We determined the prevalence of recent cocaine and alcohol use among motor vehicle fatalities occurring in New York, NY, from 1984 through 1987. Recent cocaine use was detected at autopsy in 18.2% of the sample and no significant difference between drivers (20.0%) and passengers (13.9%) was found. Both alcohol and cocaine metabolites were found in 10.0% of cases tested. The prevalence of cocaine metabolites or alcohol detected in driver fatalities aged 16 through 45 years did not change significantly when the period prior to the widespread availability of "crack" cocaine (1984 through 1985) was compared with the period immediately following the introduction of crack cocaine (1986 through 1987). Additional studies are needed both to elucidate the association between cocaine use and these fatalities and to determine the value of screening persons seriously injured in traffic accidents in areas where such drug use is endemic.