Methadone (Dolophine, Amidone, Methadose, Physeptone, Heptadon and many others) is a synthetic opioid, used medically as an analgesic, antitussive and a maintenance anti-addictive for use in patients on opioids. Methadone acts on the opioid receptors in the brain. It works to prevent withdrawal symptoms and also reduces the effect of injecting Heroin. Methadone is not indicated for patients who use drugs outside of the opiate class.

The thinking behind prescribing Methadone is that of the "harm reduction" paradigm. Instead of trying to stop an addict from using drugs this method of thinking seeks to make drug use more manageable and less harmful. An addiction treatment program wouldn't neccessarily seek complete abstinance from all mood-altering substances under this paradigm.

Critics of this paradigm say that it keeps addicts sick and doesn't treat the addiction. The addiction to the street drug is just replaced with an addiction to methadone. They also argue that addicts often sell their methadone to purchase heroin, or use heroin as well as their methadone dose. In this paradigm addiction recovery requires complete abstinance from all mood-altering substances and a drug rehab in South Africa should help an addict achieve this. They argue that rehabilitation implies that an addict is taught a new way of living and not just taken off the drug.

Proponents argue that it is effective and more affordable than addiction treatment in residential drug rehab programs. They say that dependence on methadone is safer than addiction to heroin. Addiction is characterized by out of control behaviour and negative consequences, which they argue are not present if the addict is dependent on Methadone.

The harm reduction paradigm argues that because the addict has access to a prescribed drug he/she will not have to look for heroin on the streets. This reduces some of the dangers associated with using heroin. Also, methadone is taken orally and so addicts will be less likely to spread HIV/AIDS or other bloodborne diseases like Hepatitis. The harm reduction paradigm argues that admission to a residential drug rehabilitation clinic is expensive and not always associated with a positive treatment outcome.

Unfortunately people using Methadone will develop tolerance and dependence with repeated doses. Tolerance usually comes within the first few weeks of use. Methadone has withdrawal symptoms similar to the street opiates that are very uncomfortable. A patient should only try to detox under medical supervision in a properly equipped drug rehab center. Methadone withdrawal normally lasts for about a week but individual factors may influence this.

If Methadone is used as part of a rehabilitation program it should be closely monitored to ensure that the addict is using the correct dose, is not using other substances, and is not selling the methadone on the street. If Methadone is abused it can have very negative side effects and addiction is quite possible if the patient is permitted to continue abusing this drug.

Methadone is not addiction treatment in itself and the addict will still need to receive behavioural therapy to learn a new way of life. It can help to make life easier for the opiate addict, but is not currently particularly popular in South Africa.