Background <p>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.</p> Methods <p>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.</p> Results <p>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%, <i>p</i> &lt; 0.001) and computer access (11.1% vs. 51.9%, <i>p</i> &lt; 0.001). Multivariable analyses revealed that older age (per 1-year increase: OR = 0.94, 95% CI [0.89, 0.99], <i>p</i> = 0.03)), IDU within the past year (0.29 [0.10, 0.88], <i>p</i> = 0.03), and homelessness (0.29, [0.13, 0.65], <i>p</i> = 0.003) were associated with lower odds of internet access.</p> Conclusions <p>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.</p> Trial registration <p>Registered on ClinicalTrials.gov (ID: NCT05794984, Protocol: STUDY00007088, Date: 2023-04-03)</p>