Cocaine occupies an established place in the British illicit drug scene; data point to London and several other metropolitan areas as core centers of the problem. Smokable cocaine (crack) represents a notable and worrisome new feature of cocaine use in the 1990s. After discussing the prevalence of cocaine use and associated problems, the article describes the orientation of existing services toward cocaine users and identifies future challenges for responding effectively to cocaine users in need of treatment services. The article calls for a new research and development program to guide the national response to cocaine problems, which should include an improved range of monitoring activities to follow trends in cocaine-related morbidity and mortality and hospital emergency admissions for drug-related crises. The needs of dependent users must not be overlooked and evidence-based treatment programs are required to assist those who have established problems. Figures, note, references