Theme 2: Committing to the OTP and HCV treatment
depression, vulgar’, anxiety
DISORDER
Participants described their experiences of substance use as losing control of their lives. One participant described his substance use as a primary need ‘to feel a high. [You] will spend all your money, [and] the next day, you're broke’. When experiencing substance use disorder, participants also struggle with symptoms of anxiety and depression that manifest in their attitudes of impatience, short attention spans, and ‘loud and vulgar’ behaviour. Once participants decided to pursue treatment for substance use disorder, they enroled in the OTP ‘trying to get clean and sober’, as the programme provides methadone as an evidence‐based treatment to manage withdrawal symptoms and counselling to address mental health issues, as one participant explained:There's a lot of ways to beat addiction. It is not just ‘give me a bottle of methadone and let me be on my way’. Sometimes people need to talk… Groups are very supportive.One participant explained the need to commit themselves to treatment for both substance use and HCV, ‘It's not mandatory, most of the people [are] there on their own will. Help is there, but [it is] up to you’. Participants depicted the wide array of OTP services in addition to methadone and counselling.[They] can refer you to mental health services… They also have job training programmes… Having a counselor to help with [individual] needs… one‐on‐one is the therapeutic value.Almost uniformly, participants considered the OTP a destigmatizing community where they felt positive reinforcement from frequent contact with OTP staff. Participants appreciated that OTP staff, including counsellors who address them by their first names, nurture mutual respect and understand the nature of substance use disorder:Everybody there really cares and it's personal, we're not just numbers. I can trust them enough to speak [about] what I was going through, and they helped me out a lot.Counsellors provided the first line of support, not only for substance use treatment, but they also facilitated patient engagement in HCV treatment through facilitated telemedicine. The net effect of the OTP is to promote recovery from substance use disorder and co‐occurring conditions, such as HCV, and improve self‐awareness, ‘[The treatment goal] is less of the addiction part and more of It is hard to get someone to come to the programme but stay in the programme as long as it takes because the OTP is an intricate part of your life.