Abstract
Despite the proven effectiveness of methadone maintenance treatment in the management of opiate dependence, methadone maintenance programmes have met with almost universal opposition and controversy in countries all over the world. The unique aspects of methadone treatment are examined, including the stringent restrictions imposed on methadone programmes and the convention of sub-optimal dosing adhered to in many programmes. Finally, some reasons for the under-utilization of this treatment mode are proposed, and the implications of current attitudes towards methadone maintenance programmes are examined.