Percocet is a brand-name combination of oxycodone, a potent opioid analgesic, and acetaminophen, a nonsteroidal anti-inflammatory drug (NSAID). The combination of painkillers eases pain for a little longer and more effectively for more people. However, this Schedule II drug is not intended to be taken to treat chronic pain on a long-term basis. Instead, it was designed to treat pain that would subside after a matter of months, like postsurgical pain or an injury. Unfortunately, Percocet was less tightly regulated in the early 2000s. More prescriptions with refills were much easier to acquire, and this led, in part, to an epidemic of opioid addiction and overdose in the United States.
The Centers for Disease Control and Prevention (CDC) reported that, in 2015, over 40 people per day die because of an overdose on prescription opioids, including Percocet. Oxycodone, the narcotic in Percocet, is one of the most addictive and abused opioid painkillers on the market.
Why Percocet Is Abused
In the 1990s, pharmaceutical companies began developing new forms of prescription painkillers to treat both temporary and chronic pain. Drugs including Percocet and OxyContin – a high-dose, long-acting medication – were advertised to doctors and potential consumers as being safe. Physicians came under fire for failing to provide enough pain management to their patients when helpful drugs were available. By 1999, prescribing rules were loosened, and doctors began prescribing more opioid drugs to those who required any level of pain treatment.
Because these prescriptions were not monitored as thoroughly as they are today, many people began abusing their prescription drugs, demanding more refills, and taking the medication longer than necessary to manage their injury or post-surgery pain. The National Institute on Drug Abuse (NIDA) reports that as many as 21-29 percent of people who receive prescriptions for opioids for chronic pain begin to abuse them; about 8-12 percent develop an opioid abuse disorder.
Now, because prescription medications like Percocet are more tightly controlled, many people who develop an addiction to opioids cannot access the substances they abused. Instead of seeking treatment to overcome the addiction, however, they are turning to dangerous, potent, and uncontrolled illicit drugs like heroin.
How Addiction to Percocet Begins
Oxycodone is a semisynthetic drug chemically similar to opium and morphine. This drug binds to opioid receptors in the central nervous system (CNS) to relieve pain sensations. However, binding to the opioid receptors also means that the drug interacts with the reward system in the brain, which produces pleasure-causing neurotransmitters like dopamine and serotonin. These neurotransmitters, when released by the opioid receptors, lead to pleasurable relaxation and possible euphoria. For some, the release of mood-elevating neurotransmitters adds to pain relief because it alleviates the negative experience of pain. For others, the high caused by opioid drugs like oxycodone can lead to compulsive, drug-seeking behaviors as well as abuse and addiction.
Because oxycodone is a potent narcotic painkiller, it is possible for a person to develop a physical dependence on, and tolerance to, the drug without developing an addiction. People who work with their physicians and take Percocet as prescribed may experience less pain relief over time, indicating that they are developing a tolerance to the medication and need a stronger prescription. The pain relief from opioid painkillers like oxycodone may also lead to opioid receptors producing fewer neurotransmitters to kill pain on their own, which is a physical dependence on the drug. This means that other narcotic painkillers will likely be less effective.
However, neither dependence nor tolerance means a person is addicted to a substance. Abusing the drug for nonmedical reasons, intentionally taking too much of the substance, feeling worried about the supply of the drug, and being psychologically unable to stop taking the drug are all indications that a person may be addicted to oxycodone.
In contrast, acetaminophen is not considered addictive. Although it can cause side effects and even overdose in large enough doses, acetaminophen relieves pain through different neural pathways, primarily reducing inflammation and fever. The drug is found in numerous over-the-counter medications because it is considered so safe. The addictive substance in Percocet is oxycodone.
Symptoms of Percocet Addiction
Signs of Percocet intoxication include:
- Sleepiness, including nodding off
- Respiratory depression, breathing irregularity, or shallow breaths
- Nausea and vomiting
- Cough suppression
- Falling unconscious
- Taking more of the prescription narcotic than directed
- Getting refills frequently or “losing” prescriptions and needing refills
- Increased or decreased sleep
- Stealing prescription drugs from friends or family
- Lying about, or in denial about, how much Percocet is consumed
- Changes in mood, including hostility and mood swings
- Getting prescriptions for Percocet from more than one doctor
- Appearing intoxicated
- Changes in social behavior, failing to go to work or school, or changes in hygiene habits
A person who struggles with addiction may try to hide their addiction or their behavior may change.
Depending on the size of the dose, analgesia may last for 4-6 hours while behavioral effects like euphoria can last for about five hours. Other signs that a person may struggle with Percocet addiction include consuming the drug in ways other than as prescribed. Percocet was designed to release orally, but some people crush and snort the tablets, smoke them, or mix the powder with water and inject it into a vein or a muscle.
There are many complex factors that contribute to an individual’s risk of developing an addiction to Percocet. Their genetics, family history, and current environmental stresses are all indications of how serious their risk for addiction may be. However, anyone can develop an addiction. A person who consumes a nonmedical dose of Percocet is more likely to develop an addiction to the drug and show side effects from the drug than those who take the painkiller as prescribed.
Side Effects from Abusing Percocet
- Sleepiness, drowsiness, or fatigue
- Confusion or clouded thinking
- Lowered inhibitions and poor judgment
- Nausea, vomiting, stomach pain, and appetite changes
- Dizziness or loss of coordination
- Flushing or sweating
- Pinpoint pupils
- Dry mouth
- Lightheadedness or fainting
- Physical weakness
- Skin rashes
- Redness or skin sensitivity
- Swelling in the extremities
- Ongoing headache
- Trouble breathing
- Tightness in the chest
- Other symptoms associated with allergic reaction
Chronic Health Problems from Percocet Abuse
People who abuse Percocet put themselves at risk for long-term health consequences – both because of the large amount of oxycodone they consume and also because of the high doses of acetaminophen.
One of the most dangerous long-term problems associated with Percocet, because of the presence of acetaminophen, is liver damage. More than 4,000 milligrams of acetaminophen per day can cause severe damage to the liver, enough to lead to liver failure. One paper published on the problem of acetaminophen overdose and chronic liver damage found that 24 grams, or about 48 extra-strength NSAID tablets, would cause overdose or long-term harm to the liver. Among those surveyed who had developed liver problems because of high doses of acetaminophen, 63 percent reported that they were not taking acetaminophen alone, but combination prescription painkillers like Percocet and Vicodin.
A side effect from consuming too much oxycodone can be chronic constipation. For many people, the experience of constipation is an annoyance that passes; however, over time, constipation can cause intestinal obstructions, anal fissures, and diverticulitis.
Withdrawing from Percocet
Since some people may develop physical dependence without becoming addicted to Percocet, it is important for a doctor to work with these patients to taper off the drug when they no longer need the prescription. However, people who struggle with abuse or addiction to Percocet are more likely to take large, nonmedical doses of the drug to get high and develop dependence on the substance, which will lead to withdrawal symptoms if they attempt to stop taking Percocet without help. Withdrawing from opioid drugs is not life-threatening, but it can be uncomfortable, and people who struggle with opioid addiction are at a higher risk for relapsing back into substance abuse if they do not get evidence-based treatment.
Withdrawal symptoms come in three basic phases.
- Early phase: These symptoms begin within 8-16 hours after the last dose of Percocet, depending on how much the individual took. These early withdrawal symptoms feel like a cold and may include sweating, runny nose, watery eyes, dilated pupils, involuntary twitching or twinging, and goosebumps. More intense withdrawal symptoms may include aching muscles in the arms, back, or legs.
- Peak phase: This period begins 2-3 days after the individual stops taking Percocet. Emotional symptoms begin during this phase, and include cravings, anxiety, panic, depression, restlessness, and agitation. The person may experience nausea, vomiting, and diarrhea. They may feel like they have the flu, as body aches, chills, and shaking become more intense.
- Final phase: Within 7-10 days after the person stops taking Percocet, the final physical symptoms will wear off. Insomnia, weakness, aches and pains, nervousness, and stomach cramps will all subside. If the person develops post-acute withdrawal syndrome (PAWS), they may experience some psychological symptoms, including intense cravings, depression, and panic, for weeks or months after their body is no longer dependent on the drug, but this is rare, especially with medical supervision for the detox process.
Both oxycodone and acetaminophen pose risks when consumed in very large quantities. If a person overdoses on Percocet, it is extremely important to contact 911 immediately. Without emergency medical attention, they are at risk of death.
Signs that a person is overdosing on the oxycodone in Percocet include:
- Pinpoint, unresponsive pupils
- Stomach spasms and vomiting
- Low blood pressure
- Weak pulse
- Extreme confusion and agitation
- Stupor, or being awake but unresponsive
- Stumbling, falling, or loss of coordination and balance
- Slow, shallow, or irregular breathing
- Difficulty taking breaths
- Extreme drowsiness
- Falling unconscious and unable to be roused
- Bluish tint to the skin, especially around the fingers, nose, or lips
- Cold or clammy skin
- Seizures (rare)
Although most people assume acetaminophen to be safe, taking more than 4,000 mg can lead to an overdose or long-term damage to internal organs.
- Nausea and vomiting
- Abdominal pain
- Breaking out into a rash
- Other skin problems
Many states are passing laws to make naloxone available to caregivers, more emergency responders, and even customers at pharmacies. This medication has no known side effects and temporarily reverses an opioid overdose long enough for the person to get medical treatment. It is not a cure for an overdose, but it can give the person more time to get lifesaving help.
Treatment to Overcome Percocet Addiction
Evidence-based treatment to overcome addiction to a narcotic like Percocet involves safely detoxing from the drug with medical supervision. A physician may prescribe buprenorphine or methadone to ease withdrawal symptoms, depending on how severe they are. Once the person has been stabilized with either of these detox medications, the physician will taper them off all medications. For buprenorphine, the taper may last for a few weeks while methadone tapers can last for months.
Treatment with buprenorphine or methadone often overlaps with rehabilitation. Participating in support groups, individual therapy, family therapy, and other evidence-based programs offered through either inpatient or outpatient rehabilitation programs helps to change behaviors around intoxicating substances, so the person can stay sober and healthy.