Opioid Use Disorder (OUD) poses a significant public health challenge globally, with an estimated 23 million opioid users in India. Opioid Agonist Therapy (OAT) stands as the cornerstone of treatment, offering potential reductions in morbidity, societal burdens, and improvements in patient quality of life. However, OAT coverage remains fairly low in India, with clinical guidelines lacking comprehensive information on implementation pragmatics. This viewpoint delves into the nuanced challenges faced by clinicians in the daily operations of OAT emphasizing disciplinary issues, practical responses, and the broader implications for treatment outcomes and public perception. The treatment provider's response is explored from different aspects like learning theory, attitude, psychodynamic interactions, and ethics. Understanding patient perspectives, including employment demands and perceptions of fairness, is crucial in tailoring responses and optimizing treatment engagement. While disciplinary measures are integral to maintaining treatment sanctity, their effectiveness must be balanced with patient autonomy and harm reduction goals. The discourse surrounding OAT disciplinary measures necessitates a multifaceted approach, integrating evidence-based practices, clinician experiences, patient rights, and administrative considerations to ensure equitable and effective treatment provision.