Treatment of opiate addicts is still difficult, and often has only limited success. Methadone therapy offers an alternative, in particular for patients who have repeatedly attempted conventional treatment without success. According to experience in Switzerland, about two-thirds of these patients become medically stable and socially rehabilitated during methadone therapy, or even drug-free in the long term following therapy. The therapy does not consist solely in a daily dose of methadone, but also involves intensive psychosocial care. In Germany, methadone therapy has been under discussion for more than 20 years. In this discussion doubts have been expressed about the criteria used to assess the indications for and the degree of success attained with methadone therapy. In addition, ethical arguments question whether social rehabilitation should be a primary goal of therapy. In order to objectify the discussion, methadone therapy is now being tested in Germany. A social consensus must be sought on goals and strategies in the treatment of opiate addicts.