Psychosis was present in 29 percent of cocaine-disordered patients hospitalized in 1985 during an epidemic of freebase cocaine abuse in the Bahamas. Record reviews revealed that a variety of psychotic phenomenologic patterns were present. Prior major mental disorders and increased dosage of cocaine were more common among psychotic than non-psychotic patients. Violent behavior was common among cocaine patients, especially those with psychosis. We conclude that freebase cocaine psychosis is neither rare nor benign.