OBJECTIVE To study the utilization patterns of herbal drug use in urban Ethiopia. METHODS A cross-sectional community-based survey was conducted in Addis Ababa, capital city of Ethiopia, using a pretested semi-structured questionnaire. The questionnaire was administered to 600 heads of households, largely mothers, selected using a multi-stage systematic random sampling technique, where the final sampling units were households. RESULTS The prevalence of herbal drugs use was found to be 37%. The main reasons given for choosing herbal medicine as the first line medication option were: dissatisfaction with the services of modern health institutions due to their time consuming nature, cost considerations and perceived efficacy. CONCLUSIONS This study showed that in spite of the geographic accessibility of modern health institutions in urban areas, the use of traditional medicine, particularly herbal drugs, remains a major form of health care option. Hence health planners should give appropriate consideration to this sector.