Opioid prescribing in Italy remains cautiously conservative, with national data showing stable and comparatively low use of medium-potency opioids relative to other European countries.
Migrants and ethnic minority groups, however, display increased vulnerability to substance use disorders due to linguistic, cultural, and religious barriers that hinder access to and continuity of care.
The case concerns a 19-year-old North African male presenting with a severe iatrogenic opioid use disorder involving tramadol, oxycodone, and benzodiazepines, accompanied by detailed self-monitoring of substances, dosages, routes, and psychoactive effects.
His tramadol use, initially therapeutic, rapidly evolved into complex experimental practices informed by online psychonautic resources, producing atypical euphoria and sensory distortions even at standard doses.
Family opposition, rooted in strict religious norms, significantly interfered with treatment, leading to compromised methadone adherence, suspected diversion, and eventual relapse with periods of homelessness.
Cultural tension intensifi ed during Ramadan, a period associated with autonomous modifi cations of oral medications.
The subsequent transition to long-acting injectable buprenorphine provided a culturally acceptable alternative, enhancing adherence and clinical stability.
Pharmacogenetic considerations, particularly the higher prevalence of CYP2D6 ultrarapid metabolizers in North African populations, may have contributed to the heightened psychoactive responses and misuse risk.
Overall, the case illustrates the necessity of integrating cultural, religious, and pharmacogenetic factors into individualized treatment strategies to improve engagement and long-term outcomes.
