The use, advantages, disadvantages and side-effects of methadone are described. Outcome studies are reviewed. It is suggested that there is no good scientific evidence that dispensing methadone to non-compliant patients is an effective intervention. This is supported by studies at the Royal Newcastle Hospital which show that the longer the non-compliance the greater the failure rate. The dangers of continuing to prescribe methadone to patients using other illegally obtained drugs are emphasised. The need to supervise urine collection is highlighted. Alternatives to methadone maintenance (including therapeutic communities, narcotic antagonists, drug-free counselling, needle exchange programmes and benign neglect) are discussed.