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Table 4 Quotes illustrating factors contributing to drop-out from the OST program

From: Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India

Wanting to experience the pleasure of drugs
In my view, yes, taking methadone keeps us away from the pain, but it does not give us any pleasure. After taking the methadone, people become free from all the tension about money or police, but sometimes people like to enjoy the pleasure of the drugs which they don’t get it if they take the methadone. Even for me, during the initial stage of starting the methadone, I had an extreme desire to enjoy the pleasure of drugs just for once… So I think the chief reason for dropout would be people having the desire to enjoy the pleasure of taking the drugs. Participant 18 (retained)
He [the client] can’t forget the pleasure that drugs give, and when he sees someone experiencing the pleasure of the drugs, he also wants to experience again that pleasure he once had. With methadone there is no kick or pleasure, it only gives relief from the enduring pain… He thinks of continuing the drugs for some more time as the methadone opportunity will always be there down the road. Participant 4 (retained)
I started mixing up the methadone with other drugs and enjoyed the pleasure, which continued further. Later on, a problem cropped up with the family members regarding money and other issues, so they finally put me in the rehabilitation centre. Participant 20 (dropped-out)
Influence of drug using peers
It might be that there are still some active users in his locality who persuade him, or he cannot set apart from them. After taking the methadone dose he may have returned to a group of active users who are still his friends, even though he hasn’t taken drugs for some days. When he mingles with these active users, he could feel the odd man out…. So this could be one of the reasons. Participant 4 (retained)
Wanting a faster pathway to a drug-free life
I joined the program thinking that it was some kind of detoxification and hoping it would work for me. I thought I could be free from drugs in a short duration of time, but it happened to be long term, so I left the program. I had wanted to quit the drugs very soon, but as the methadone program consists of one year, I could not continue that long. So I did not complete the program. Participant 6 (dropped-out)
For me I wanted the total abstinence. I did not want to continue depending on anything else. I wanted to be free from everything, so I dropped out from the program… I never had any problem with the methadone. Taking the methadone was far better than taking the drugs. I only wanted a total abstinence without depending on any other drugs. Participant 9 (dropped out)
Misunderstanding/misinformation about methadone
Interviewer: Have you ever thought of quitting the methadone?Respondent: Yes, sometimes I had that feeling. But who flees from a tiger only to confront a bear… Even though the methadone is not exactly like the heroin, it is still some kind of drug. So there is a feeling that if we continue taking it for long time, it might be harmful for us. There is an apprehension of being dependent on the methadone. Participant 14 (retained)
I had heard that methadone is very harmful to the body and wherever the methadone flows inside the body, it gets damaged. After that I thought of quitting it and once I asked the counsellor if there are any side effects with the methadone. The counsellor told me there is no side effect except some constipation and slight effect to the teeth. They told me not to worry and I got more relaxed after hearing that. Participant 18 (retained)
Pressure from family members
There are some situations where the clients have dropped out due to the influence of the parents because the parents thought that as their son has taken methadone for a few months and has changed, it would be better for him to quit the methadone rather than depending on it for a longer period of time. Hoping so, their parents withdraw their son from the program and their son gets relapsed after a few days. Service provider 26