Objective To explore the effects of repetitive transcranial magnetic stimulation （rTMS） on craving， mood， and sleep in opioid-dependent patients. Methods A total of 42 patients who were hospitalized in Beijing Changping Huayou Hospital from May 1， 2020 to June 30， 2021 and met the diagnostic criteria for opioid dependence in the Diagnostic and Statistical Manual of Mental Disorders （5th Edition） （DSM-5） were selected for the study. The patients were randomized into 21 cases each in rTMS group and control group on a 1∶1 basis using a computer. All patients received methadone replacement therapy，on top of which rTMS group received 10 Hz rTMS treatment （5 times/week for 4 weeks） and control group was treated with pseudostimulation （5 times/week for 4 weeks）， with the site of stimulation being the left dorsolateral prefrontal cortex （DLPFC）. The 12-item Opiate Addiction Severity Inventory （OASI-12）， Visual Analogue Scale （VAS）， Pittsburgh Sleep Quality Index （PSQI）， Generalized Anxiety Disorder GAD-7）， and Patient Health Questionnaire-9 （PHQ-9） were used for assessment at baseline and at the end of the treatment （4 weeks） to compare the OASI， VAS， PSQI， GAD-7， and PHQ-9 scores and subtractive values between the two groups after 4 weeks. Results The scores of OASI-12， VAS， PSQI， GAD-7 and PHQ-9 after treatment were （33.90±7.27）， 6.00（5.00，8.00）， （11.38±1.77）， （5.05±2.42） and （5.10±2.07） in rTMS group and （31.78±5.24）， 7.50（4.75，10.00）， （13.22±2.24）， （7.89±3.58）， and （8.72±3.61） in control group respectively. The differences in VAS， PSQI， GAD-7， and PHQ-9 scores before and after treatment in rTMS group were statistically significant （t=-3.095， 10.242， 6.011， 6.706； all P ＜ 0.001）. The subtraction values of OASI- 12， VAS， PSQI， GAD-7， and PHQ-9 scores before and after treatment in rTMS group were 0 （-1.50，1.00）， 2.00 （1.00，3.50）， 8.00（4.00，8.50），5.00（2.00，8.00）， and 9.00 （2.00， 13.00）， which were greater than those in control group with statistically significant differences （Z=-2.154，-2.551，-3.711，-3.015，-2.140； all P ＜ 0.05）. Conclusions The rTMS may help reduce cravings， improve sleep， and alleviate anxiety and depressive disorder in patients with opioid dependence.