In case of infection, physician should be aware that patients with comorbid COVID-19 and OUD present specificities, including drug interactions between methadone and other medications such as hydroxychloroquine or antiviral agents. Recently, three plausible biological mechanisms for potentially worsened outcomes were suggested (Schimmel and Manini, 2020): opioid-related respiratory depression (amplify risks of hypoxemia), complex opioid immune modulation (may impact host response to the virus), and finally drug-drug interactions, particularly due to cardiac adverse effects. Based on pre-clinical studies, Coppola et al. recently suggested an efficacy of hesperidin (antiretroviral drug with an affinity for opioid receptor), but it remains to be tested (Coppola and Mondola, 2020).
