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Opioid dependence is a chronic relapsing condition associated with serious infection, crime, profound social and occupational disability, and fatal overdose. The best current treatment available, methadone maintenance, is only variably effective, with high rates of drop-out and illegal drug use. In this Canadian study, 251 people with opioid dependence and long-term daily use of opioids (typically, heroin) who had had two previous treatments were randomized in a 45:45:10 ratio to receive oral methadone, injectable diacetylmorphine (the active ingredient in heroin), or injectable hydromorphone (Dilaudid) for 12 months. The purpose of the hydromorphone arm was to validate self-reported heroin use through urine testing. Participants received t…