Drugging the Poor: Legal and Illegal Drugs and Social Inequality (review)

Given the repeated metaphor of "drug wars" in the national narrative, it would seem an obvious objective to delineate who, or what, in these "wars" is the "enemy." If it is drugs, per se, then, as Richard le Grande aptly notes, drugs are a pervasive 24-hour phenomenon in US society, where a Manichean public discourse lurches back and forth between drugs as evil and drugs as angel (2006a, 2006b)—depending upon which drugs one is talking about, and at which point in history. Unfortunately, the "good guy/bad guy" discourse surrounding drugs obscures the complex social impact of drugs of all kinds in the US as well as globally, and the disparate impact of drugs on those who are poor and without resources.

Merrill Singer, in Drugging the Poor, approaches this issue from a long-standing commitment to the perspective of critical medical anthropology (Baer, Singer, and Susser 2003, Singer and Baer 1995). In brief, critical medical anthropology (CMA) reframes health issues as embedded in the broader context of inequitable socioeconomic, class, ethnic, and gender relationships that create vulnerabilities. Singer, for example, has linked HIV/AIDS to a litany of other health problems (tuberculosis, infant mortality, hypertension, diabetes, cirrhosis, and substance abuse) that are disproportionately found in poor urban populations, and together calls the aggregate situation a syndemic—that is, several epidemics that exist together because conditions promote their co-existence (Singer and Clair 2003, Singer 1994). These conditions include poor housing, lack of economic opportunity, racism, violence (at many levels), lack of access to resources, and, generally, to the tools of power. Continued exposure to such conditions creates a multifaceted vulnerability, in which drug abuse plays a significant role because of its simultaneous qualities of delusion and destruction. As Singer poignantly writes, drug use among the poor is "the medicine that relieves but does not heal; the remedy that takes far more than it yields; the lie that embodies all the lies between rich and poor" (214).

Singer deserves enormous credit for his tireless and significant efforts to bring the CMA perspective to the broader public health community through his applied research and intervention work, through a prolific output of publications (particularly focusing on the intersections of drug abuse, HIV/AIDS, and violence, as well as critical theory), and through his longstanding public engagement within anthropology and applied anthropology. His work has been highly influential, including, if I may say, to this author. Moreover, if I am not mistaken, he is the originator of the term syndemic (described earlier)—an important construct that has begun to take root in key public health institutions including the Centers for Disease Control and Prevention (CDC). With that background in mind, Drugging the Poor is Singer's third volume in a series of books on drug use and abuse, and is perhaps the broadest of the three in its focus on the social impact of drug capitalism writ large. The book begins with a broad commentary on the nature of globalism and contemporary capitalist enterprise, calling social injustice neither a product of indifference among those who benefit or moral failure among its victims, but "an arrangement that materially benefits some while harshly punishing others" (17). During this discussion a key purpose of the book is stated: "The role of drugs in maintaining inequality is not often addressed in public discussion of social disparities. Doing so is a primary purpose of this book" (ibid).

How does Drugging the Poor carry out that purpose? First, the introductory chapter situates both legal and illegal drug industries as functional equivalents within a global capitalist framework. This is followed by a series of chapters taking the reader through an extensive exegesis of both the legal and illegal drug industries, describing their operative dynamics as well as their optics, or (situated) point of view. In each of these chapters, covering the specific legal/illegal drugs—from tobacco, alcohol, and pharmaceuticals to marijuana, cocaine, heroin, methamphetamine, and ecstasy—Singer...