AbstractThe question of how cocaine overdoses are related to preferred routes of cocaine administration and other aspects of cocaine use patterns is sufficiently complex that very little information is available on it. Even the most extensive information on cocaine overdoses, that of the Drug Abuse Warning Network, is severely limited for purposes of examining this topic. Findings are presented from a 1988–1990 study of a purposive but demographically diverse sample of 699 crack and other cocaine users in Miami, 349 of them interviewed in residential treatment and 350 interviewed on the street. Among these respondents: a history of cocaine overdose is extremely common; overdose episodes do not commonly motivate treatment entry and in some populations are relatively unlikely to result in an emergency room visit; cocaine overdose is less associated with crack smoking than with snorting or intravenous (IV) use, whereas IV use is especially likely to result in overdose; and the street and treatment samples are strikingly different in regard to drug use patterns, overdose history, changes some users made to use patterns as a result of overdose experiences, and reasons given by other users for not making such changes.