London: Pharmaceutical Press; 2005. 376 pages*
The aim of this book, now in an extensively revised second edition, is to be a detailed but easily digestible guide for healthcare professionals who work with drug users. As the author notes, the use of psychoactive drugs is long-standing, ubiquitous, often associated with considerable harm and subject to considerable variation over time.
Basic concepts and common complications of psychoactive drugs are covered in two somewhat perfunctory introductory chapters. A chapter is devoted to each major drug category under the following headings: history, effects sought, administration, pharmacology, adverse effects, dependence, drug-drug interactions with therapeutic medications, potential effects on concurrent medical conditions, pregnancy and breastfeeding.
The text is up to date, including material on relatively new illicit drugs (such as gamma hydroxybutyrate) and recent developments (such as use of the internet as an information resource). Separate chapters are appropriately devoted to tobacco and alcohol. The health and economic costs to individuals and communities from legal drugs dwarf the costs associated with illicit drugs.
The author still refers to drug 'misuse' and 'abuse' although many regard these terms as unscientific and pejorative. Apart from this terminology, judgemental attitudes are (mercifully) avoided. But terminology 'sends a message' and a large part of the problem of healthcare management of people using illicit drugs includes keeping negative attitudes under control. People who 'misuse' and 'abuse' illicit drugs should be just as entitled to excellent health care as people who 'misuse' and 'abuse' cigarettes, red meat or high-fat ice cream.
The strengths of this readable book include its clarity, brevity and practicality. Arcane and academic details are avoided. The information on drug-drug interactions with therapeutic medications is particularly useful. Perhaps the introductory chapters could have been expanded as clinicians are generally more troubled navigating their way through the vexing framework questions than the more straightforward pharmacological aspects of psychoactive drugs. This is especially true in parts of the world where authorities wage a 'war on drugs', claiming to create a utopian 'drug-free world'.
This book will be a useful reference for busy clinicians managing patients using psychoactive drugs, especially general practitioners and pharmacists, but also some specialist practitioners.
* Available from Pharmaceutical Society of Australia, phone (02) 6283 4783. Price $154, $123 PSA members.
