Factors Associated With Opioid Agonist Treatment Engagement and Harm Reduction Service Use: Findings From the New South Wales Opioid Dependence Survey

Introduction:
Opioid agonist treatment (OAT) is one of the most effective treatments for opioid dependence, but there can be barriers to accessing treatment. This study examined characteristics associated with OAT engagement—never, previous or current—among people with opioid dependence in NSW, Australia, following recent reforms to OAT access.

Methods:
Between October 2023 and March 2024, people with opioid dependence were recruited from services and community settings across NSW. Participants completed structured interviews on socio-demographics, mental health disorders, substance use and use of prevention and treatment services. Logistic regression was used to examine associations between participant characteristics and engagement with OAT.

Results:
Of 403 participants (mean age 44; 65% male), 77% were currently receiving OAT (60% methadone, 11% sublingual buprenorphine and 27% long-acting injectable buprenorphine), 13% previously and 9% never. Differences between OAT status groups included those currently receiving OAT reporting lower rates of homelessness and extra-medical opioid use, and greater group therapy engagement and past-year receipt of naloxone kits compared to those previously and never receiving OAT. Past-month daily injecting drug use was higher among those previously and never receiving OAT; those previously receiving OAT also reported the highest rate of past-year supervised injecting facility use and overdoses in the past 6 months.

Discussion and Conclusions:
Those not receiving OAT reported greater social instability, recent injecting drug use and drug-related harm. Variation in harm reduction service use suggests tailored strategies are needed to reach those outside OAT. These findings highlight the need for integrated, diverse strategies to address dependence-related harms.