After ten years since its introduction by Dole and Nyswander methadone maintenance remains a controversial treatment for opiate addiction. In a historically oriented examination of the sources of controversy, changes over time, and evaluation evidence, the present status of methadone maintenance treatment reflects the influence of a complex mixture of pressures and counterpressures in the political, economic, social, law enforcement, and medical domains. Both social control aspects, representing official concern with “the addiction problem,” and medical-rehabilitational aspects are merged in the system that makes methadone available as an experimental drug for maintenance treatment. Evaluation results show that this treatment has overall been highly effective and that in cost benefit terms, even if it were structured to include all of the staff and rehabilitation services required for optimal results, it would still compare favorably with residential, inpatient, and comparable outpatient treatments.
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