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

## TL;DR

This study explores factors linked to opioid treatment engagement and harm reduction service use among people with opioid dependence in New South Wales.

## Contribution

The study identifies differences in social stability, drug use patterns, and service use between individuals currently, previously, and never engaged in opioid agonist treatment.

## Key findings

- Those not in opioid agonist treatment (OAT) were more likely to be homeless and use opioids extra-medically.
- Harm reduction service use varied, with higher naloxone uptake among those in OAT and greater supervised injecting facility use among those never in OAT.
- Integrated strategies are needed to address dependence-related harms among those outside OAT.

## Abstract

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.

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.

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.

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.

A cross‐sectional survey was conducted in New South Wales (October 2023–March 2024) with 403 people with opioid dependence recruited via needle and syringe programs, treatment services, pharmacies and online.Socio‐demographic, mental health and substance use characteristics are summarised overall and by opioid agonist treatment (OAT) status, comparing people currently (77% of cohort), previously (13%) and never (9%) receiving OAT.Compared to those currently receiving OAT, people not receiving OAT (never or previously) were more likely to be homeless, inject daily and use opioids extra‐medically (e.g., heroin, buprenorphine).Harm reduction service use was high overall, with higher naloxone uptake among those in OAT than not in OAT (59% vs. 32%), and greater use of supervised injecting facilities among those never in OAT than currently in OAT (29% vs. 22%).

A cross‐sectional survey was conducted in New South Wales (October 2023–March 2024) with 403 people with opioid dependence recruited via needle and syringe programs, treatment services, pharmacies and online.

Socio‐demographic, mental health and substance use characteristics are summarised overall and by opioid agonist treatment (OAT) status, comparing people currently (77% of cohort), previously (13%) and never (9%) receiving OAT.

Compared to those currently receiving OAT, people not receiving OAT (never or previously) were more likely to be homeless, inject daily and use opioids extra‐medically (e.g., heroin, buprenorphine).

Harm reduction service use was high overall, with higher naloxone uptake among those in OAT than not in OAT (59% vs. 32%), and greater use of supervised injecting facilities among those never in OAT than currently in OAT (29% vs. 22%).