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The World Health Organization declared the SARS-CoV-2 pandemic on March 11, 2020. SARSCoV-2 is a single-stranded RNA β-coronavirus showing 89 percent nucleotide identity with bat SARSLike-CoVZXC21 and 82 percent with Human SARS-CoV.1 Health complications related to the SARS-CoV-2 infection, in particular the interstitial pneumonia, are rapidly became the first public health concern worldwide. The emergency state produced an impairment of the ordinary healthcare activity making the management of vulnerable patients complex. In this regard, many health institutions and organizations issued specific guidelines for managing drug dependent patients in order to reduce morbidity and mortality.2 In a recent article, Adem and colleagues3 in their virtual screening based molecular docking study reported a potential binding affinity exerted by some bioflavonoids at the active site of the main viral protease (MPro). To explore the potential inhibition properties they used the Molegro Virtual Docker Program and some flavonoids, in particular hesperidin and rutin (Figure 1) showed a better affinity for the MPro than nelfinavir.3 Hesperidin and rutin are well known for many biological and therapeutic effects including antioxidant and antiviral properties. Furthermore, they were showed to exert antinociceptive, anxiolytic, antidepressant and sedative effects in the absence of significant toxicity. Particularly, Loscalzo and colleagues found that both antinociceptive and sedative activity were inhibited by opioid receptors antagonists suggesting a critical role of these receptors in determining many hesperidin clinical effects.4 Moreover, in a mice study, Selvaraj and colleagues found that rutin exerted their central and peripheral antinociceptive activity targeting opioid receptors. In their preclinical study, a pretreatment with naloxone or pentazocine deleted the analgesic effect induced by a methanol solution of rutin.5 Despite the hard work of many research centers in various countries, the timing for the development of novel specific, sure and effective medicines/vaccines against SARS-CoV-2 is unpredictable. Pandemic state and the correlated consequences for public health and economy suggest to use all potential alternatives for treating infected patients. In this view, notwithstanding the paucity of scientific data, the combination between the potential antiretroviral LETTER TO THE EDITOR DOI:10.5055/jom.2020.0564

Potential pharmacological perspectives for the treatment/prevention of the SARS-COV-2 infection in opioid dependent patients