Introduction
Several major cities face public health challenges related to Open Drug Scenes (ODS), where illicit drugs are used and sold openly in public spaces. Despite the growing public and political attention attracted by ODS, quantitative studies exploring the profile of people who use drugs (PWUD) within ODS are lacking. This study aimed to: i) examine the profile of PWUD within ODS in three metropolitan cities of Brazil, and ii) explore potential profile factors associated with willingness to change and healthcare utilisation among PWUD within ODS. 

Methods
Cross-sectional survey using time-location sampling method interviewed 489 PWUD at ODS across three Brazilian cities during 2021–22. Latent class analyses to identify homogeneous classes of PWUD based on ODS attendance patterns. Multinomial logistic regression models examined factors associated with willingness to change across profile classes. 

Results
Two PWUD profiles in ODS were identified: Chronically Excluded (61.0%) and Self Excluded (39.0%). Both showed high levels of willingness to change, and it was associated with physical health problems. Among the CE group, willingness increased with welfare benefits, emergency care for drug intoxication, and SUD treatment.

Conclusion
This study offers new insights into PWUD profiles in Brazil’s ODS, showing high willingness to change across both profiles despite varying levels of social exclusion. The association between willingness to change and healthcare use underscores the need for brief interventions and improved referrals to specialised treatment within primary care services. To respond to the ODS challenge public policies must integrate social and healthcare models.