Background: The widespread proliferation of high-potency synthetic opioids, particularly fentanyl, has precipitated a severe public health crisis in North America, with escalating overdose fatalities. Emerging concerns are observed in Australia, where recent incidents underscore the global impact of these substances. This study aimed to explore the role of synthetic opioids in overdoses among people in Queensland, Australia, and identify appropriate harm reduction responses from their perspective.

Methods: Semi-structured interviews with 27 people who used opioids and who had experienced overdose in their lifetime were conducted. An iterative coding process, incorporating deductive and inductive codes, was employed.

Results: Participants emphasised the unpredictability and toxicity of the drug supply, especially with the presence of fentanyl. They highlighted the heightened risks due to decreased tolerance if there were periods of abstinence, and the challenges of using drugs in unsafe environments. There was strong support for safe consumption rooms to mitigate overdose risks.

Conclusion: There are risks faced by people who use opioids due to an unpredictable and toxic drug supply, particularly with the presence of fentanyl. These findings underscore the importance of implementing proactive harm reduction strategies, including safe consumption spaces, to address the harms of synthetic opioids.