This article examines the satisfaction of users of cocaine and/or opiates and non-drug users with access to the health care system. Data were obtained from a sample of 1,477 injection drug users, non-injection drug users, and non-drug users recruited from neighborhoods with high drug use. Multiple regression examined the relationship between satisfaction with access to health care and demographic, health status and health care utilization, ability to pay, and alcohol and drug use variables. Age, ethnicity, health status, having received health care in the last 12 months, not having received health care when needed, having received preventive health care, health insurance, and drug use were independently associated with satisfaction. Injection drug users and non-injection drug users were less satisfied with access to health care. The article discusses strategies to improve health care delivery to drug users.