Victims of homicides and fatal accidents in New York City from 1990 through 1998 were identified through manual review of all medical files at the Office of the Chief Medical Examiner of New York (OCME). These files contained victim demographics, manner and cause of death, place of death, and toxicology. The study excluded accidental fatal drug overdoses and victims who were younger than 15 years old and those who were over 65 years old. The drugs considered in the analysis were cocaine, opiates, and alcohol. The study calculated the homicide and accident death rates in the city over the targeted period, stratified by age, race, and gender, as well as the rates of homicide and accidental deaths with positive drug and alcohol toxicology. The study found that the proportion of homicide and accident victims with cocaine in their systems declined between 1990 and 1998 (13 percent and 9 percent, respectively). The proportion of homicide and accident victims who tested positive for opiates and/or alcohol did not change significantly over the study period. Changing patterns of drug and alcohol use by homicide victims were comparable to changing patterns of drug and alcohol use in accident victims. These findings suggest that changes in drug and alcohol use among homicide victims between 1990 and 1998 cannot be the only or the primary explanation for the decline in New York City homicide rates. 1 table, 4 figures, and 27 references