Naloxone rebound akathisia: It could turn on you (1 August 2021)

Summary

The rise in opioid overdoses warrants a review of the symptoms of akathisia writes Russell Copelan.

Content

Before the coronavirus pandemic, the nation was struggling with escalating drug overdose deaths. Now, there are some who are convinced that the COVID-19 pandemic has led to further increases in opioid overdoses. Public services were disrupted. Some treatment programmes had to restrict access, reduce staffing, and increase supply between limited provider visits. Many addicts are homeless and do not have Internet or telemedicine contact. Social distancing may have prevented some individuals from having anyone around to administer naloxone (Narcan, Evzio). Inadequate border restrictions have likely increased drug supply with higher potency.

These conjoint "opioid epidemics" have heightened and stirred conversations about prescribing and regulatory practices, "war on drugs" rhetoric, the "fifth vital sign," opioid accessibility, prescription rates, and effectiveness of opioids for non-cancer chronic pain, among many others.

With the rise in opioid use and death, a review of the many and sometimes paradoxical expressions of akathisia is warranted.