Opioids in the Time of the COVID-19 Pandemic: From Cellular Mechanisms to Public Health Policy

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Background

A report from the American Medical Association during the early days of the COVID-19 pandemic stated that as “as the COVID-19 pandemic grows so does the nation’s opioid epidemic”. With hindsight we now know this to be true as a record number of opioid overdose fatalities occurred in 2021 at the height of this pandemic. We also know that the social conditions created by the COVID-19 pandemic of unemployment, social isolation and despair, further facilitated a sharp increase in substance abuse disorder (SUD) in the USA and around the world. Another effect of COVID-19 has been the change in the supply and use of illicit substances worldwide. With the closure of borders, drugs were initially stockpiled and the normal supply chains and routes constricted. This soon eased as sales moved online and users pivoted to alternate supplies and types of drugs as reflected by a sharp rise in deaths caused by synthetic opioids.

Against this backdrop of a disturbing collision between a pandemic and the opioid epidemic are a host of questions that can now be considered and addressed. Firstly, there is the need to fully comprehend and document the epidemiology and nature of the interaction between COVID-19 and illicit drug use in the different cultures and countries of the world. Secondly, we need to establish both clinical guidelines and public health policy for the treatment and control of pain and SUD during pandemics induced by COVID-19 or other pathogens. Thirdly, both COVID-19 and opioids may have an impact on the same physiological functions within the human body and we are yet to fully understand the immediate and prolonged effects of these interactions. The most well-known are the respiratory and immune systems, but the effects of both opioids and COVID-19 on inflammation in the brain and the gastro-intestinal tract, and perhaps other unknown systems, are yet to be explored. At the level of intracellular trafficking and signaling, COVID-19 is known to hijack the angiotensin system. As both angiotensin and opioid receptors are members of the G-protein-coupled family of receptors that signal and traffic in a similar manner, the effect of COVID-19 on opioid receptor signaling and trafficking is yet to be explored.

• The effect of the COVID-19 pandemic on the socioeconomic factors that contribute to substance abuse disorder.

• The effect of the COVID-19 pandemic on drug trafficking, use and abuse worldwide;

• The direct and indirect effects of different COVID-19 international public health policies and approaches on substance abuse disorder treatment during this pandemic.

• Public health guidance on vaccine use and availability for disadvantaged populations and groups such as those susceptible to substance abuse or other disorders.

• The relationship between opioid use and the response to a COVID-19 infection.

• The treatment of chronic pain or substance abuse disorder, particularly that of opioids, during the COVID-19 pandemic. Potential respiratory, immune, gut and brain interactions that should be considered in light of the effect of opioids and COVID-19 exposure.

• The treatment of chronic pain or substance abuse disorder if COVID-19 is present or likely to be present.

• The long term effect of COVID-19 on systems that may alter the analgesic or rewarding effects of opioids.

• The potential effects of COVID-19 on the intracellular trafficking and signaling of the opioids or other GPCRs.


Topic editor Wendy Walwyn founded WmScience,Topic Editor Kathryn DeFea founded PARMedics, Inc., and Topic Editor David Walwyn founded Reseva. All other Topic Editors declare no competing interests with regards to the Research Topic subject.

Keywords: Opioid overdose, COVID-19, public health policy, pandemic, cellular interactions

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