Objective Globally, drug-related deaths impact both urban and non-urban areas. In Australia, regional areas face a concerning rise in drug-induced fatalities and suicides, exacerbated by structural factors like limited services and stigma. We sought to explore the experiences of people who use drugs (PWUDs) in regional Queensland to understand the structural vulnerabilities influencing drug-induced deaths.

Methods The sample comprised 19 PWUDs from regional Queensland, Australia who had experienced overdose. Semi-structured interviews explored participants’ overdose experiences and contributing factors, focusing on regionality. Iterative coding was used to develop thematic categories.

Results Participants highlighted the complex interplay of trauma, coping and drug use influencing overdose dynamics. Regional challenges, including limited access to support services, exacerbate risks for PWUDs. Structural inequalities perpetuate cycles of harm, with rural areas disproportionately affected. Participants emphasized the need for systemic changes to facilitate effective suicide prevention efforts, advocating for enhanced service engagement and legislative reforms.

Conclusions These findings challenge systemic factors such as stigma and healthcare accessibility, which appear to be driving drug-related harm. Based on the findings, recommendations are made for systemic change, represented by comprehensive, community-driven interventions to address structural inequalities, and improve access to support services.