A double-edged sword of using opioids and COVID-19: a toxicological view
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(2020) 15:91
COMMENTARY
Open Access
A double-edged sword of using opioids and COVID-19: a toxicological view Mahshid Ataei1, Farshad M. Shirazi2, Roland J. Lamarine3, Samaneh Nakhaee1 and Omid Mehrpour1,4*
Abstract Today, COVID-19 is spreading around the world. Information about its mechanism, prognostic factors, and management is minimal. COVID-19, as a human disease, has several identifying phases. Physicians of patients with COVID-19 may be interested in knowing whether opioid use disorder may affect their patients’ course or prognosis. This information may be crucial when considering the opioid epidemic in the US and other parts of the world. Opioid use at high doses and over several months duration can mitigate the immune system’s function, which may complicate the course of COVID-19 disease. Potential suppression of parts of the immune response may be important in prevention, clinical support, and therapeutic use of medications in various phases of the COVID-19. Specifically, opioid use disorders via an inhalation route may enhance the “late hyper-inflammatory phase” or result in end-organ damage. It is well established that opioids decrease ventilation as their effect on the medullary respiratory centers increases the risk of pneumonia. This increased risk has been associated with immunesuppressive opioids. The ultimate role of opioids in COVID-19 is not clear. This paper endorses the need for clinical studies to decipher the role and impact of chronic opioid use on viral diseases such as COVID-19. Keywords: Opioids, Immune system, COVID-19, Prognosis
Background Today, COVID-19 is spreading around the world. Information about its mechanisms, prognostic factors, and management is minimal. Like other coronaviruses, SARS-COV2 infects respiratory epithelial cells using receptor-mediated endocytosis via the angiotensinconverting enzyme II (ACE2) as an entry receptor [1, 2]. In symptomatic patients, clinical symptoms usually begin during the first week, this includes fever, fatigue, weakness, cough, nasal congestion, and other signs of upper respiratory tract infection [2]. The infection can eventually lead to serious illness with shortness of breath in approximately 21% of patients and severe pneumonia, as * Correspondence: [email protected] 1 Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran 4 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA Full list of author information is available at the end of the article
seen by computed tomography scan (CT scan) at admission [3]. Three or four phases for COVID-19 have been potentially identified, including 1- viral replication accompanied by mild symptoms (early infection phase), 2- adaptive immunity stimulation and predominance of respiratory symptoms (pulmonary phase), 3- hyper coagulopathy phase, and in some cases hyper-inflammatory or end-organ damage phase [4]. Before this outbreak, two clinically significant corona virus-associated diseases were known, MERS
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