Several key points demand consideration before routine ECG screening can be endorsed. Although many medications can cause QT prolongation, published trials documenting that torsade de pointes and sudden death can be averted by baseline ECG screening are lacking. The literature is replete, on the other hand, with examples of screening tests that seemed sensible when recommended yet whose disadvantages, once carefully considered, were found to negate if not outweigh associated benefits (11). Significant harms potentially associated with routine ECG screening of all patients entering methadone treatment include unnecessary evaluation, anxiety, treatment and costs associated with false-positive findings (red herrings), costs of implementation (which in many systems will be borne by patients), and the potential wrongful determination that some persons should not receive sorely needed opioid-dependence treatment. For the typical person who begins methadone treatment, the risk for death from torsade de pointes is likely to be substantially lower than that from competing causes of mortality associated with untreated opioid addiction (12–13). Although the panel members point out that buprenorphine may be a safer alternative for the estimated 2% of patients receiving methadone who are anticipated to benefit most from ECG screening, this newer medication is rarely prescribed by traditional methadone treatment programs and remains difficult to access in some areas (3). Some patients who have finally mustered the motivation to begin methadone maintenance only to be referred elsewhere for alternative treatment after an abnormal ECG will inevitably return to opioid use.