Needle service provider trends for image and performance enhancing drugs in Queensland, Australia 2016–2023

Image and performance-enhancing drug (IPED) use is an emerging health concern in Australia, particularly within needle and syringe programs (NSPs). This study examined trends in IPED equipment access, demographic shifts, and metropolitan–regional disparities in Queensland (2016–2023). A retrospective observational analysis used data from Queensland NSPs and the Queensland Injectors Health Network (QuIHN) (2016–2023). Statistical tests (paired t-tests, ANOVA, Chi-square) assessed changes in demographics and regional access patterns. Access to IPED injection equipment via QNSP services declined from 12.4% (2016–2019) to 8.7% (2021–2023, p < 0.01), with requests nearly halving in 2020 during the pandemic. Access among clients aged 16–24 years dropped 4.2% post-COVID (p < 0.05). QuIHN services increased from 9.5% to 17.9% (p < 0.01). Regional sites recovered faster than metropolitan ones, increasing provision nearly twice as quickly (1.56% vs. 0.94% per month). Younger people (18–24 years) showed rising initiation rates over the study period. IPED equipment provision increased prior to 2020 and stabilized post-pandemic at elevated levels. Rising service provision among younger clients highlights the need for targeted education and accessible harm reduction services, while regional differences emphasize the importance of alternative service delivery models, ongoing monitoring, and coordinated stakeholder engagement.