HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2026, 28: 103-110

The Hidden Phase of Regulated Relapse: A Case for Early Methadone Longterm Treatment in Opioid Use Disorder

Carlo Minestrini, and Icro Maremmani

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-13

Summary: Background: Heroin addiction is a chronic, relapsing condition with neurobiological underpinnings that evolve across distinct clinical stages. Among these, the phase of regulated relapse – characterised by apparent psychosocial stability despite persistent craving and neuroadaptation – can be misleadingly interpreted as remission. This case explores the role of early opioid agonist treatment (OAT) in interrupting this deceptive plateau and preventing progression toward more entrenched addiction. Methods: A minor under judicial supervision was referred for diagnostic evaluation. Despite negative toxicology and no withdrawal symptoms, structured interviews revealed strong craving, emotional dysregulation, and risk of relapse. Buprenorphine/naloxone was initiated, later replaced with methadone due to clinical need. Longitudinal monitoring included psychiatric, educational, and familial variables. Results: The patient demonstrated rapid stabilisation and functional recovery. Improvements in school performance, emotional autonomy, and family dynamics were sustained. Pregnancy, often viewed as a reason to suspend treatment, instead reinforced therapeutic adherence and identity restructuring. The transition from buprenorphine to methadone was well tolerated, guided by clinical staging and individual response. Conclusions: This case underscores the clinical value of recognising regulated relapse as a critical stage requiring timely intervention. Early, stage-appropriate OAT can redirect disease trajectory – even without explicit patient motivation – supporting sustained recovery within a comprehensive care framework.

Keywords: Regulated Relapse; Opioid Agonist Treatment; Heroin Addiction; Early Intervention; Pregnancy and Addiction