It would hardly surprise nurses to hear that opioid use is a significant problem in Australia. Yet how many would have a precise idea of the extent of the problem or the availability of services to meet the associated health needs? In 2010, 46,078 Australians were registered in Opioid Replacement Therapy (ORT). Its popularity reflects demonstrated benefits in: reducing illicit drug use; the occurrence and severity of physical and mental illness; and criminal activity, common consequences of drug seeking behaviour. The attractiveness of ORT has resulted in a wait for treatment. Despite demand exceeding availability there is no national triage system for ORT. Therefore it is unknown whether people with the most pressing need for treatment (those at risk of harm and with minimal protective factors) are receiving it in a timely manner. With reports of a further 41,000 people in need of opioid treatment intervention, research is required to identify the real extent of the problem and to implement a system which processes people efficiently into treatment.