Methadone maintenance as a treatment modality for heroin addiction in the mid-1960s was part of the medicalization of social problems in the United States. By the 1970s methadone maintenance was seen as a way to reduce drug-related crime, and federally funded programs proliferated. However the expansion of methadone use was accompanied by increased regulation, bureaucratization and criticism. The early 1980s brought fiscal austerity, the new "just say no" abstinence morality and demedicalization of methadone maintenance. By the time needle-sharing was recognized as a major contributing factor in the spread of HIV, methadone had been transformed into a largely fee-for-service, short-term, begrudgingly tolerated treatment modality. While other countries were able to use methadone to curb the spread of AIDS, the United States refused to facilitate its expansion and, in fact, impeded it. This original harm-reduction tool, with the potential to influence the epidemic, was demedicalized and remains marginalized. Notes, references