I’ve been aware of methadone maintenance since about 1981, when I rotated through a clinic as a medical student.
Methadone maintenance started as a ‘harm reduction’ strategy, when it was noted that heroin addicts who used methadone instead generally were able to engage in goal-oriented activity (above and beyond obtaining their next fix), weren’t on the nod constantly, and when they did take heroin on top of the methadone, didn’t get as much euphoria from it.
The goal was to get the heroin addict habituated to a high enough methadone dose that would keep them from seeking out more heroin. The euphoria of methadone is much much less than that of heroin, oxycodone, morphine, and other shorter-acting opioids. These folks could get go out and hold down some sort of job, stop burglarizing homes to get money for their next fix, etc.
In the medical community it was never considered the equivalent of antabuse.
It’s been somewhat successful in reducing harm for some folks. Personally I think it’s a better plan to eventually get folks off opioids completely. But for chronic relapsers whose lives are really going to hell, it’s something.
Suboxone maintenance is all the rage now, and that’s probably safer than methadone. But problems exist there too. I’m a licensed suboxone prescriber, but use it only to detox patients, not to maintain an opioid addiction.
So I feel the approach is legit, if not ideal. Of course, a number of unscrupulous practitioners did open methadone clinics, and made lots of money off it, or tried to, and didn’t always practice up to best principles. But this happens in any venture, sadly.