Understanding issues of driving safety and transport utilisation among clients receiving opioid agonist treatment: a cross-sectional survey in New South Wales, Australia

Background Barriers to accessing opioid agonist treatment (OAT) extend beyond regulatory and clinical constraints, with logistical factors such as clinic location, limited prescriber availability, and transport challenges also playing a role. Despite this, transport-related barriers remain underexplored in the literature. This study aims to examine transport practices and driving histories among OAT clients. Methods A cross-sectional survey across 15 public OAT clinics in New South Wales, Australia, was performed. Data were collected on participant demographics, sedating medication and illicit substance use, driving and other transport practices, and driving offence histories. Multivariate binary logistic regression examined factors associated with driving under the influence and reported driving offences. Results Of the 482 clients surveyed, 86.5% reported using sedating medications or illicit drugs in the past month, and 40.3% had driven within that period. Fifty-seven participants reported driving after using a potentially impairing substance in the last month, who were more likely to receive OAT from a private clinic or pharmacy (aOR = 2.37, 95% CI = 1.14–4.92) and report past month illicit drug use (aOR = 6.55, 95% CI = 2.89–14.83). Participants with recent driving offences were more likely male (aOR = 1.87, 95% CI = 1.11–3.13) and to have a history of a driver licence suspension (aOR = 8.95, 95% CI = 5.38–14.90). Conclusions Although substance use was common among participants, which could impact on driving safety, most did not report driving under the influence. A subset of clients who drive while impaired may present a public safety risk, and strategies to address this issue would be warranted. Ensuring appropriate access to OAT, including consideration of transport availability, remains a key component of equitable and safe treatment delivery.