Background: Telehealth has the potential to increase healthcare access for people who use drugs (PWUD), a typically medically underserved population, by overcoming geographical and temporal barriers. However, PWUD’s access to telehealth and necessary technological infrastructure, such as the internet and computers, remains understudied. We studied the access to digital technology and telehealth utilization among PWUD to inform the planning of telehealth interventions tailored to their needs. Methods: We employed respondent-driven sampling to recruit 162 PWUD to participate in a 109-item structured questionnaire. Eligibility criteria required participants to be at least 18 years old, have a history of injection drug use (IDU), and Greek verbal fluency. The main study outcomes included current internet and computer access, and telehealth use. We used logistic regression to evaluate the impact of sociodemographic characteristics and IDU on these outcomes. Results: The participants' mean (standard deviation) age was 45.9 (8.8) years, with 84.0% (136/162) being male and 90.1% (146/162) Greek. Among the participants, 77.8% (126/162) reported IDU within the past year, 85.2% (138/162) were not currently linked to opioid agonist treatment, and 50.0% (81/162) were currently experiencing homelessness. Internet and computer access were reported by 66.0% (107/162) and 31.5% (51/162) of participants, respectively. Compared to participants with secure housing, those currently experiencing homelessness reported decreased internet (50.6% vs 81.5%, p<0.001) and computer access (11.1% vs 51.9%, p<0.001). Only 1.9% (3/162) had ever used telemedicine, and 24.1% (39/162) reported awareness of telemedicine as a healthcare delivery modality. Multivariable analyses revealed that increasing age (per 1-year increase: odds ratio OR=0.94, 95% confidence interval 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. Unemployment (0.25 0.07, 0.98, p=0.05) was also associated with lower odds of computer access. Conclusion: Homelessness, older age, unemployment, and IDU within the past year were associated with limited access to digital technology among PWUD. These factors, along with the need to enhance patient education on telehealth, should be considered in policy development to ensure equitable access to digital healthcare for underserved populations.