M ethadone is “the best tool we have” to fight opioid addiction, says Ashish Thakrar, a doctor at the University of Pennsylvania’s school of medicine. Yet many of his patients are unable to get it. At his hospital, Dr Thakrar can administer methadone for pain or for opioid addiction. But as soon as he steps across the street to his outpatient addiction clinic, he complains, he is barred from doing so by federal regulations. Methadone rules are “very, very silly right now”, he sighs.