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Pregabalin is a medication licensed for the treatment of epilepsy and anxiety disorders. In addition, Pregabalin is increasingly recognised as a drug of abuse. Teratogenic effects have been demonstrated in animal models, however, there is a dearth of research relating to potential teratogenic effects in humans. This case highlights the potential role of intrauterine exposure to Pregabalin in contributing to Global Developmental Delay in two children.

Introduction The HSE National Drug Treatment Centre is an inner city drug treatment centre in Dublin which provides opiate agonist treatment (OAT) to approximately 565 patients, many of whom have complex care needs. Objective This study was conducted to determine seropositivity to the COVID-19 virus in patients attending NDTC, and to establish if patients tested had any clinical symptoms of this disease since March 2020. Method All patients attending for OAT were invited to participate and 103/565 patients agreed. The patients were tested for the presence of serum antibodies to COVID-19 in a single sample collected over a 4-month period (July-October 2020). A questionnaire was administered at the same time as sample taking. Results Results showed that the majority of patient samples (100; 97%) tested were negative for the presence of antibodies to COVID-19. There were only two confirmed positive results (1.9%) and one equivocal result (1%). None of the approximately 565 attendees at the HSE NDTC presented with serious illness indicative of COVID-19 throughout the three waves of the pandemic, nor were any deaths due to COVID-19 reported. Conclusion These findings indicate (a) possible low level of exposure to COVID-19 among this patient cohort or (b) that those patients who have been exposed have not developed or maintained detectable antibody levels, nor developed symptoms of the disease. Public health measures could explain the low level of COVID-19 in this cohort. The findings are also consistent with the possibility of a protective effect of OAT medications on development of the disease.

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Despite the advent of a vaccine, broadening the arsenal of drugs effective in the treatment and prevention of COVID-19 disease remains critical in the global effort to control the SARSCoV2 pandemic. Opioids and opioid antagonists may have a role in treating and in the prevention of this disease based on a number of observations: an unexpectedly low incidence of COVID-19 has been observed in patients treated for opioid dependency with long acting opioid drugs such as methadone; opioids bind to the ACE2 transmembrane protein, a molecule that is widely considered to be main host cell receptor for SARS CoV2 cell entry; opioids have systemic immunomodulatory effects which may influence the response to the virus; studies aimed at repurposing drugs for treatment of COVID-19 have identified that opioids have therapeutic potential and finally there are ongoing trials of some of these drugs. The interaction of long acting opioids or opioid antagonists with the ACE2 receptor and the possible effects on TLR4 function in SARS CoV2 infection should be given serious consideration when developing effective therapies. Note an updated version of this preprint is under review with the British Journal of Anaesthesia

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Despite the advent of a vaccine, broadening the arsenal of drugs effective in the treatment and prevention of COVID-19 disease remains critical in the global effort to control the SARSCoV2 pandemic. Opioids and opioid antagonists may have a role in treating and in the prevention of this disease based on a number of observations: an unexpectedly low incidence of COVID-19 has been observed in patients treated for opioid dependency with long acting opioid drugs such as methadone; opioids bind to the ACE2 transmembrane protein, a molecule that is widely considered to be main host cell receptor for SARS CoV2 cell entry; opioids have systemic immunomodulatory effects which may influence the response to the virus; studies aimed at repurposing drugs for treatment of COVID-19 have identified that opioids have therapeutic potential and finally there are ongoing trials of some of these drugs. The interaction of long acting opioids or opioid antagonists with the ACE2 receptor and the possible effects on TLR4 function in SARS CoV2 infection should be given serious consideration when developing effective therapies.

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