Methadone maintenance is the most effective known treatment for heroin addiction. Used properly, methadone reduces drug use and related crime, death, and disease among heroin users. But methadone has been handicapped by restrictive government regulations, by misinformation - among treatment providers and drug users alike - and by prejudice against methadone treatment. Methadone is the most tightly restricted drug in the U.S. It is confined to specialized treatment programs, which tend to be underfunded, punitive, and in short supply. Doctors in general medical practice can't prescribe methadone, and regular pharmacies don't distribute it.
Given the upswing in heroin use in many U.S. cities, coupled with a raging HIV/AIDS epidemic among drug injectors, it is now essential to reinvent methadone as a harm reduction intervention. This means delivering methadone treatment in such a way that it is available and acceptable to a far greater range of heroin users. It is time to give serious consideration to foreign models of providing methadone, which utilize not only standard methadone clinics but family medical doctors, pharmacies, methadone buses (mobile clinics), and reduced-service clinics. There is no sound economic, medical, or practical argument against at least trying these innovations, which are already commonplace in many other western nations.