ABSTRACT Introduction Opioid agonist therapies (OAT) reduce adverse outcomes of illicit opioid use, with individual preferences potentially improving treatment outcomes. We explored preferences for OAT and associated factors in a national sample of people with opioid dependence. Methods This cross‐sectional study recruited 400 participants (October 2020–April 2021) across Australia (excluding Tasmania) through snowball sampling. Participants completed an interviewer‐administered questionnaire on sociodemographic and drug use characteristics. Multivariable logistic regression assessed factors associated with methadone preference (vs. buprenorphine). Results Among all participants (median age 45, 41% female, 87% ever received OAT), 92% ( n = 366) indicated a preference for receiving OAT (vs. not receiving OAT) and 96% of those ( n = 352) preferred a particular type of OAT. Among 366 with a stated preference, 61% ( n = 216) preferred methadone and 39% ( n = 136) preferred buprenorphine. Among those preferring buprenorphine ( n = 136), 50% ( n = 68) preferred buprenorphine ± naloxone and 50% ( n = 68) preferred long‐acting injectable buprenorphine. Independent correlates of preferring methadone included past month heroin use (aOR 1.78, 95% CI 1.06–3.00) and non‐prescribed pharmaceutical opioid use (aOR 2.23, 95% CI 1.07, 4.95), and any prior receipt of methadone treatment (aOR 6.54, 95% CI 2.66, 17.91). Among those receiving OAT, a higher proportion of people currently receiving buprenorphine preferred their medication (61/66, 92%) compared to methadone recipients (180/235, 77%). Discussion and Conclusions Nearly all participants preferred OAT, mostly reflecting prior experiences, underscoring the need for expanded access to OAT in Australia. Given the multiple stated preferences, OAT options should include a variety of treatment options aligned with patient preferences, including expanded take‐home options.