Major findings from this reassessment include: according to medical examiner and toxicology reports, and other data sources, methadone-associated deaths continue to rise; males 35 and older had the highest rate of methadone-associated deaths, approximately twice that of females; in the majority of cases, the reason for methadone-associated deaths is often unknown, with accidental exposures accounting for the majority of cases where a reason for death could be identified; all forms of methadone distribution continue to rise, with the greatest increases in distribution being seen for the tablet form and going to pharmacies; prescriptions for methadone have risen, although they are far lower than for other opioids; and circumstances of methadone-associated deaths vary by State, suggesting a complex phenomenon. This report presents the results of a meeting conducted by the U.S. Department of Health and Human Services (HHS) to reassess the notable increase in methadone-associated deaths. Since 2001, the Substance Abuse and Mental Health Services Administration (SAMHSA) of the HHS has been tasked with the regulation and oversight of the Nation's opioid treatment programs (OTPs). The meeting was conducted to update the 2003 national assessment of OTPs and included the review of current data on methadone-associated deaths; the determination of whether and to what extent such deaths might be related to the clinical practices of SAMHSA-monitored OTPs; and the formulation of strategies and action steps to address the problem. The strategies and action steps developed by the working groups at the meeting are discussed in detail.