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March-April 1998

"Buzzed" by Cynthia Kuhn, Scott Swartzwalder, and Wilkie Wilson (W.W. Norton, New York, 1998, ISBN 0-393-131732-3 (pbk.)); reviewed by Tom O'Connell, M.D.

Despite its improbable title, "Buzzed" is a serious book about psychoactive drugs; the title is street argot for the way a drug is supposed to make its user feel. In fact "The Buzz" for each agent or class of agents is described in a paragraph located just after they are introduced.

"Buzzed" was written by two pharmacologists (Kuhn and Wilson) and a psychologist (Swartzwalder) from the Duke University Medical School. They were prompted by the dearth of accurate modern information available to adolescents and their parents, faced with the drug temptations now part of any journey through adolescence in our society. They have tried to include an overview of the latest information on receptors, neurotransmitters, and of recently enhanced understanding of electrochemical and neurohumoral mechanisms of drug action on specific neural structures. The main thrust of the book, however, is a systematic consideration of all drugs, including inhalants, caffeine, nicotine and alcohol as well as the numerous herbs, alkaloids and synthetic analogues on the current menu of drugs used recreationally.

If the desire to produce a drug handbook sounds reminiscent of Edward Brecher's 1972 "Licit and Illicit Drugs," it should. The major difference is that in the process of researching and writing his book, Brecher clearly became intrigued with the history and ramifications of U.S. drug policy and produced a landmark study of those aspects, one which is still indispensable to anyone interested in drug policy. The present authors seem, with the single exception of marijuana, to be studiously disinterested in either the genesis of, or rationale for, American drug policy.

In their introduction, they refer to their own crash courses on current drug laws from a federal judge and a federal prosecutor. Their last chapter is entirely devoted to a practical consideration of legal issues which surround the possession and use of illegal drugs.

The book is written in no-nonsense narrative prose which commendably simplifies complex neurochemistry without unduly sacrificing accuracy. The chapters on the brain ("Brain Basics") and on drug mechanisms ("Drug Basics") are well done, but badly misplaced, coming at the very end of the book, just before the last two chapters on addiction and legal issues. Reading them first would enhance the pharmacologically challenged reader's ability to understand the material on specific drugs.

The major deficiency of the book may be due to the authors' lack of acquaintance with the criminal drug market. It does not address risk associated with how and where drugs are consumed. In "Buzzed," the parenteral route is barely discussed, and when it is, the issue of AIDS transmission is only tangentially addressed. Intravenous drug use is barely mentioned and Hepatitis C is not mentioned at all. Omission of this basic information from a handbook is simply unacceptable.

In summary, a worthwhile modern treatment of the range of psychoactive drugs, a good update on neuropharmacology for the layman -- however, glaringly deficient on the hazards of parenteral use and clueless on policy.