Drugs in the modern era

WILLIAM B. MCALLISTER 1

Since the dawn of humanity, almost all societies have had access to locally indigenous psychoactive substances.² With the exception of peoples in far northern climes where no suitable plants or domesticable animals existed, cultures have enjoyed the benefits of, and encountered the problems atten­dant to, the use of chemicals that alter consciousness and body functioning.

1 The views expressed here are the author's and do not necessarily represent those of the US Government or the Department of State.

2 No universally agreed definition of what constitutes a “drug” exists. Functionally based characterizations divide drugs into categories of control according to their physiological effects as defined in legislation or treaties; the main classes include narcotics, central nervous system stimulants and depressants, and hallucinogens/cannabis (United Nations Office on Drugs and Crime, Information about Drugs, www.unodc.org/unodc/en/illicit-drugs/defini tions/index.html). This chapter will combine that categorization with an adaptation of F. E. Zimring and G. Hawkins, The Searchfor Rational Drug Control (Cambridge University Press, 1992), pp. 31-32: “a psychoactive substance, often of medicinal value, capable of being used recreationally, and subject to control measures.” Incorporating the notion of “addiction” raises difficulties because the conception of the term as currently used is relatively recent, and even since its modern inception, definitions of addiction changed as an increasing number of substances have proven to cause some form of physical or psychological withdrawal symptoms, or consciousness alteration.

psychoactive substances across the globe caused significant changes in drug consumption, economic activity and world trade, societal functioning, behavioral norms, and political organization. For the purposes of this over­view, the modern history of global drug expansion is divided into three periods: the Era of Diffusion (1500 to mid nineteenth century), the Era of Development and Control (mid nineteenth century to mid 20^th century), and the Era of Globalization (later twentieth century to present). The cross- cultural interaction engendered by widespread drug use - for both medicinal and non-medicinal purposes - generated many schemes to manipulate the market for profit and power, as well as influential movements to regulate drug consumption.

The Era of Diffusion

Psychoactive substances played a crucial role in facilitating early modern global exchanges of goods, ideas, and people. When Christopher Columbus landed in the Caribbean, the indigenes offered him tobacco among their inaugural friendship gifts. Unknown previously outside the Americas, within 150 years tobacco use and cultivation spread all over the world.

Habit-forming substances emerged as prized items for merchants, gov­ernments, and consumers across multiple strata of society. First introduced into new environments by soldiers, missionaries, and imperial administra­tors, the profit potential of drugs became apparent to traders, public house proprietors, and revenue officials. Their high value and low bulk made them excellent cargo: a productive farmer distant from major markets or a merchant ship owner could reap much higher returns from a load of whiskey or tea than from a comparable weight of grain or timber. Governments monopolized or taxed substances first considered luxury goods and later mass consumption commodities. When introduced to a new region, early adopters usually viewed psychoactive substances as possessing medicinal qualities, which helped spread their use. Drugs also served as a status marker. When tobacco smoking became commonplace, for example, elites developed a preference for snuff. Over time, public establishments, especially in European countries and their settler colonies, distinguished themselves by the beverages they served - coffee for business­men, alcohol for workers, tea for ladies. Houses of refreshment also provided venues for civic engagement, political activity, military recruit­ment, and sedition. The drugs trade also stimulated other key sectors of the economy.

The introduction of new and more concentrated drugs, however, gener­ated significant concern that led to control initiatives. After an initial period of euphoria about the medicinal qualities of non-indigenous drugs, a backlash often occurred. The objections fell into several general categories including direct health effects, diminution of worker efficiency, diversion of resources from more laudable purposes, or threat to the established social order. Many governments across the Eurasian continent attempted to prohibit the increas­ingly ubiquitous use of tobacco.^[709] KingJames I of England, for example, issued a decree in 1604 declaring smoking, “A custome loathesome to the eye, hatefull to the Nose, harmefull to the braine, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomlesse.”^[710] Regardless of the medicinal qualities coffee might have been perceived to possess, Ottoman rulers attempted to suppress serving houses that they feared operated as sites of political dissent. The problems associated with alcohol use generated the most opprobrium. Religious leaders objected to the loss of individual moral control and the pernicious effect of drunken­ness on families. Employers expressed concerns about productivity loss. Government officials feared that unruliness, especially among the lower classes, posed a challenge to state authority. Many Asians, Africans, and Native Americans, as well as a few westerners, found the role of alcohol in enslaving people distasteful.

Despite many individually successful interventions, regulatory efforts generally failed to reduce drug consumption. One reason is the self­reinforcing nature of drug use; once habituated to psychoactive substances, humans will often go to great lengths to acquire them (a phenomenon that applies not only to “hard drugs" - every day untold numbers perceive they cannot function without their morning coffee). If the preferred substance is unavailable or too expensive, the poly-drug phenomenon occurs as habitues attempt to secure a substitute. In turn, this habit-forming character of psychoactive substances proved immensely profitable for entrepreneurs. After the introduction of vodka in Russia during the sixteenth century, the industry generated enormous profits for manufacturers and retailers, which eventually provided much of the capital for nineteenth-century industrial development.^[711] The growth of Glasgow, Scotland, as an early center of international sea-borne trade rested largely on the city's reputation as a key exchange point for tobacco. Moreover, governments themselves became addicted to the revenues generated from drug consumption. State authorities taxed imports, exports, and sales, or monopolized the trade, either control­ling it directly or selling concessions to the highest bidder who then charged whatever the traffic would bear. Many governments drew an increasing share of support from the trade; by the early nineteenth century vodka receipts comprised the largest single source of revenue for the Tsarist regime.^[712] The government-supported cartels that played a central role in colonization, such as the East India and West India trading companies, profited handsomely from the traffic in tea, coffee, sugar, tobacco, and opium.

This combination of increasingly widespread drug use, profit potential for businesses, government revenue opportunities, and attempts to regulate consumption also spawned an impressive array of clandestine activity. Entrepreneurs willing to take risks for high returns smuggled, evaded taxes, circumvented control measures, and cut in on monopolies. Although smug­gling is an ancient practice, its pace and scope accelerated with the expansion in world trade, and the concentrated value of psychoactive substances played an important role. Storing and transporting drugs illicitly created distribution systems that could carry other contraband. In some colonial settings, drug profiteering stimulated comprador relationships, which restructured power dynamics among imperial agents, local collaborators, and regimes in Africa and Asia that resisted incorporation into the global system on disadvanta­geous terms. Governments themselves engaged in agricultural espionage, ferreting out samples of promising substances from territory controlled by rivals and attempting to manipulate the most promising strains for cultiva­tion in friendly possessions. The booming licit drug economy existed symbiotically alongside illicit trafficking, which produced profound effects on state capacity and societal functioning, a dynamic that continues to the present day.

The most notable manifestation of this worldwide activity in psychoac­tive substances developed across East and South Asia. Opium had long been employed widely as an important medicine, but usually in a relatively weak form - either eaten or dissolved into a solution and drunk. After smoking tobacco reached East Asia and Indonesia in the seventeenth century, the inevitable drug experimentation ensued. Individuals mixed tobacco with various substances, and opium produced a powerful narcotic effect. Chinese imperial attempts to restrict smoking exempted opium as a med­icinal, a state policy that inadvertently stimulated development of a pre­pared form of opium that could be inhaled when heated, which came to be called “opium smoking.” Dutch, Portuguese, and English traders supplied increasing amounts of smoking opium, primarily from India; although exact figures are impossible to calculate, by the mid eighteenth century opium imports into China alone probably exceeded 100,000 kilograms per annum. To reduce a chronic trade imbalance (created, in large measure, by imports of the popular drug-food tea) and to earn hard currency, the British East India Company created a monopoly to buy up all opium within the territory it controlled, and marketed the produce to merchants who carried the precious cargo to East Asian ports. In the Dutch East Indies and elsewhere, colonial authorities monopolized the distribution of opium, subcontracting retail operations to the highest bidder (referred to as “opium farming” because colonial authorities “farmed out” supplies to locals who paid handsomely for the right to an exclusive sales territory). By the early nineteenth century the trade exceeded 300,000 kilos per annum. The Chinese government became increasingly concerned about both problems associated with opium smoking and about the silver drain out of the country to pay for imports. Over the course of the eighteenth and early nineteenth centuries, Qing imperial authorities promulgated a series of edicts to reduce both imports and opium use, but to little avail. European traders coopted local officials in entrepots such as Macao and Hong Kong to smuggle opium into China. Eventually the tension led to hostilities. The Chinese Empire suffered a serious defeat by small but technologically superior British forces in the Opium War of 1839-1842, which ushered in an era of increasing encroachment on Chinese sovereignty. Most nineteenth­century contemporaries observed that opium use contributed significantly to a serious deterioration in Chinese society and governance, an assessment that eventually provided a geopolitical rationale for the imposition of drug control on a global scale.

By the mid nineteenth century, psychoactive substances played a key role in global exchanges of commodities, capital, people, and power. On a pound-for-pound basis, opium comprised the most profitable item traded across the planet. For example, the original “clipper ships” were designed to carry relatively small cargoes of the highly valuable drug from India to the East; well-armed and fast, the clippers featured not only quick turnaround times but also the capacity to outrun or outfight the pirates who plied the transit routes in search of doubly illicit gain.

Cumulatively, over the course of several centuries, “new” drugs (that is, not native to the local culture) spread around the globe as part of the post­Columbian increase in global trade. The European-dominated licit trade and illicit traffic in drugs contributed to major alterations in the daily lives of individuals, the structuring of trade relations, commodity preferences, and the balance of power among nations. Many embraced, for better or worse, a life featuring cheap and (relatively) unfettered access to mind-altering con­sumable substances. As the pace of global interaction quickened and its scope deepened after the mid nineteenth century, drugs presented both opportu­nities and challenges to emerging 20th century commercial, social, legal, medical, and governmental arrangements.

The Era of Development and Control

During the nineteenth century, a constellation of technological and commercial developments expanded the range of psychoactive substances available in an increasingly integrated global environment. Innovations stemming from the “second industrial revolution” spawned chemical­pharmaceutical companies that included units specializing in the research and development of mass-market medications. Through experimentation with different compounds, chemists created heroin, morphine, cocaine, and a variety of similar substances, all intended primarily for analgesic applica­tions. This endeavor proved so profitable that pharmaceutical firms, such as Bayer, emerged as some of the first multinational corporate entities. As they became increasingly sophisticated at concocting medicinal substances for a variety of maladies, transnational pharmaceutical companies initiated major marketing programs to advertise their wares among both doctors and patients. Innovations in medical technology, especially the hypodermic needle, made it possible to administer the new drugs directly into the bloodstream in precise doses, and with more powerful effect. Mechanized transportation, especially steam-powered oceangoing vessels, enabled the fast, reliable, cheap shipping of high-value medicines. Rapid transport proved especially important to perishables, such as coca, the use of which remained restricted primarily to South America until it became possible to transport the leaves to western processing centers before they lost their potency.

The nineteenth century emergence in industrialized states of a medical profession and medicalized criteria for assessing drugs' efficacy influenced perceptions about psychoactive substances. Formal medical education and specialist periodical literature enabled verifiable information about a particular drug's effects to be disseminated among practitioners. Doctors played a gatekeeper function, deciding which substances qualified as “drugs,” and dividing drug use into categories of “legitimate” (for medical purposes) and “illicit” use (for pleasure). A distinction between “patients” and “abusers” developed over time. Notions about “addiction” often drew upon stereotypical characterizations of race, class, or gender; the typical “drug addict” came to be seen as a person on the margins of society and therefore susceptible to regulatory measures.

Because they gradually shed the label of “drug” during this period, the manufacture, marketing, and consumption of the most commonly used psychoactive substances proceeded apace with little interference from med­ical or regulatory authorities. Coffee and tea came to be seen primarily as beverages, their purported medicinal qualities no longer a principal driver of consumption. The primary cacao derivative, chocolate, which required liberal application of (cheap) sugar to be palatable for a mass audience, became categorized as a sweet. Tobacco, especially cigarette smoking, grew into an extremely popular activity, viewed as essentially benign except when engaged in by children. Alcohol occupied an intermediate terrain. While not usually classified as a “drug,” in most societies a general recogni­tion maintained that distilled spirits, and often wine and beer as well, con­stituted a special case. Local, regional, or national governments imposed a variety of restrictions on who could drink alcohol, as well as when and where it could be sold or consumed.^[714] Some jurisdictions prohibited drinking alto­gether. Yet even when proscribed entirely, alcohol use proved very difficult to eradicate. The mild stimulants (tea, coffee, cacao), tobacco, and alcohol all came to be treated as ordinary commodities in the international marketplace, subject to taxation, tariffs, and other trade policies that applied to normal items.

In the later nineteenth century, changes in perceptions about drug abuse and increases in demand, supply, potency, and availability caused govern­ments to impose increasingly thoroughgoing control measures on opium- and coca-based substances. In a number of industrially developed countries subnational and national jurisdictions enacted measures to limit the distribution of opiates and coca products to “legitimate medical” purposes, as defined by Western medical standards. Colonial administrations shifted from concessions (farming) to government-controlled opium monopolies. Both in the dependencies and at home, governments implemented regula­tory changes in large measure to placate religious organizations that objected to state-sponsored profiteering from the sale of addicting substances at the expense of ordinary citizens and subjects. It soon became evident, however, that the global nature of the drug trade required international cooperation because illicit traders easily circumvented the strictures of indivi­dual states.

East Asian geopolitical calculations constituted the proximate factor driving the creation of an international drug control regime. By the later nineteenth century Chinese opium imports, domestic production, and consumption had reached unprecedented levels - in the 1880s Chinese imports from India alone (not counting rising imports from other sources such as Persia and Turkey) amounted to 6 million kilos per annum.^[715] Most observers perceived that opium addiction seriously weakened China, and some worried that the country might be divided into spheres of influence not unlike the “Scramble for Africa” that took place in the mid 1880s. The strongest of the imperial powers, Great Britain, and the weakest, the United States, expressed the most interest in maintaining Chinese territorial integrity and central authority. The UK and the USA preferred a unified Chinese export market in order to sell their wares throughout the country. With rising tensions in Europe that required a greater proportion of British military forces closer to home, London favored an intact Chinese government that could fend off the advances of Russia, France, Japan, and the other middling imperial powers. After acquisition of the Philippines in 1898, the United States still possessed little capacity to project power on the Asian mainland and thus preferred stability in the region. Additionally, small but vocal domestic constituencies, especially in the United States, expressed concern about a potential plague of drug addiction threatening the homeland. The specter of Chinese immigrants to Western countries operating opium smoking dens that corrupted the nation’s youth presented a powerful argument in favor of regulation. To promote national interest at home and abroad, London and Washington played leading roles in advocating a coordinated international response to counteract the opium scourge.

One of the most important developments in modern drug history, the fashioning of an international control regime, developed in stages during the first third of the twentieth century. A conference at Shanghai in 1909 laid out principles of action. Treaties negotiated at The Hague in 1912, and under the auspices of the League of Nations at Geneva in 1925 and 1931, created the essential elements of the control system, and the majority of states adhered to the regime's strictures. The basic approach focused on restricting the supply of controlled substances to the amount necessary for legitimate medicinal use. Governments estimated their annual needs, and international supervisory bodies monitored the licit traffic, bringing attention to any discrepancies that might signal leakage of licit supplies into the illicit traffic. The treaties divided drugs into categories (called “schedules”) that placed greater or lesser controls on their dissemination, according to their perceived addiction potential. However, the regime's framers also recognized the necessity of providing valuable medicines at a reasonable price, so the system did not limit manu­factures to a predetermined amount. In practice, the profitability of drug sales ensured legal manufacturing routinely exceeded legitimate medical need, requiring detailed accounting procedures to regulate national and international distribution. Over time, the system succeeded in providing an affordable supply of high-quality medicines, at least to patients of sufficient means.

The international drug control system created incentives that channeled licit activities. Pharmaceutical firms that played by the rules benefited from access to worldwide markets, and began to refer to themselves as “ethical” drug compa­nies. At the same time, those companies invested considerable pharmacological research and development into concocting a non-addicting analgesic; a drug that worked as well as morphine but did not carry addiction risks could corner the global market because it would not be regulated as a scheduled substance. In the 1930s, pharmaceutical companies began developing other classes of drugs, primarily stimulants and depressants, in part because they did not fall under international restrictions and therefore could be sold without interference. In subsequent decades, a plethora of non-narcotic psychoactive substances (psychotropics) reached the market, with little attention from regulatory officials. Although not recognized at the time, this quest for a type of comparative regulatory advantage in the licit marketplace actually created additional opportunities for individuals to become addicted as new classes of drugs with novel psychological or physiological effects entered the pharmacopeia.^[716]

As officials succeeded in implementing effective controls over certain classes of drugs beginning in the later 1920s, the parallel universe of clandestine activity burgeoned. Increased enforcement of the international drug control regime generated a corresponding reaction as illegal operators developed more sophisticated methods. Trafficking in illicit opium, opiate derivatives such as heroin, and cocaine expanded because those willing to run the risks of circumventing the system could generate enormous profits. Criminal organizations maintained a technological advantage because they could afford expensive weapons, transport, and communications equipment that enabled them to evade detection. A symbiotic relationship developed between drug smugglers and a transnational coalition of state-supported drug cops; when police armed with all the tools of law enforcement succeeded in some locale, the traffickers used their substantial monetary resources to devise effective countermeasures, co-opt officials, or relocate operations elsewhere.

Control of revenues derived from the drug industry comprised a key factor in the development of state capacities. In the second half of the nineteenth century, taxes on alcoholic beverages constituted between 15 and 40 percent of all national government revenues in the Netherlands, the United Kingdom, and the United States. That money fueled the growth of govern­ment social programs, especially in the fields of education and health care. Alcohol taxes also supported war; significant surcharges over and above the normal tax rate funded much of the Union effort during the American Civil War and were vital to many governments during World War I.¹¹

The struggle over drug revenues proved crucial in internecine contests for state control, although long-term dependence on drug money usually proved detrimental to governing capacity. In China, after the collapse of Qing imperial authority in 1911-12, sundry warlords vied to capture opium reven­ues. Nationalist forces gained sufficient control over the traffic to defeat their rivals, but eventually the attendant corruption and rampant drug abuse weakened the government's command and control capabilities. In the 1930s, Japanese officials bought illicit opium from Iranian suppliers to fund occupation activities in Manchuria. Competing units within the Kwangtung Army attempted to control the trade, ultimately degrading their capacity to project military power and control the population. Notably, soon after establishment of the People's Republic of China, Communist officials launched a systematic anti-opium campaign. Sometimes employing harsh measures, the initiative was not only designed to reduce the nation's ^[717] domestic drug problem, but also eliminate a source of revenue for regime opponents.^{[718] [719]} Insurgents also utilized drug money to support their attempts to overthrow established authorities. In the late 1940s, for example, Indonesian nationalists sold opium stocks captured from the Dutch and Japanese in their campaign to secure independence. After Communist forces occupied main­land China, remnant Nationalist military units retreated to Southeast Asia and maintained operations by controlling the region's illicit opium trading routes.

The money generated by illicit drug trafficking also blurred the lines demarcating the licit use of government power. The imposition of national and international control measures in the early twentieth century fostered institutionalized corruption in many states. Officials charged with enforce­ment efforts sometimes used their power to favor trafficking organizations that, in turn, provided the money, votes, and muscle to keep co-opted authorities in power. The dynamic influenced industrialists, landowners, and politicians as well as police. Authorities often blamed drug trafficking on minorities, dissident groups, or foreigners who, they believed, posed a threat to the state. Governments of regions that featured cultivation-for- export of the key controlled substances, opium, coca, or marihuana/hashish often undulated between compliance with the international regulatory norms and prevarication in order to reap the collateral benefits of illegal trafficking. In jurisdictions across the globe, some official could always be persuaded to take a bribe that facilitated transshipment and distribution. A shadowy world developed that featured addict-users willing to do almost anything for a “fix,” apolitical criminals, undercover cops, co-opted infor­mants with agendas of their own design, anti-government elements siphon­ing trafficking profits to support their objectives, interior ministries seeking to quash subversives, intelligence agencies operating with little accountability, and power brokers wielding governmental authority, all of which thrived on an economy suffused with drug money. 1³

Although ostensibly intended to eliminate abuse, national and interna­tional drug policies focused on control of supplies; regulatory officials and medical professionals paid little attention to the etiology of addiction. The system assumed that eliminating excess quantities would cause habitues simply to stop using. Few drug treatment options existed. Doctors providing maintenance doses proved unpopular with their neighbors because of concerns about the clientele they attracted. Some clinics claimed to have developed successful curative programs, but in most cases the treatment consisted merely of substituting one addicting preparation for another. The few institutional attempts to impose forced withdrawal on incarcerated individuals experienced little long-term success. In part, treatment efforts received little support because of perceptions about drug addicts. Marginalized subgroups (for example, Mexican immigrants, Chinese laborers, inner-city minorities, prostitutes, or upland indigene Andean coca chewers) attracted little sympathy among members of mainstream society. Addicts from majority communities were often characterized as moral weaklings who exhibited some incorrigible pre-existing condition, such as “criminal tendencies” or “degenerate behavior.” Because addressing the causes of demand seemed both unlikely to succeed and directed toward those unworthy of the effort, control efforts concentrated on supply restriction. That strategy resulted in significant unanticipated effects in subsequent decades.

During the first half of the twentieth century, attitudes toward psychoac­tive substances varied widely across the global cultural landscape. Several belligerent nations limited alcohol consumption for the duration of World War I. Czarist Russia even halted retail sales of the national drink, vodka, promoting instead a variety of theatrical and educational “counter attrac­tions” as healthier alternatives.^[720] “Care packages” sent to soldiers at the front routinely included cigarettes and sometimes opiates as well. In the postwar era, even after the demise of national alcohol prohibition in Finland, Norway, and the United States, in many local and regional jurisdictions temperance advocates expressed continued concerned about the moral and social effects of drinking sufficient to maintain restricted availability. Injunctions against alcohol use remained official policy in the Muslim world. The burgeoning motion picture industry appealed to both audiences; smoking and drinking could exemplify urbane sophistication or signify a characters' descent into disrepute. American jazz music often alluded to drug use, including the mysterious substance marihuana, which, although neither a narcotic nor a coca-like stimulant, governments voted to regulate under the international drug control treaties. The image of degenerates languishing in the opium den continued as a staple of pulp fiction and popular imagination, especially in East Asian settings. At the same time, pharmaceutical companies touted the advantages of “modern medicine,” presenting an attractive portrait of white-coated doctors dispensing cures for all manner of ailments, backed by the full force of scientific research. In the 1930s, governments quietly accumulated large reserve stocks of morphine and other medicines; war planners had to assume heavy military casualties and significantly greater civilian requirements in the event of another world war entailing mobiliza­tion of whole societies and shortages of basic necessities. Yet the medical experience of many of the world's inhabitants changed little; lacking access to modern drugs or not persuaded of their efficacy, traditional cures remained commonplace across the globe.

Through World War II and the subsequent two decades, the trends established earlier in the century continued in much the same fashion. Governments provided beer and cigarettes at low or no cost to troops to boost morale and calm nerves, and those items routinely served as valuable specie in belligerent economies ravaged by wartime conditions. Opium monopolies run by the colonial powers ceased operations as World War II drew to a close. Owing largely to American pressure, Great Britain, France, and the Netherlands ended longstanding government policies that promoted, or at least permitted, sales of addicting substances to colonial subject peoples. Elements of the United Nations Organization took over administration of the international regulatory regime from the defunct League of Nations. States negotiated additional treaties that focused on supply control of the traditional drugs of abuse (narcotics, coca, and marihuana), including the advent of synthetically produced opiate equivalents (opioids) developed by pharma­ceutical firms. At the same time, an explosion of drug development resulted in the large-scale introduction of stimulants and depressants for a variety of physical and psychological maladies. Because definitions of addiction remained tied primarily to symptoms experienced by opiate users, the new drugs remained largely outside the scope of control, traded across bound­aries with few impediments. Tobacco usage reached all-time highs in indus­trialized countries, where as much as half the adult population smoked.^[721] Alcohol consumption remained a normative societal activity in much of the world. Use of drugs that never expanded beyond their traditional region (khat in the Horn of Africa, coca chewing in upland South America), remained the province of local consumers. Conceptions about the differ­ence between medicinal and non-medicinal use became entrenched in the industrialized West and among elites in other regions; that distinction mattered less in much of the developing world owing to continued lack of affordable “modern” alternatives.

At the dawn of the 1960s, then, psychoactive substances were fully inte­grated (on both the licit and illicit sides of the ledger) into the continuing worldwide exchange of goods, peoples, ideas, rules, and conceptual para­digms. Consumption of the mild stimulants, alcohol, and tobacco were commonplace, as reflected in the popular culture of the day. An alliance of medical gatekeepers and government regulatory officials defined the bound­aries between licit and illicit drug use. Pharmaceutical companies played by the rules that applied to scheduled drugs, while engaging in considerable entrepreneurial activity regarding unscheduled substances. The advent of numerous synthetic opioid and psychotropic substances also created a wider gap between the relative few who could afford them and the majority who continued to rely on traditional medicines and less expensive preparations long in circulation. Insofar as the future appeared predictable, few anticipated major changes in the realm of drug use. Beginning in the mid 1960s, however, an unprecedented series of events fundamentally altered the socio- pharmacological landscape.

The Era of Globalized Interdependency

Responses to revelations about tobacco demonstrate the complexity of interactions generated by a ubiquitous psychoactive substance fully inte­grated into global society. A groundswell of concern emanating from the medical community about the hazards of tobacco smoking came to public consciousness in first half of the 1960s. In 1962, the British Royal College of Physicians issued an assessment critical of tobacco use, drawing on a large collection of scientific studies dating back several decades. The breakthrough moment came in 1964, when the United States Surgeon General released a major report that outlined numerous deleterious effects of tobacco use. The report immediately became front-page news, indicating the power of health officials imbued with the imprimatur of modern medical science to dramatically impact the public sphere. Nevertheless, indicating the centrality of tobacco to the world economy, the US Surgeon General announced his findings on a Saturday in hopes of lessening the impact on stock markets. The report declined to declare nicotine an addicting substance because conceptions about addiction at that time remained wedded to the opiate model. Tobacco usage in the United States and other industrialized countries began a gradual but continuous decline as millions of individuals heeded warnings about the danger of smoking. Local and national governments passed legislation limiting advertising of tobacco products and restricting access, especially to young people. But tobacco companies and their agricul­tural suppliers, enjoying government crop subsidies and marketing support, accelerated sales of cigarettes overseas. They directed their efforts largely toward lower- and middle-income countries that taxed tobacco imports as a source of revenue; neither farmers nor governments wished to forego the income from this profitable crop. Of course, if tariffs were raised too much, smugglers moved in to undercut the licit suppliers. In subsequent decades, prevalence of tobacco use receded to approximately half its post-1945 highs in most industrialized countries, indicating the efficacy of programs to reduce consumption that featured a mixture of public health-oriented policies and educational initiatives. Tobacco consumption increased in other parts of the world, and remains today a leading cause of preventable death, with a growing percentage of those fatalities occurring in poorer countries.^[722]

In the later 1960s, consumption of controlled substances erupted into mainstream societies across the globe. Non-medical drug use, primarily among the young, served as a cultural marker signifying resistance to authority, the exercise of personal independence, the search for enlighten­ment, or pursuit of pleasure. Heroin use escaped the confines of inner city subcultures where it had long resided; particular concerns arose about addiction among American soldiers serving in Southeast Asia. Marihuana smoking became a common activity among young people in the industria­lized West. Some leaders of an emerging “counterculture” advocated use of psychedelic drugs (primarily LSD, a substance of no medicinal value inadvertently invented by a Swiss chemist decades earlier), the effects of which remained almost entirely unknown. Recreational use of non-narcotic stimulants and depressants developed by the pharmaceutical industry sky­rocketed into notoriety. Cocaine made a comeback that far exceeded earlier short bursts of popularity between the 1880s and 1920s. In addition to unprecedented activity in North America and Western Europe, reports of increased indiscriminate use of drugs came from locales across Latin America, Africa, and South Asia, including societies as diverse as Japan, Israel, and Yemen, and even behind the Iron Curtain. This dramatic trans­formation propelled drug-related issues to headline news status, engendering an array of consequences of fundamental import in world affairs.

One reaction focused on engineering adjustments to regulatory and ameliorative measures. States negotiated additional treaties that tightened strictures on narcotics, and brought psychotropic drugs under control (although the regulatory structure created featured less rigorous strictures than those imposed on narcotics). Although the enhanced control initiatives produced scattered governmental resistance, most notably the somewhat more tolerant attitude toward personal use of certain “soft drugs” by Dutch authorities, the majority of national and local governments strengthened drug regulations, increased penalties, and enhanced the capacities of law enforcement agencies. Extreme examples include the imposition of death penalties for users and individuals caught smuggling small amounts, which in turn generated concerns about the institutionalized violation of human rights inherent in draconian enforcement policies.^[723] The widespread explosion of drug use also caused many to question the primacy of supply control as the only appropriate policy option. The advent of highly publicized recreational drug use among middle-class youth generated support for alternatives to punitive enforcement policies. The United States, Great Britain, and other industrialized states initiated significant public funding and program­matic efforts to provide treatment for drug addicts, study the causes of drug abuse, and examine the psychological and physiological effects of addicting substances.

The late-1960s explosion of non-medical drug consumption also ushered in an era of heightened international enforcement activity generally referred to as the “war on drugs.” The United States championed a series of assaults

on supply “at the source” by focusing on eliminating excess production in agricultural regions responsible for most of the world's opium, coca, and marihuana/hashish supplies. The US government first targeted, in turn, Turkey, Southeast Asia, Mexico, and upland South America as sources of the illicit trade. American drug control efforts became intertwined with counterinsurgency programs and modernization projects aimed primarily at achieving Cold War objectives. To fight communism, US officials supported national governments that wished to extend their authority to the hinterlands by defeating insurgencies and creating economies integrated into the capitalist world market. Eradicating illicit crops was subordinated to those larger goals. The USA sent technical advisers, provided military aid to bolster internal state-building capacity, supplied airplanes for spraying herbi­cides and transport of personnel, and attempted to “export” the American approach to drug control by encouraging other countries to amend their law enforcement statues. Although sometimes a particular center of illicit activity might be eliminated, suppression initiatives ultimately achieved little long-term success. The inhabitants of targeted regions often resisted integra­tion into larger polities and markets, using the profits from drug running to maintain their autonomy. The dilemmas posed by the drug question could not be contained within the parameters of anticommunist or anti-insurgent campaigns.

Responding to the array of heightened control efforts, illicit drug traffick­ing organizations enhanced their capacities during this period of increasing interdependency. The narco-industry rose to rank among the most impress­ive transnational business operations in the age of globalization. Without benefit of legal status, traffickers engaged in vertical and horizontal integra­tion, enforced contracts, developed multiple sources of supply, generated manufacturing capacity, organized extensive transportation networks, cre­ated distribution outlets, incorporated protection costs into their business model, engineered international monetary transfers and currency exchanges, and reinvested profit, all on a massive scale. In some regions drug organiza­tions came to rival or supplant local and national governments as the arbiters of power. “Narco-states” funded entire economies that depended on illicit revenues to support schools, hospitals, municipal services, businesses engaged in ordinary (licit) activities, security forces, and even sports teams.^[724] Beginning in the 1970s, Colombian drug traffickers took over many such basic elements of state capacity, engendering societal changes of fundamental importance. In the early twenty-first century narco-organizations took advantage of the collapse of state authority in Guinea-Bissau to create a haven for global transshipment of illicit psychoactives, in turn affecting all aspects of governance.^[725] Narco-regimes proved unstable and prone to violence, retarding integration of legitimate economic and social activities into global networks. Nevertheless, whenever a kingpin fell or a cartel collapsed, the profit potential ensured that others took over the business. This long-extant dynamic of heightened control enforcement followed by trafficker countermeasures, which produced additional government regula­tory efforts that in turn spurred further adjustments by illicit actors, spiraled to unprecedented levels beginning in the 1970s. Having outlived the Cold War, the Drug War contributed to terrorist coffers, fueled insurgencies around the world, disrupted state governance capabilities, facilitated other disfavored activities, and redistributed wealth to actors with little stake in the functionality of the international system.

The control impetus, however, proved not only resilient, but expansive and inventive. Beginning in the 1970s, an unprecedented coalition of non­state actors combined to generate a new international agreement intended to curb tobacco consumption. A series of initiatives launched first by the World Health Organization and subsequently supported by the European Union, the World Bank, the United Nations Children's Fund, the International Civil Aviation Organization, professional medical associations, local jurisdictions, and national governments eventually resulted in creation of the 2003 Framework Convention on Tobacco Control. It represented a comprehen­sive approach, encouraging a variety of measures to reduce demand, support cessation programs, limit tobacco industry lobbying of politicians, pursue research about tobacco's effects, and develop programs to substitute other crops for tobacco in order to lessen the economic impact of control on farmers. This agreement differed from earlier drug treaties in that it treated tobacco usage as a public health problem. Unlike previous control agree­ments that often languished for lack of support, the Framework Convention quickly gained wide adherence. Whether this alternative approach proves attractive for the regulation of other psychoactive substances will be an important issue over the course of the twenty-first century.^[726]

On the legal side of the licit/illicit divide, multinational pharmaceutical companies developed an ever-wider array of psychoactives designed to alleviate all manner of complaints. Although often claimed to be non­addicting, subsequent experience demonstrated that many of those sub­stances could also produce physical or psychological dependence. As in the case of earlier generations of drugs, medical professionals wrestled with expanding the definition of “addiction.” Many researchers, armed with neuroscientific insights into the brain's shared pathways of pleasure, motiva­tion, and learning, advocated including compulsive behaviors like gambling or overeating as well as use of psychoactive drugs under the heading of addictive disorders. The debate over whether the concept of addiction should be applied to new products and introduced into new realms of behavior may prove to be an important development in coming decades.^[727]

Despite all the pharmaceutical developments of the modern era, the importance of traditional medicine continued unabated for many, in large measure because access to modern (licit) drugs proved elusive for the majority of the world's people. Expenditures on medicines, including con­trolled substances, varied widely across the globe. In poor countries, annual per capita consumption totaled as little as US$10, while in wealthy countries the average person spent as much as US$400 on medicines. At least one third of the world's population had no reliable access to modern drugs, and 70-90 percent of people in developing countries still depended on traditional medicine. With regard to morphine, a century after its debut still the most essential analgesic, a few developed states used most of the world's licit stocks; the middle- and lower-income countries that comprised 80 percent of the world's population consumed less than 10 percent of medicinal morphine. In the case of controlled substances, the World Health Organization attributed this consumption disparity to a combination of factors stemming primarily from the global supply-control regime: over- zealous access limitations imposed by regulatory strictures, the complexities of complying with the import-export accounting requirements of the international treaties, high retail (not wholesale) costs in some regions, and concerns about iatrogenic addiction that hinder physicians' prescribing options. The very same farmers who supplied narcotics for the impressively globalized drug trafficking business were unlikely to have access to the pharmaceutically produced medicinal form of those same substances.^[728]

Conclusion

The story of human-drug interaction in the modern era includes elements of both change and continuity. The drug-use phenomenon grew to unprece­dented proportions, touching every inhabited portion of the globe. As the range of substances available expanded, the prospects for addiction increased. Government attempts to regulate drug-related exchanges, and the activities of those who attempted to avoid control, produced far-reaching effects. But the underlying dynamics of human desire remained little changed. Access to modern psychoactive substances highlighted the question of pleasure in human life, a topic fully familiar to the ancients. How does one calculate the value of self-control, the benefits of delayed gratification, the definition of health, the attractions of indulgence, or what constitutes respon­sible behavior toward oneself and others? The modern pharmaco-universe provided a variety of new lenses through which to examine multiple facets of the human condition.

Further reading

Andreas, Peter and Ethan Nadelmann. Policing the Globe: Criminalization and Crime Control in International Relations. Oxford University Press, 2006.

Bello, David A. Opium and the Limits of Empire: Drug Prohibition in the Chinese Interior, 1729-1850. Cambridge, ma: Harvard University Press, 2005.

Berridge, Virginia and Griffith Edwards. Opium and the People: Opiate Use in Nineteenth Century England. London: St. Martin's Press, 1981.

Blocker, Jack S., David M. Fahey, and Ian R. Tyrrell, eds. Alcohol and Temperance in Modern History: An International Encyclopedia. Santa Barbara, ca: ABC CLIO, 2003.

Brook, Timothy and Bob Tadashi Wakabayashi, eds. Opium in East Asian History. Berkeley, ca University of California Press, 2000.

Christian, David. “Living Water”: Vodka and Russian Society on the Eve of Emancipation. Oxford: Clarendon Press, 1990.

Courtwright, David T. Forces of Habit: Drugs and the Making of the Modern World. Cambridge, ma: Harvard University Press, 2002.

Dikoetter, Frank, Lars Laamann, and Zhou Xuyn. Narcotic Culture: A History of Drugs in China. University of Chicago Press, 2004.

Forrest, Beth M. and Thomas F. Glick, eds. “Cacao culture: case studies in history,” Special Issue of Carol Counihan and Ailen Grieco, eds. Food and Foodways: Explorations in the History and Culture of Human Nourishment 15/1 (2007).

Gerritsen, J. W. The Control of Fuddle and Flash: A Sociological History of the Regulation of Alcohol and Opiates. Leiden and Boston: Brill, 2000.

Goodman, Jordan, Paul E. Lovejoy, and Andrew Sherratt, eds. Consuming Habits: Drugs in History and Anthropology. London: Routledge, 1995.

Grivetti, Louis E. and Howard Shapiro, eds. Chocolate: History, Culture and Heritage. Hoboken, nj: Wiley, 2009.

Gootenberg, Paul, ed. Cocaine: Global Histories. London: Routledge, 1999.

International Harm ReductionAssociation, report entitled “Partners in Crime: International Funding for Drug Control and Gross Violations of Human Rights,” June 2012, www. ihra.net/files/2012/06/20/Partners_in_Crime_web1.pdf (accessed June 13, 2013).

International Smoking Statistics, Web Edition, www.pnlee.co.uk/ISS.htm

Journal of Drug Issues, special issue on drugs on Colombia 35/1 (Winter 2005).

Kleiman, MarkA. R. and James E. Hawdon, eds. Encyclopedia of Drug Policy. Los Angeles and Washington: Sage, 2011.

Korsmeyer, Pamela and Henry R. Kranzler, eds. Encyclopedia of Drugs, Alcohol, and Addictive Behavior. Detroit, Michigan: Macmillan, 2008.

Marshall, Jonathan. The Lebanese Connection: Corruption, Civil War, and the International Drug Traffic. Stanford University Press, 2012.

McAllister, William B. Drug Diplomacy in the Twentieth Century: An International History. London and New York: Routledge, 2000.

McCoy, Alfred W. The Politics of Heroin: CIA Complicity in the Global Drug Trade. Chicago: Lawrence Hill, 2003.

Matthee, Rudi. The Pursuit of Pleasure: Drugs and Stimulants in Iranian History, 1500-1900. Princeton University Press, 2005.

Mills, James H. Cannabis Britannica: Empire, Trade, and Prohibition 1800-1928. Oxford University Press, 2003.

Nadelmann, Ethan. Cops Across Borders: The Internationalization of U.S. Criminal Law Enforcement. University Park: Penn State University Press, 1993.

Parssinen, Terry and Katherine Meyer. Webs of Smoke: Smugglers, Warlords, Spies, and the History of the International Drug Trade. Lanham, md: Rowman and Littlefield, 1998.

Porter, Roy and Mikulas Teich. Drugs and Narcotics in History. Cambridge University Press, 1995.

Proctor, Robert N. Golden Holocaust: Origins of Cigarette Catastrophe and the Case for Abolition. Berkeley, ca: University of California Press, 2012.

Rush, James. Opium to Java: Revenue Farming and Chinese Enterprise in Colonial Indonesia, 1860-1910. Ithaca: Cornell University Press, 1990.

Spillane, Joseph. Cocaine: From Medical Marvel to Modern Menace in the United States, 1884-1920. Baltimore: Johns Hopkins University Press, 2000.

Studlar, Donley T. Tobacco Control: Comparative Politics in the United States and Canada. Peterborough, Ontario: Broadview Press, 2002.

Thoumi, Francisco. Illegal Drugs, Economy, and Society in the Andes. Washington, do: Woodrow Wilson Center, 2003.

Trocki, Carl. Opium and Empire: Chinese Society in Colonial Singapore, 1800-1910. Ithaca: Cornell University Press, 1990.

United States, Centers for Disease Control and Prevention, Smoking and Tobacco Use, Consumption Data, www.cdc.gov/tobacco/data_statistics/tables/economics/ consumption/index.htm.

Wallis, Patrick. “Exotic drugs and English medicine: England's drug trade, c. 1550-c. 1800,” Social History of Medicine 25/1 (2011), 20-46.

Walker, William O. Opium and Foreign Policy: The Anglo-American Search for Order in East Asia. Chapel Hill: University of North Carolina Press, 1991.

Wiemer, Daniel. Seeing Drugs: Modernization, Counterinsurgency, and U.S. Narcotics Control in the Third World, 1969-1976. Kent State University Press, 2011.

World Health Organization, Prevalence of Tobacco Use Among Adults and Adolescents, http://gamapserver.who.int/gho/interactive_charts/tobacco/use/atlas.html.

Zheng, Yangwen. The Social Life of Opium in China. Cambridge University Press, 2005.

Zimring, Franklin E. and Gordon Hawkins. The Search for Rational Drug Control. Cambridge University Press, 1992.