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Therapeutic potential of long-acting opioids and opioid antagonists for SARS CoV-2 infection

Title
Therapeutic potential of long-acting opioids and opioid antagonists for SARS CoV-2 infection
Publication Type
Journal Article
Research Type
Human
Reported as
Review
Date
September 15, 2021
Authors
Marie Eagleton, Siobhan Stokes, Fiona Fenton, Eamon Keenan
Institution
HSE National Drug Treatment Centre (Ireland); National Social Inclusion Office
Link
Abstract
Aware of few reports of COVID-19 in patients undergoing opioid substitution treatment, we proposed that OST may have a protective effect on clinical manifestations of COVID-19 based on a publication proposing an interaction between opioids and SARS-CoV-2 pathology. Consideration of possible mechanisms to explain a low incidence of disease in opioid substitution treatment patients raises the possibility that specific opioids interfere with the pathogenesis of SARS-CoV2, thereby affecting clinical manifestation of COVID-19 in the host. Review of immunomodulatory properties of opioids suggests that different opioids have a varied impact on immunity. We have considered the widespread and varied systemic effects of opioids and opioid antagonists, their ability to stabilise cell redox balance and their antitussive properties which could attenuate respiratory symptoms in COVID-19 patients, (dyspnoea and cough), suggesting the possibility of a protective effect of opioid substitution treatment medications on clinical manifestations of SARS-CoV-2 infection. The restorative effect of methadone on cellular immunity in injected drug use has been observed. The therapeutic possibility for opioids in the treatment of COVID-19 has been identified including tramadol, given its anti-inflammatory, antioxidant, analgesic and antitussive effects. Inhibition of the interaction of SARS-CoV-2 with ACE-2 by morphine and codeine has been identified as a therapeutic strategy for COVID-19.14 Other in vitro studies included naloxone and naltrexone among drugs that could be repurposed for treatment of COVID-19.15 Moreover, in vitro, naltrexone suppressed production of pro-inflammatory cytokines, and in docking simulation studies disrupted interaction between ACE-2 and the receptor binding domain of the SARS-CoV-2 virus spike protein, leading to a proposal to repurpose low dose naltrexone to treat patients with COVID-19.
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