In 2000 substitution treatment with methadone was extended to a total of eight departments in the Czech Republic. One of them is also the AT surgery for the prevention and treatment of addictions in Mělník, which is the only department lacking in-patient facilities. The paper deals with the general approach to methadone substitution, availability of treatment, the ratio of methadone substitution in the treatment of drug addiction and problems associated with treatment: selection of patients, optimal dose, methadone tolerance, non-compliance with abstinence from opioids and complications associated with the use of other drugs, in particular benzodiazepines. The author emphasizes the ritual component of addiction and the necessity of toxicological exa- mination of urine. The conclusion contains a brief recommendation of the procedure for methadone substitution in departments without in-patient facilities.

        Key words: methadone substitution, optimal dose, heroin and Rohypnol, ritual component of addiction, toxicological examination.