This study aimed to explore the contraceptive practices of women in methadone treatment for opiate use in rural New South Wales and the reasons for those practices. Demographic characteristics, including age, marital status, sexual activity and contraceptive use, of all 23 women on a rural methadone program were documented. A smaller subgroup of seven women was interviewed using a semi-structured qualitative technique and issues around contraception explored in more depth. The study found that women who did not use contraception often had a low perceived risk of pregnancy for a variety of reasons including past infertility, menstrual irregularities and effect of drugs. The women had concerns about, and often felt guilty about, the effect of drug use on their children. They also had concerns about the side-effects of contraception. The study has implications for education and counselling of women when they enter drug treatment programs. Problems associated with opiate use are not just restricted to metropolitan areas but are part of rural health.