In Malaysia, because of an alarming increase in the number of intravenous drug users, the government has started a harm reduction program in which methadone is used as a drug substitution therapy. This article discusses a 19-month-old Malay girl who was brought to the hospital after an episode of accidental ingestion of methadone. The methadone was for her uncle, who was found to be an intravenous drug user. Although methadone has been proven to be cost-effective and useful, it has also been reported that increasing availability of methadone can put children at increased risk of accidental ingestion. In Malaysia, methadone is available at government as well as private medical clinics. Home consumption may be problematic as the drug may be dispensed without adequate patient education and clear instructions on its handling, storage, and indication of use. In this scenario, a greater emphasis on and the adaptation of clear guidelines on the use and storage of methadone are required. There is also a need to create awareness among the public as well as health care professionals regarding the issue.