Methadone maintenance treatment for heroin addiction remains controversial worldwide. This article presents a brief history of the emergence of heroin into Germany’s illegal drug market and of methadone’s uses in treating heroin addiction. Focusing on the evaluation of methadone maintenance treatment programs in Germany, the author found that the average age of methadone patients is above 30 years old and that there is often marked improvement in the general health status of methadone patients even in the initial phase of the treatment program. The author details the modern German Narcotics Act, passed in 1971 and modified in 1982, in order to describe the specific ways in which drug-substitution treatment legislation has controlled the administering of methadone maintenance treatment programs. Addressing the current state of affairs in Germany’s drug substitution programming, the author explains that current methadone maintenance treatment programs work in conjunction with Germany’s overall drug policies of emphasizing harm reduction, assistance, and treatment options rather than emphasizing law enforcement approaches to drug abuse. The Federal Medical Board’s plan to draw up drug substitution guidelines in accordance with the Regulation on the Prescription of Narcotics is likely to improve the quality and availability of drug-substitution treatment in Germany. References