Case Study: Le implicazioni culturali/religiose nella terapia con Buprenorfina Long-acting sottocutanea in giovane adulto con disturbo da uso d’oppioidi

Journal title MISSION
Author/s Stefano Vertullo, Concettina Varango
Publishing Year 2026 Issue 2025/72
Language Italian Pages 4 P. 48-51 File size 0 KB
DOI 10.3280/mis72-2025oa21725
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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.

Keywords: Opioid Use Disorder;Substance Use Disorder;Ethnical minorities;Religion;Long Acting Buprenorphine

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Stefano Vertullo, Concettina Varango, Case Study: Le implicazioni culturali/religiose nella terapia con Buprenorfina Long-acting sottocutanea in giovane adulto con disturbo da uso d’oppioidi in "MISSION" 72/2025, pp 48-51, DOI: 10.3280/mis72-2025oa21725