AbstractThe present paper is concerned with factors which compromise the effective delivery of programmes incorporating methadone. Current clinical practices and programme characteristics are reviewed and policy issues regarding the role of methadone are considered, especially within the context of containing the spread of HIV infection. These issues are discussed in relation to empirical outcome studies, local prescribing trends and clinical case material. The authors conclude that there is an urgent need for: (1) an evaluation of the outcome of private practitioner methadone dispensation versus comprehensive agency‐based therapy; (2) the accreditation of staff in all programmes incorporating methadone; and (3) the development of monitoring mechanisms, including on‐site clinical audits of program