by the US, have themselves provided mountain villagers with opium poppy seed, and encouraged them to plant. Then at harvest time the soldiers take their cut from some of the growers and ruthlessly bust others. I treated a man with broken ribs who had been beaten by the soldiers because he had refused to grow drugs. We amputated the hand of boy who was shot by the soldiers with a high velocity bullet. Use of these explosive bullets -- apparently supplied by the US for the drug control initiative -- is a violation of the Geneva Convention.

Human rights abuses peaked during a time when the World Bank made a forthcoming bale-out loan to Mexico contingent upon more aggressive drug control efforts. Former US "Drug Tzar" Bennett called for a "massive wave of arrests". As a result, men and boys in mountain villages -- some of them my friends -- were dragged from their beds at night, then tortured and jailed on false charges of growing drugs. This way the soldiers could meet their quota of arrests.

The US government vehemently condemns terrorism by the countries it dislikes. But it is guilty of extremes of terrorism not only to destabilize national liberation movements, but also to prevent exposure of its own deep involvement in international drug trafficking.

Do you remember 4 years ago (Dec. 21, 1988) when the White House demanded United Nations sanctions against Libya for blowing up Pan American Flight 103 over Lockerbie, Scotland?

Well . . . Pan Am's insurance company -- faced with $10 billion of claims for the passengers killed -- called for an independent investigation. It found that Libyan terrorist were not responsible for the bombing, but rather the CIA. For years the CIA had been using Pan American airlines to courier heroine into the US, with drop-offs in Detroit, St. Louis, Los Angeles and New York. Flight 103 was carrying 8 CIA agents involved in directing the drug traffic, and also a high-ranking operative of the Drug Enforcement Agency (DEA) who has been implicated with Oliver North in the Iran-Contra arms-for-drugs deals. What made Flight 103 exceptional, the investigation revealed, was that these agents were coming back to the US unauthorized, with intentions to blow the cover on the operation. An article in The Toronto Star, titled "Pan American Bomb Linked to Double-Dealing Drug Plot" states that, "The agents became outraged when they discovered that the Central Intelligence Agency operation in drugs and arms was going to be escalated. One of the leaders of the group, Maj. Gen. Charles McKee, had decided that it was time to expose the operation."

Appalling as it seems, apparently the US government -- to stop its own agents from exposing government complicity in the drug trade that it claims to be fighting -- blew up a whole jumbo jet full of innocent passengers.

After reading the 27-page investigator's report, Pan American Chairman Thomas Plaskett, said "You mean to tell me that the Central Intelligence Agency has been using Pan American planes to run drugs over a period of years, and I thought I was running an airline!"

Unfortunately, the bombing of Pan AM 103 is probably not an isolated incident. Events surrounding the mysterious crash of the Gander flight, over Newfoundland, are remarkably similar. The Gander plane was reportedly carrying members of the clandestine RDS force, another drug smuggling operation of the US government. According to Toronto's Sunday Star, the flight also carried bodies of US operatives who had been killed after they had been silenced for their role in the drug operations.

The financial magazine, Barrons, reporting on these events, spells out the close links between the drug trade and big business. It states, "The 'take' from the drug traffic is approximately $500 billion annually, and these funds are entirely integrated within the US banking system, processed through Morgan Stanley, Chase Manhattan, Citibank, First National. The $500 billion expresses itself in controlling shares in major blue chip US corporations such as Ford Motor Company, AT&T, General Electric. You cannot distinguish the operations of the mob or the drug traffic from the normal workings of finance capital in the United States."

Given this appalling scenario, what can be done to control the "drug problem"? Trying to control it by strong-armed force has clearly not worked. Today the jails both in drug-producing and drug-consuming countries are full to bursting. Hundreds of millions of dollars have been spent in police action and military operations to curtail growing and dealing. The results in terms of human suffering have been enormous, but in terms of reducing drug production or use have been negligible.

One thing has become clear. Worsening social and economic conditions aggravate the drug problem. As an example, when Mexico went into its extreme dept crisis in 1982, not only did drug growing and trafficking sharply increase, but the government -- desperately in need of export earnings -- was clearly less motivated to effectively combat the lucrative drug trade. Indeed, during the mid-80s, the few remaining signs of economic growth were the new 5-star hotels and discos built with drug money.

Clearly, the debt crisis and economic recession which began in the 1980s have done more to promote drug trafficking than the ruthless War on Drugs has done to stop it. A major set-back, which has pushed many more poor people into growing and dealing drugs, has come from the structural adjustment policies of the World Bank and IMF. These policies -- imposed on poor countries to make sure they keep servicing their debts to Northern banks -- have forced poor countries to cut back on health, education and other public services, while reducing the real value of worker's wages. In many countries, the earnings of farmers and laborers have fallen so low they can no longer feed their families. Hence the growing numbers of homeless people, street children, and poverty-related crimes.

The impact of structural adjustment and other aspects of so-called "free market policy" on the drug crisis is in some countries quite evident. In Colombia the economy depends on two export crops, coffee and cocaine. In 1989, the US government -- consistent with its free market agenda -- refused to renew the commercial agreement on coffee price stabilization. As a result, coffee prices collapsed and Colombian producers lost 52 cents on the dollar, with global losses of $4 billion. The sharp fall in coffee prices continued through 1990 and 1991, and more and more coffee growers begin to cultivate coca. The paltry amount of money the US government has put into promotion of "alternative crops" is nothing compared to the vast losses to the peasantry and labor force caused by the economic and so-called development policies imposed on them by today's global power structure.

Ironically, even in the world's wealthiest and most powerful nation, the USA, the events exacerbating the "drug problem" are very similar to those in the Third World. The numbers of homeless people, street children, and poverty-related crimes rise every day.

Indeed, the same sociopolitical and economic forces that are widening the gap between rich and poor, both between countries and within them, are at work right here in the United States. Here, too, "structural adjustment" policies have been applied similar to those imposed elsewhere. To sustain our huge military budget and build our dominion as "cop of the world", the White House has systematically gutted public assistance programs, low-cost housing, and other benefits for the poor. Over the past decade real earnings of working people have steadily fallen. Taxes extracted from the poor have risen, while those of the rich have been lowered. The result for many is a deteriorating standard of living. Today in the US, 1 of every 7 families, and 1 out of 5 children, lives below the poverty line. Infant mortality in cities from Washington DC to Oakland California is higher than that of China or Jamaica. Nearly 40 million people in the US have no form of health insurance, and daily 24 million people go hungry. Racial minorities -- especially Afro-Americans and Hispanics --- are systematically marginalized and scapegoated. Rates of crime, violence, suicide, school drop-out, and police brutality have soared. High-level corruption and disinformation have become institutionalized.

Such a deteriorating situation leads to an increase of both drug dealing and drug use. Is it realistic to try to control the problem by pointing guns at poor farmers in poor countries? Or by providing more policemen and more jails in the United States? Neither approach gets to the root of the problem. The peasant of Peru grows coca for the same reason that the street pusher in the US peddles cocaine. Both have been marginalized and deprived by a political and economic system that favors the haves at the expense of the have-nots.

The War on Drugs is in reality a War on the Poor. In the United States, as in the drug-producing countries, it is the little guys rather than the big guys who are the primary target. Many of the biggest drug dealers in the US have immunity from the law. They include mafiosos or drug lords from the Golden Triangle, Cuba, and elsewhere, who have collaborated with US covert operations abroad. If they happen to get arrested on drug charges, the police chief or judge soon gets a call from the CIA or State Department, requesting that charges be dropped for reasons of "national security."

But what kind of security does such action really provide to a nation? It seems to me that the most intelligent first step our nation could take -- for real security and to reduce the drug problem -- would be to dissolve the Central Intelligence Agency. Then maybe we could do something to stop the big guys in the drug trade, and get off the backs of the little guys.

The American "way of life" -- which too often places the greed of the strong before the needs of the weak -- is rapidly becoming a global "way of life" by imposing servitude to its "free market" world view. Yet for increasing numbers it is becoming a "way of death." The whole paradigm of the neoliberal New World Order needs to be seriously questioned, not only in terms of resolving the problem of drug abuse, but in terms of the quest for world peace and the sustainability of the global environment and ultimately of the human race.

It is becoming clearer that the American "way of life" is not sustainable. Today we the people of these United States, with 4% of the world population, consume 25% of the world's energy and resources. But we consume 60% of the world's illegal drug supply.

But why this hunger for drugs? What does it reflect about our consumer-oriented culture? About the loneliness and alienation from Nature of our compartmentalized lifestyle? How much real sense of community is left? For all our talk about democracy and people's participation, how much control do average citizens have over their government, or over the decisions and events that shape their lives? Why do nearly half of eligible voters not vote? Who really elects our national leaders? The people? Or the lobbies and PACs of giant industries: the weapons industry, the oil industry, the tobacco industry, the pharmaceutical industry ... and, of course, of the AMA? Why do we still not have an equitable national health plan? In a nation as wealthy as the United States, why is their so much poverty, hunger, homelessness, crime, and desperation?

These are the questions that I think we need to tackle in confronting the issue of misuse and abuse of drugs. It seems to me that the question of legalization or illegalization of drugs -- whether tobacco, alcohol, or the drugs that are currently considered illicit -- is not the key issue. To overcome the crises of our times -- the crises of poverty, environment, militarization, and drugs -- we need to work toward a fairer, more equitable, more compassionate world order. Resolution of the drug problem is, in last analysis, not an issue of crime and punishment but of social justice.

To say no to drugs, we must first say no to the social structures that perpetuate inequality.