Use, Abuse, Health Effects,
Overdose Risk, and Treatment
Abusing Percocet can cause death in many ways, notably, stopped breathing and liver failure. The risk of abuse exists even when the drug is used as recommended.
The combination may help better pain control and reduce abusability. It might be due to the lower opioid content compared to high-strength products like OxyContin.
Nonetheless, the risk of abuse may not be as low as previously thought. Besides, overdose deaths may occur due to not only oxycodone but also acetaminophen.
A Quick Overview of Opioid Use in the United States
The U.S. is the world’s top consumer of prescription opioids. The number of opioid prescriptions skyrocketed from 76 million in 1991 to about 207 million in 2013.1 CDC states that over 191 million opioid prescriptions were dispensed in 2017.2
Oxycodone, the drug in Percocet, is one of the four most frequently prescribed opioids. The others are hydrocodone, codeine, and morphine. In 2013, Americans consumed over four-fifths of the world’s total oxycodone.1
What is Percocet?
First, oxycodone activates opioid receptors in the brain and spinal cord. That way, it alters how the brain perceives pain.
Second, acetaminophen elevates the brain’s pain threshold, the upper point beyond which it would start to sense pain. The higher the pain threshold, the lower the pain would be felt. Moreover, acetaminophen blocks the production of prostaglandins in the brain. Prostaglandins are chemicals involved in swelling and pain sensation.
Percocet is available in the form of oral tablets. The tablets contain 325 milligrams (mg) acetaminophen and varying strengths of oxycodone. The amount of oxycodone in each tablet ranges from 2.5 mg to ten mg.
Street Names of Percocet
Is Percocet Addictive?
Oxycodone present in Percocet is a highly addictive drug. On the contrary, acetaminophen is not addictive and does not account for the addictive potential of Percocet.
According to some instances, a single prescription of Percocet can trigger an addiction. One such report appeared in the Journal of Medical Toxicology in 2012.5 The author was prescribed Percocet for a severe headache. Within two weeks of use, the pain was gone. Yet, the author continued taking the drug until an addiction developed.
While this might not be true in all cases, oxycodone has a well-documented history of abuse and addiction. Taking Percocet for longer or in higher doses than recommended causes the brain dopamine levels to surge. It results in euphoria or a high.
Over time, not only the brain but also the body becomes dependent on the effects of oxycodone. Severe psychological and physical dependence leads to long-term compulsive use of Percocet.
Drug Class and Schedule
Percocet belongs to a class of drugs known as opioid combinations. These products mix an opioid with a non-opioid pain drug, such as acetaminophen, ibuprofen, and aspirin.
These products are used for the short-term management of moderate-to-severe pain.
- Anexsia (hydrocodone + acetaminophen)
- Apadaz (benzhydrocodone + acetaminophen)
- Norco (hydrocodone + acetaminophen)
- Percodan (oxycodone + aspirin)
- Reprexain (hydrocodone + ibuprofen)
- Tylenol #3 and Tylenol #4 (codeine + acetaminophen)
Where is Percocet on the Schedule?
Percocet contains a Schedule II controlled substance – oxycodone. Acetaminophen is not a controlled substance.
Schedule II substances have high abuse potential. Misusing or abusing them can cause severe psychological and physical dependence.
Is Percocet Safe?
A drug product reaches the market only after it has passed several safety and efficacy tests. These tests are carried out in the laboratory, animals, and humans. Even after the product has been available on the market, the US FDA continues monitoring its safety. It is known as post-marketing surveillance.
Every drug can cause unwanted effects along with the desired effects. Before prescribing a drug, your doctor checks if the benefits outweigh the potential risks.
Percocet has been on the market for over four decades. The product was often considered the gold standard of pain management in the early 2000s. Notably, both oxycodone and acetaminophen have a proven track record of safety and efficacy. Based on the available evidence, we can say that Percocet is safe.
Nonetheless, Percocet contains drugs that might cause addiction and liver damage. Besides, post-marketing reports reveal that Percocet can cause potentially life-threatening allergic reactions (anaphylaxis). Interestingly, any drug–or even peanuts or wheat– can cause similar reactions.
Can You Take Percocet During Pregnancy?
Human data on Percocet safety during pregnancy is not available. It may be used if the benefits outweigh the potential risks. Oxycodone can cause physical dependence in infants. The lowest possible dose should be taken to prevent these side effects. Acetaminophen is generally considered safe for use in pregnant women.
How is Percocet Used?
Percocet is used to relieve moderate-to-severe pain after an injury or surgery. Doctors prescribe it for the pain that does not improve with other non-opioid painkillers.
Proper Use of Percocet
Percocet (oxycodone + acetaminophen) is used to treat moderate-to-severe pain due to an injury, tooth extraction, or surgery. Long-term use is not generally recommended because of the risk of abuse and liver damage from acetaminophen.
How is Percocet Abused?
Percocet or any other opioid may be abused to get high. Drug abuse refers to the inappropriate use of medication. Abusing Percocet, even for a few times, can cause addiction and death.
Most notably, Percocet abuse increases the risk of developing an addiction to heroin. The likelihood to abuse Percocet increases when there is:
In one survey, researchers asked Massachusetts adolescents about their drug use behavior. The participants revealed easy access and low cost as the main reasons behind using combination products, such as Percocet.6 Most experts agree that easy access is the biggest but often overlooked risk factor for addiction.
Access to Percocet is sometimes illegally obtained by:
The abuse of Percocet may occur by:
Mixing Percocet with Controlled Narcotic Substances and depressants like alcohol, opioids, and benzos can cause excessive sedation and slowed breathing. Both of these can cause coma or death.
Signs of Percocet Abuse
The signs of Percocet abuse may not be obvious if a person has been abusing the drug for a few days or weeks. However, over time, changes in behavior, social interactions, and wellbeing may become prevalent.
Below are some of the signs and symptoms of abuse.
Problems with focus, memory, or judgment
Unusual mood swings
Changes in sleep schedule
Loss of interest in normally enjoyable activities
Avoiding people, including the family members or friends
Poor performance at school or office
What are the Short-term Effects of Percocet?
The effects of the drug will be felt within 30 to 45 minutes after taking a tablet. The two most desirable short-term effects of Percocet are a reduced sensation of pain and an enhanced feeling of well being.
In addition to the desirable effects, it also causes several short-term side effects. They include:
- Digestive problems
- Dry mouth
- Increased sweating
In some people, Percocet can cause potentially fatal allergic reactions or other severe symptoms. Presence of any of the following symptoms should be discussed with a physician immediately:
Hives and skin rashes
Swelling of the face, lips, tongue, or throat
Pain in the upper region of the stomach
Lack of coordination
Severe breathing problems
Shallow or noisy breathing
Yellow skin or eyes
Uncontrollable muscle contractions
Elevated body temperature
Long-term Effects of Percocet
- Effects of oxycodone
- Brief periods of stopped breathing during sleep
- Irregular breathing patterns
- Increased sensitivity to pain
- Abnormally low blood oxygen levels
- High blood levels of carbon dioxide (can cause seizures, panic attacks, or coma)
- Increased risk of falls, fractures
- Sexual dysfunction
- Decreased testosterone levels in the blood
- Brittle bones, especially in women
- Irregular menstrual periods
- Unusual discharge from nipples in women
- Weak immune systems
- Kidney disorders
- Heart disease
- Bleeding in the stomach or intestines
Moreover, using Percocet for a long duration also increases the risk of dependence, tolerance, and addiction.
Dependence occurs when a patient cannot function without using a drug. Percocet can cause severe physical and psychological dependence.
Tolerance occurs when one no longer feels the effects of a drug with the initial dose. Stated another way, now, there is a need for more of the drug to feel the same way as with a lower dose.
Addiction is a long-term brain disorder. It causes the continued use of a drug despite the known harms.
Overdosing on Percocet is like killing oneself with two different weapons simultaneously. Both oxycodone and acetaminophen can cause severe health consequences and death.
Oxycodone can cause slowed or stopped breathing, which can be deadly. High doses of acetaminophen can damage liver cells and cause liver failure.
Acetaminophen is the number one cause of liver failure in the U.S., ahead of viral hepatitis. Moreover, it is the leading cause of liver transplantation. Each year, acetaminophen overdose causes 56,000 emergency department visits and 500 deaths. Most notably, about half of the overdose cases are unintentional.10
Signs of an Overdose
- Slowed or stopped breathing
- Excessive sleepiness (sometimes, the person does not wake up and may slip into a coma)
- Loss of muscle tone
- Pinpoint pupils
- Cold sweaty skin
- A heart rate below 60 beats per minute
- Low blood pressure
- Unusual snoring
Appearing after 48 to 72 hours after overdosing on Percocet.
- Problems with blood clotting
- Nausea and vomiting
- Usual sweating
- A feeling of uneasiness
Death may occur without immediate emergency medical care. 911 should be called immediately, as well as the local poison control center at (1-800-222-1222).
Treatment of an Overdose
Two antidotes for oxycodone overdose are available. They are naloxone and nalmefene. N-acetylcysteine (NAC) is used to prevent liver damage from acetaminophen toxicity. Supportive treatments include oxygen therapy and drugs to raise blood pressure.
If a doctor thinks there is a longer need for pain relief, they will ask the patient to stop taking Percocet. Moreover, one may want to reduce the dose because they have started feeling better. Opioid medications should not be stopped without a physician’s guidance. Abrupt discontinuation can cause many undesirable effects called withdrawal symptoms. Withdrawal from Percocet can be extremely uncomfortable, but rarely life-threatening.
A gradual decrease in the dose under medical supervision is called tapering. Tapering helps reduce the severity of withdrawal. Depending on the usual dose and intensity of pain, tapering may be done in two ways. They are:
It involves reducing the dose by ten percent to twenty percent every seven to 21 days with regular follow-ups. Slow tapering focuses on lowering the doses rather than increasing the interval between two doses. Once one has adapted to the lowest possible dose, they may decrease the frequency of use.
It involves stopping use completely or reducing the doses rapidly over a few days. Fast tapering can cause severe withdrawal. Thus, it is usually carried out in a supervised center.
Withdrawal may not occur if one is on Percocet for 14 days or less. That being said, withdrawal is unique to every person, and there is no one-size-fits-all approach for discontinuation. A physician’s assistance is needed for all instances of ending use.
Most withdrawal symptoms appear 12 to 48 hours after the last dose. They peak during the first 24 to 96 hours, and one may feel better within the next 5 to 7 days. However, some people may have weakness and a feeling of illness for a few weeks. It is particularly true if they have been taking high doses of Percocet.
Withdrawal from Percocet can cause the following symptoms.
Treatment for Percocet Addiction
The first step in addiction treatment is detoxification (detox). A carefully designed detox program is essential to removing the drug from the body without the risk of severe withdrawal.
Medications may be needed during detox to relieve withdrawal symptoms and prevent relapse. It is known as medication-assisted detox. Because Percocet addiction can be severe, detox under medical supervision is necessary.
The actual journey to sobriety starts once the system has been successfully cleaned.
Comprehensive addiction treatment involves:
Methadone and buprenorphine are two commonly used drugs for opioid addiction. These drugs help control cravings and relieve withdrawal symptoms. They are available in inpatient and outpatient treatment facilities.
A severe addiction may require a stay in an inpatient facility for at least a month to several months, with continuing treatment at an outpatient facility once stabilized.
Psychotherapy (talk therapy) is an integral part of addiction treatment. It involves:
- Recognizing the drug use behavior
- Identifying triggers
- Building strategies to curb drug use
Cognitive-behavioral therapy (CBT) is a type of psychotherapy. It has incredible benefits in addiction treatment. CBT helps identify and correct problematic thought patterns behind drug use behavior.
These are long-term programs that help a person live a drug-free, meaningful life. In essence, aftercare is more than just preventing relapse. They include long-term monitoring, recovery education, and follow-ups. The duration of these programs can range from one to several years.
- National Institute on Drug Abuse. America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
- Centers for Disease Control and Prevention. U.S. Opioid Prescribing Rate Maps.
- NCBI Bookshelf. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.
- Securities and Exchange Commission. Endo Pharmaceuticals Holdings Inc.
- Journal of Medical Toxicology. My Story: How one Percocet Prescription Triggered my Addiction.
- The American Journal of Drug and Alcohol Abuse. A brief survey to characterize oxycodone abuse patterns in adolescents enrolled in two substance abuse recovery high schools.
- The Primary Care Companion for CNS Disorders. A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide.
- NHS. Is long-term paracetamol use not as safe as we thought?
- British Journal of Clinical Pharmacology. Long‐term adverse effects of paracetamol – a review.
- NCBI Bookshelf. Acetaminophen Toxicity.