A new drug is created. It goes through animal testing, then, if safe, it goes through testing in humans to find the proper dosage and to see how it should be used and not used. This information is critically evaluated and summarized in a package insert distributed with the drug. Wouldn’t it be great if drugs of abuse went through this process? Unfortunately, they do not. What we have instead are bits and pieces of information, often based on adverse effects or outright disasters that occurred with uncontrolled use of these substances. The healthcare provider is thrust into this minefield of unknowns when encountering a pregnant or breastfeeding patient who is using a substance of abuse. Some clinicians may refuse to deal with these women, while others rely on limited personal experience or snippets of information picked up from others during their careers. Frank Nice and his colleagues have addressed this lack of information for those who deal with pregnant and nursing mothers with substance abuse issues. This book brings the medication expertise of pharmacists together with the expertise of experienced clinicians of other disciplines. It sets down guidelines from professional organizations into one place to rationally assess the information that is available, while putting them into an organized and useable context. Case vignettes sprinkled throughout the chapters provide a sense of the real world that the reader may encounter in practice. No book of this nature can ever be entirely complete or cover every possible situation because of the uncontrolled nature of substance abuse and lack of high-quality information. Nevertheless, the authors have done well in creating a rational framework that can guide clinical decision-making. This book should serve well as a starting point for inexperienced clinicians and a solid resource for more experienced practitioners who may not have the formal pharmacologic background that the authors bring to the discussion.
