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FrancoAngeli Journals

Contributi Scientifici

No. 74 (2026)

Il “last mile” della sospensione metadonica: utilizzo della Passiflora incarnata 600 mg/die in tre pazienti con terapia sostitutiva di lunga durata

DOI
https://doi.org/10.3280/mis74-2026oa23184
Submitted
luglio 2, 2026
Published
2026-07-27

Abstract

Complete discontinuation of methadone maintenance therapy in patients with opioid use disorder undergoing long-term substitution treatment represents one of the most challenging phases of the therapeutic pathway.
In clinical practice, progressive methadone tapering is often well tolerated down to very low dosages, whereas the final phase of complete discontinuation is frequently characterized by the emergence of residual subjective symptoms preventing treatment completion, thus configuring the so-called “last mile” of methadone discontinuation.
The aim of the present study is to describe three patients followed at the Monza Addiction Service (SerD), who had been receiving methadone treatment for many years and in whom progressive dose reduction had substantially stalled at extremely low dosages, making complete discontinuation impossible despite repeated attempts.
In all cases, patients showed clinical and toxicological stability, absence of relapse, and good tolerability of progressive dose reductions.
Difficulties emerged exclusively during the terminal phase of tapering and were mainly characterized by subjective symptoms such as inner restlessness, agitation, insomnia, psychophysical discomfort, and emotional instability, in the absence of a major opioid withdrawal syndrome.
During the final tapering phase, Passiflora incarnata dry extract was introduced at a dosage of 600 mg/day for three months.
In the observed cases, this intervention appeared to be associated with successful completion of methadone discontinuation, good clinical tolerability, and six-month negative toxicological follow-up on keratin matrix analysis.
In light of the GABAergic modulatory properties of Passiflora incarnata, the observed findings suggest a possible role for phytotherapy in the management of residual symptoms characterizing the terminal phase of long-term methadone discontinuation.

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