The effect of concomitant cocaine and methadone use on the neonatal withdrawal syndrome was examined in a group of 68 infants born to mothers participating in a methadone maintenance program. Fifty-three (78%) of the mothers in the sample reported regular use of cocaine during their pregnancy and/or had positive urine screens. Infants exposed to both cocaine and methadone had significantly higher first withdrawal scores. However, cocaine exposed infants did not require more medication for withdrawal management either in terms of dosage or of days treated. Additionally, there was no difference in the occurrence of intrauterine growth retardation, prematurity, or early perinatal complications such as respiratory distress.