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The patient has been using heroin or another opiate. Methadone is not appropriate for dependence on stimulants, minor tranquillisers or alcohol.

The patient wants to stop using opiates. Methadone should not be used together with other opiates. Although tolerance to the pleasurable effects of the opiates occurs fairly rapidly, there is little or no tolerance to the respiratory depressant and antitussive effects.

The patient is using more than 0.25 g heroin daily on most days. Patients who use only small amounts ("a small habit") or who use opiates infrequently are unlikely to be physically dependent. Methadone therapy would ensure that they become physically dependent.

The patient's pattern of use is erratic, impulsive and/or places them at risk of infections such as HIV, hepatitis A or C. Methadone programs provide a stabilising routine for these patients, reducing the incidence of needle-sharing and accidental overdose (due to varying potency of supplies). The programs aim to reduce the patient's contact with and involvement in the drug subculture and crime.

The patient is pregnant. Heroin use presents many risks to the pregnant woman and her fetus. In addition to fetal distress caused by repeated cycles of intoxication and withdrawal, heroin use is associated with increased risks of maternal septicaemia, intrauterine infection with HIV or hepatitis viruses, low birth weight and impaired neonatal general health.

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