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Methadone replacement is a common answer for some when it comes to heroin abuse, but one of the biggest problems with this treatment method is that the root causes and underlying problems that cause the addiction are not eliminated. Another issue is the fact that methadone is an opiate drug that is highly addictive, so using methadone replacement to treat heroin abuse is simply switching one opiate drug for another. The end result is still the same, although people who inject heroin will stop shooting up because methadone can survive while going through the digestive tract so the drug is swallowed. The user is still addicted to an opiate throughout treatment, and if the methadone is stopped then the user will normally go back to heroin abuse.

When methadone replacement for heroin use is initially started the user will receive a specific dose, and then there is a waiting period. If the individual still has cravings and the opiate receptors in the brain are not fully saturated an additional amount of methadone is given, and then there is an additional waiting period. This process repeats until the optimal dose of methadone is discovered, and then that is used as a daily maintenance dose. A clinic or physician provides the maintenance dose to the user, normally on site. In some situations the user may be provided with more than a daily dose, and these are typically referred to as take home doses. There is some counseling provided during the appointments to receive methadone but there are usually short and not very effective.