Methadone maintenance therapy arose as a treatment for opiate use in the mid 1960s. At the time, neither drug use nor treatment for it were considered disabilities. When Vincent Dole, the Rockefeller Institute metabolic researcher who was one of the progenitors of methadone maintenance therapy (MMT), asked, ‘What kind of disablement does a drug produce?’ (Courtwright et al., 1989, p. 334), this was a prescient question.1 Dole’s team stabilised patient-subjects on methadone, hoping to displace reliance on shorter-acting opiates, and explored dosages that would enable ‘cooperative relationships with patients’ (Courtwright, et al., 1989, p. 336). Opposing detoxification and abstinence as the sole basis for treatment, Dole saw opioid use disorder as a metabolic condition that required ongoing pharmacological stability. Contrasting the stabilising effects of one opiate (methadone) to another (heroin), Dole emphasised that drugs should be judged in terms of their social effects – did they improve or undermine capacity for stable relationships with family members, treatment providers or employers? Did they produce ‘disablement’ or did they instead ‘enable’ capacities for productive citizenship? Such questions dominated the social contexts into which methadone maintenance was inserted. Making stable, productive citizens was adopted as the goal of methadone maintenance.