Abstract

This paper presents a critical evaluation of opioid agonist treatment (OAT), particularly methadone maintenance treatment (MMT), compared with opioid antagonist therapy using naltrexone. Drawing on a broad body of literature including randomized controlled trials, cohort studies, and government reports, the paper questions the longstanding assumptions regarding the effectiveness and safety of methadone. It highlights serious concerns regarding methadone-related mortality-especially during induction and cessation phases-long-term dependency, limited efficacy in preventing illicit drug use, and poor impact on the transmission of blood-borne viruses such as HIV and hepatitis C. The review also exposes methodological weaknesses and selective reporting in key studies supporting MMT. In contrast, evidence is presented to support the safety and effectiveness of long-acting naltrexone implants, which offer lower relapse rates, improved social functioning, and the potential for complete abstinence without ongoing opioid dependency. The paper argues that the continued privileging of methadone by public health institutions may be driven more by ideology and institutional inertia than evidence. It calls for a re-evaluation of harm reduction policies and urges greater accessibility to abstinence-focused, naltrexone-based treatment options, along with ancillary psychological and medical support. Recommendations include transparency in data reporting, broader dissemination of naltrexone research, and a policy shift toward full recovery rather than prolonged maintenance.