Free methadone isn't all that much better from that perspective. You come to your doctor and tell him, "I'm useless, my life's hardly worth living, I'll never amount to anything so I might as well take opiates to dull the pain" - is it then the doctors job to basically say, "yes, clinically your life is not worth living", even if it is a milder opiate?

It's writing people off as lost cases. And many addicts WANT to be written off as lost cases, because a) they already did so themselves, but feel guilty about it, an official confirmation would be nice and b) it will give them access to painkillers.

Which is why I'm very skeptical of involving doctors in the first place in free methadone programs, if such programs should exist. It shouldn't be anyone's job to validate you if you say you're a lost cause.