Does opioid substitution treatment have a protective effect on the clinical manifestations of COVID-19? Comment on Br J Anaesth 2020; 125: e382–3

Abstract

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A cross-section observational study on the seroprevalence of antibodies to COVID-19 in patients receiving opiate agonist treatment

“…Many of patients engage in behaviours that may increase the risk of exposure to COVID-19: sharing masks, drug paraphernalia, poor observation of social distancing etc. The findings are also consistent with the possibility of a protective effect of OAT medications on development of the disease [7]. Whatever the reason for low seroprevalence and COVID-19 disease, the expectation that COVID-19 would spread rapidly through the OAT patient population has not materialised here or elsewhere.…”

“…People with a drug dependency were widely considered to be at particular risk for infection with this virus [1][2][3][4]. Despite expectations to the contrary [4][5][6], there have been very few reports internationally of COVID-19 in people who use drugs (PWUD) treated with OAT [7][8][9]. The European Monitoring Centre for Drugs and Drug Addiction [8] provided a snapshot of the current situation re COVID-19 in addiction populations.…”

“…We have postulated that OAT has a protective effect on the clinical manifestations of COVID-19 and called for further research on this [7]. Given the widespread concern about COVID-19 amongst PWUD, establishing the rate of exposure to COVID-19 in this population is important from a public health perspective, and in understanding how to optimally protect vulnerable groups.…”

Anaesthesia-related drugs and SARS-CoV-2 infection

“…Although chronic use or misuse of opioids leading to immunosuppression might increase the risk of SARS-CoV-2 infection [ 20 ], opioids may attenuate respiratory symptoms in COVID-19 patients such as shortness of breath and cough[ 21 ]. Moreover, opioids used in substitution therapy may aid in the maintenance of antioxidant capacity[ 21 ]. Opioids have the potential to exert both ‘theoretical’ beneficial and detrimental actions; further evaluation is required.…”

“…21 Moreover, opioids used in substitution therapy may aid in the maintenance of antioxidant capacity. 21 Opioids have the potential to exert both 'theoretical' beneficial and detrimental actions; further evaluation is required.…”