We describe the use of psychotropic medications among youth in treatment foster care (TFC). Data from 240 youth were coded to examine rates of medication use, including polypharmacy and an indicator of ‘questionable polypharmacy.’ Fifty-nine percent of youth in TFC had taken a psychotropic medication within the past 2 months. Of the youth taking psychotropics, 61 % took two or more and 22 % met criteria for questionable polypharmacy. The majority of youth taking psychotropics also received psychosocial mental health services and were more likely to receive such services than youth not taking medication. Use of psychotropic medication use was not significantly related to demographic factors, maltreatment history, or custody. However, youth with more severe symptoms were more likely to be on medications and to be on multiple medications. Youth with ‘questionable polypharmacy’ were less likely than other youth on multiple medications to have a recent visit to a psychiatrist.