Preface

To the best of my knowledge, this is the first meeting on prenatal drug use that brings together basic and clinical researchers, epidemiologists, healthcare providers, those concerned with legal and ethical issues, and policy makers. But what makes this conference especially unique is the unusually broad range of drugs that will be discussed. These include major licit substances-alcohol, nicotine and caffeine, as well as the major illicit drugs-opioids, cannabinoids, central nervous system (CNS) stimulants and phencylidine. Traditionally, the public health aspects of these compounds have been assigned to and administratively sequestered in various governmental agencies. The National Institute on Alcohol Abuse and Alcoholism has been concerned exclusively with alcohol. Illicit drugs fall under the purview of the National Institute on Drug Abuse, although this agency also funds basic research on nicotine in both adult and immature organism. At the same time, the National Institute on Child Health and Human Development has a long history of interest in the effects of smoking on human pregnancy. One result of this compartmentalization is that it has, in part, given rise to increasingly specialized and narrowly focused scientific disciplines, meetings, societies and journals. And while this is all quite understandable as the natural evolution of scientific activity, information has become widely scattered yet, at the same time, isolated in scientific minicommunities. This clearly serves the interests of the specialized practitioners and scientists, enabling them to interact and share mutual technical and scientific problems unique to their endeavors. But inevitably, boundaries have become more rigid and these specialty groups more insular and self-directed with the result that communication between groups has been impeded. For example, clinicians concerned with drug-exposed infants often view the basic researcher as reducing whole organisms to neurochemical systems, receptors and binding sites, and their mechanistic findings may be dismissed as either tortuously arcane or of ambiguous relevance to their clinical problems. And, indeed, the daily world of the perinatal treatment staff and the one that they publish papers about, consists of women in a compulsive pattern of drug abuse who also happen to be pregnant and are likely to give birth to very sick, at-risk babies that will require highly specialized medical management. Their major concern is to utilize their medical skills to provide increasingly improved healthcare and treatment to these infants to ensure as optimum an outcome as possible. On the other hand, clinical researchers may not be as well informed about pharmacokinetics or the fundamental pharmacological processes of tolerance, physical dependence and abstinence. To cite an example from the mid-1970s, at that time pediatric lore suggested that the prolonged or subacute abstinence lasting some 4-6 months in infants that had been prenatally exposed to methadone, was the likely result of the persistence and slow clearance of methadone from the babies’ CNS. But opioid pharmacologists knew that human adults in withdrawal from either morphine or methadone similarly show a prolonged abstinence. Although the adult symptoms have a different temporal pattern compared with infants, their symptoms d o persist for six months or longer and are not associated with the persistence of the drug in the CNS. Thus, what was thought by some pediatricians to be pharmacologically unique to the neonate would have been viewed by an opioid pharmacologist as possibly a minor variation on the adult phenomenon of prolonged abstinence. Likewise, basic researchers, in their quest to develop animal models, assess risk, and discover mechanisms underlying toxic outcomes while grappling with the intract-