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Injectable diacetylmorphine is more effective than oral methadone in the treatment of chronic relapsing opioid dependence

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Is injectable diacetylmorphine more effective than oral methadone maintenance therapy in patients with opioid dependence that is refractory to treatment?


Users of injectable heroin for at least 5 years, aged 25 years or older who had not responded to at least two previous attempts at treatment for addiction (including at least one methadone treatment, undertaken at least 6 months prior to the study). Exclusions: medical or psychiatric conditions that are contraindications for diacetylmorphine (diamorphine), pregnancy, involvement with the criminal justice system which may have resulted in incarceration during the study period.


Montreal, Quebec and Vancouver, British Columbia, from March 2005 to July 2008.


Oral methadone or injectable diacetylmorphine hydrochloride. Methadone was administered at a clinic or pharmacy on a daily basis; the dosage was based on best practices and current clinical practice guidelines. The diacetylmorphine (diamorphine) was self-administered under supervision in treatment clinics up to 3 times daily with a maximum daily dose of 1000 mg.


The primary outcomes were the rate of retention in treatment and the reduction in illicit …

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