Medical centers are ideal locations in which to develop and evaluate the efficacy of comprehensive drug treatment programs for pregnant women. Public hospitals have access to relatively large numbers of women whose medical and obstetrical problems may directly or partially result from the abuse of alcohol and other drugs. In addition, women residing in the community who need drug treatment services are frequently identified and referred to a particular hospital by county board of health clinics and community-based health centers. Pregnant women who receive care at public hospitals often lack the financial resources and private medical insurance that are necessary to access drug abuse treatment in the private sector, and the only treatment option for these women may be public hospital programs. Public hospitals usually offer a wide range of relevant primary through tertiary health care services, including high risk prenatal care, neonatal intensive care, and specialized pediatric followup care. Despite recent advances in multidisciplinary services for specific populations, however, services in large hospitals are generally fragmented. Further, the complex task of initiating and operating a comprehensive treatment program with an extensive research component is complicated by the need to ensure clinical program and research activities comply with hospital standards. Social and economic problems associated with poverty and drug use, problems associated with the integration of research requirements and clinical operations, and problems associated with institutional prejudice may also complicate medical-center based research programs. Three recommendations are offered to overcome program and service delivery barriers: (1) substantially increase the amount of time allowed for program startup; (2) ensure extensive involvement of all branches of medical center administration and hospital departments in the study and treatment of drug-dependent women; and (3) provide widespread and ongoing education about drugs and addiction to hospital personnel.