Drug treatment-seeking abusers generally self-select their treatment modality. Most opioid-dependent individuals select either methadone maintenance or detoxification followed by medication-free outpatient treatment. This study examined demographic, drug use, and drug abuse treatment history for opioid dependent patients entering an opioid agonist (n = 203) or a medication-free (n = 155) treatment program located on the same hospital campus. Similar demographic profiles support the assertion that samples were drawn from the same inner city urban opioid using population. Patients entering drug-free treatment, however, reported more extensive prior use of both cocaine and alcohol. Further, these patients had a generally more severe profile of psychosocial problems in medical, legal, employment, family/social, and psychiatric areas as measured by the Addiction Severity Index (ASI). These findings suggest that outpatient drug-free programs enrolling opioid abusers are faced with a unique service delivery challenge that involves service needs in multiple arenas. The findings further suggest that patient self-selection of treatment programs may in some cases result in a discrepancy between patient needs and the ability of treatment programs to retain patients and deliver an appropriate array of services.