The need for continued development of medications to address opioid and cocaine addiction is unequivocal. Methadone maintenance, despite its limitations, remains the best-established pharmacologic treatment for opioid dependence. Continued participation in methadone programs is associated with decreased risk of acquiring HIV infection. Clonidine alone or combined with naltrexone may be used for opioid detoxification in the office practice. At the present time, no proven pharmacologic therapy for cocaine addiction exists.