Considerations for equitable distribution of digital healthcare for people who use drugs

Background: Telehealth holds the potential to expand healthcare access for people who use drugs (PWUD). However, limited data exist on their digital infrastructure access, a prerequisite for telehealth participation. We studied digital healthcare accessibility among PWUD. Methods: We employed respondent-driven sampling to recruit 162 PWUD in Athens, Greece to assess current internet and computer access and telemedicine experience via a structured questionnaire. Participants were at least 18 years with an injection drug use (IDU) history. We utilized logistic regression to evaluate sociodemographic associations. Results: Participants’ mean (SD) age was 45.9 (8.8) years, 84.0% were male, 90.1% Greek, 77.8% reported IDU within the past year, 85.2% were not linked to opioid treatment, and 50.0% were experiencing homelessness. Only 1.9% had telemedicine experience. Internet and computer access were reported by 66.0% and 31.5%, respectively. Most (77.9%) used mobile phones for internet access. Compared to participants with secure housing, those experiencing homelessness reported decreased internet (50.6% vs. 81.5%, p < 0.001) and computer access (11.1% vs. 51.9%, p < 0.001). Multivariable analyses revealed that older age (per 1-year increase: OR = 0.94, 95% CI [0.89, 0.99], p = 0.03)), IDU within the past year (0.29 [0.10, 0.88], p = 0.03), and homelessness (0.29, [0.13, 0.65], p = 0.003) were associated with lower odds of internet access. Conclusions: Two-thirds of PWUD accessed the internet, mainly via mobile phones, while only one-third gained access through a computer. Very few PWUD used telemedicine. Homelessness, recent IDU, and older age may further limit digital infrastructure access and should be considered when designing equitable digital healthcare solutions for PWUD. Trial registration: Registered on ClinicalTrials.gov