The history of MMT in New South Wales, as in the United States and Europe, has been one of fluctuating political and community support. For a period there has been support for such treatment, but this has been undermined by a questioning of its validity and effectiveness. Community fear and disapproval of addiction is expressed through punitive attitudes toward addicted individuals. The unrealistic expectation that methadone treatment will solve the problems of addiction in a community has eroded support for MMT in an era when heroin supply and use are increasing. Popular perspectives of methadone treatment view it as a system of controlled drug distribution designed to reduce the harmful consequences of heroin addiction. It is within this frame of reference that regulations about how methadone should be prescribed and dispensed are more relevant than principles of treatment. The regulatory ethos, however, is antithetical to clinical judgment and individualized treatment. Regulation is particularly inappropriate in a modality of treatment in which research and experience have failed to achieve a clear prescription of how MMT should be delivered. Accreditation of treatment facilities, assessed through external, independent, clinically experienced people, is probably the most critical component of quality improvement for MMT. Accreditation should involve compliance with specifications for training, the development of practitioner skills and knowledge, standards of care, outcome indicators, and process indicators. 35 references