There has been significant debate in the Australian parliament and the wider community in recent years in relation to alternative drug treatments for opioid (mainly heroin) dependence. Within this debate, zero-tolerance style arguments have been raised by many in favour of abstinence-based treatments using medications such as naltrexone. Alternatively, harm minimisation arguments have been used to support methadone and similar treatments. This paper examines the latest research on the treatments, identifies gaps in this research and distinguishes the various treatments’ respective costs and benefits.