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The impact of long-term opioid use on the risk and severity of COVID-19

Rahul Shah, BS, Yong-Fang Kuo, PhD, Jacques Baillargeon, PhD, Mukaila A. Raji, MD

Abstract


Based on evidence of the immunosuppressive effects of chronic opioids, long-term users of prescription and illicit opioids comprise an unrecognized but growing population of Americans with compromised immune function and respiratory depression who may be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)-related hospitalization, prolonged ICU stay, adverse events, and death. This perspective is of broad clinical and public health importance because the US has the highest population of long-term users of prescription opioids, a sequel of a decade-long practice of opioid overprescribing in the US. For long-term opioid users who are hospitalized for COVID-19, clinicians face clinical challenges arising from the suppressive effects of opioids on the respiratory and immune functions, as well as the potential for adverse drug-drug interaction when opioids have to be continued in long-term users. More research is needed to further understand the association of long-term opioid use and susceptibility to COVID-19 and other emerging infections.


Keywords


opioids, COVID-19

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References


Neuman MD, Bateman BT, Wunsch H: Inappropriate opioid prescription after surgery. Lancet. 2019; 393(10180): 1547-1557.

Guy GP, Zhang K, Bohm MK: Vital signs: Changes in opioid prescribing in the United States, 2006-2015, MMWR Morb Mortal Wkly Rep. 2017; 66: 697.

Kuo YF, Raji MA, Goodwin JS: Association of disability with mortality from opioid overdose among US medicare adults. JAMA Netw Open. 2019; 2(11): e1915638.

Connolly J 3rd, Javed Z, Raji MA, et al.: Predictors of long-term opioid use following lumbar fusion surgery. Spine 2017; 42: 1405-11.

Nguyen AV, Ross E, Westra J, et al.: Opioid utilization in geriatric patients after operation for degenerative spine disease. J Neurosurg Anesthesiol. 2020; DOI: 10.1097/ANA.0000000000000682.

CDC. Coronavirus 2019: People who are at higher risk for severe illness. Available at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-athigher-risk.html. 2020.

Joseph D, Puttaswamy RK, Krovvidi H: Non-respiratory functions of the lung. Contin Educ Anaesth Crit Care Pain. 2013; 13(3): 98-102.

Eisenstein TK: The role of opioid receptors in immune system function. Front Immunol. 2019; 10: 2904.

Plein LM, Rittner HL: Opioids and the immune system—Friend or foe. Brit J Pharmacol. 2018; 175(14): 2717-2725.

Edelman EJ, Gordon KS, Crothers K, et al.: Association of prescribed opioids with increased risk of community-acquired pneumonia among patients with and without HIV. JAMA Intern Med. 2019; 179(3): 297-304.

Jakob CEM, Stecher M, Claßen AY, et al.: Association between prescribed opioids and infections in patients with neutropenia and cancer. JAMA Intern Med. 2020; 180(2): 320-322.

Yamanaka T, Sadikot RT: Opioid effect on lungs. Respirology. 2013; 18: 255-262.

Roy S, Ninkovic J, Banerjee S, et al.: Opioid drug abuse and modulation of immune function: Consequences in the susceptibility to opportunistic infections. J Neuroimmune Pharmacol. 2011; 6: 442-465.

Chang KC, Huang CL, Liang HY, et al.: Gender-specific differences in susceptibility to low-dose methadone-associated QTc prolongation in patients with heroin dependence. J Cardiovasc Electrophysiol. 2012; 23(5): 527-533.

Fonseca F, Marti-Almor J, Pastor A, et al.: Prevalence of long QTc interval in methadone maintenance patients. Drug Alcohol Depend 2009; 99(1-3): 327-332.

Jankelson L, Karam G, Becker ML, et al.: QT prolongation, torsades de pointes, and sudden death with short courses of chloroquine or hydroxychloroquine as used in COVID-19: A systematic review. Heart Rhythm. 2020; SI547-5271(20): 30431-30438.

Baillargeon J, Singh G, Kuo YF, et al.: Association of opioid and benzodiazepine use with adverse respiratory events in older adults with chronic obstructive pulmonary disease. Ann Am Thoracic Soc. 2019; 16: 1245-1251.

Davis MP: Twelve reasons for considering buprenorphine as a frontline analgesic in the management of pain. J Support Oncol. 2012; 10(6): 209-219.

Dahan A, Yassen A, Romberg R, et al.: Buprenorphine induces ceiling in respiratory depression but not in analgesia. Brit J Anaesth. 2006; 96(5): 627-632.

Winetsky D, Weinrieb RM, Perrone J: Expanding treatment opportunities for hospitalized patients with opioid use disorders. J Hosp Med. 2018; 13: 62-64.




DOI: https://doi.org/10.5055/jom.2020.0597

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