It originates in the Coquihalla Lakes and empties into the Fraser River at Hope.

[5][6] The river flows through a deep, narrow valley, dropping 3,400 feet (1,000 m) in 33 miles (53 km), a tumultuous course that creates an incessant roar.

It refers specifically to a deep pool named Skw'éxweq or Skw'exwáq, near the mouth of what is now known as the Coquihalla River.

According to Stó:lō oral history, the s'ó:lmexw (black-haired, 2-foot tall, dark-skinned underwater people) would grab the spears, preventing fish from being caught.

[7] The Coquihalla Highway, which runs from Hope to Kamloops, derives its name from running alongside this river between Hope and the site of a former toll booth about 50 kilometres (31 mi) away.