The study led by Edinburgh University researchers said methadone treatment reduced the frequency of drug use.
It also led to a drop in the risk of death by 13% each year, the research suggested.
But the findings also showed the drug could prolong the number of years users continued to inject heroin.
The long-term study followed hundreds of heroin abusers in the Muirhouse area of Edinburgh over almost 30 years.
It found that those on heroin substitutes such as methadone led less chaotic lives - and lived longer.
The researchers also rejected calls for methadone prescribing to be reduced.
Roy Robertson, a GP who led the study at the University of Edinburgh, said: "This study confirms that methadone works and works best when prescribed for as long as is needed.
"Even though some users continue to occasionally inject while on methadone, they still gain substantial health benefits from their prescription.
"Suggestions that methadone prescribing should be cut back or confined to the short-term are clearly misplaced and would lead to poorer health for drug injectors."
Three months ago, a group of 40 experts from around the world said methadone should be "readily available" to addicts seeking help.
They argued that scrapping the treatment could lead to a rise in crime and drug deaths.
But its use has been criticised by Scottish Conservatives, who claimed addicts are "parked" on methadone.
The party has called for the underlying causes of abuse to be tackled, and for more addicts to be put into rehabilitation programmes, including in prisons.
The Scottish government's drugs strategy aims to "support people to move on towards a drug-free life as active and contributing members of society".
The new study, which also involved researchers from Bristol and Cambridge universities, suggested there was a "balance" between saving lives and achieving abstinence.
Almost 800 people took part in the study, of whom 571 were still alive when research was followed up. At the end of that process, five more had died, bringing the total deaths to 228, or 29% of the group.
The study will be published by the British Medical Journal on 17 July.
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