Percocet is a medication that can be helpful in the treatment of acute pain, but its misuse has been a primary contributor to the current epidemic of opioid use and opioid deaths from overdose. It follows the course of other opioids in the body, mimicking endorphins and eventually creating physical dependence. Addiction to Percocet is defined by a loss of control of the use of the drug. Treatment begins with detoxification, and should always include a form of psychotherapy, mutual support groups or both.
Percocet is the trade name for a combination drug containing oxycodone and acetaminophen. Oxycodone is an opioid, a medication used as a pain reliever that has similar effects to morphine. It is a semi-synthetic molecule, meaning it is synthesized in a laboratory but is derived from a naturally occurring substance—in this case, the molecule thebaine, a natural opiate found in the Persian poppy plant.
Oxycodone was first manufactured in Germany during World War I as a replacement for heroin, and there is evidence of its widespread usage during World War II by Nazi soldiers and even by Adolf Hitler. Acetaminophen, which is also known as paracetamol or APAP, is a pain-relieving and fever-reducing medication classified in a chemical class called anilides. Addition of acetaminophen to pain regimens has been demonstrated to improve pain relief in patients compared to some stand-alone opioids, with significant evidence that acetaminophen may actually be providing the most significant pain relief. Percocet has been approved for usage in the United States for the treatment of acute moderate-to-severe pain since 1976.
The presence of oxycodone in Percocet makes the drug susceptible to significant side effects, to being misused, to being the source of a substance use disorder or addiction, or to being the cause of an overdose, and thus it is scheduled as a controlled substance by the United States Drug Enforcement Administration. It has the designation of Schedule II, a designation given primarily to potent opioids that have significant medical benefit but considerable risk for addiction and overdose. These types of prescriptions must be written out on paper and cannot be filled electronically or refilled from the same prescription.
How Percocet Works Within the Body
Like all opioids, the oxycodone in Percocet works by mimicking the action of endorphins, the body’s naturally produced pain control molecules—the word “endorphin” is a combination word for endogenous (produced within the body) and morphine. Each oxycodone molecule binds to an access site to the central nervous system (CNS) called the mu-opioid receptor, which is located on various cells and tissues and is responsible for pain modulation. Opioids like Percocet act as CNS depressants, slowing down or limiting many brain functions, but functioning primarily by controlling the flow of pain signals. This action results in pain relief about 10 to 15 minutes after ingestion of Percocet and can last up to 12 hours.
The mu-opioid receptor is also distributed throughout several other body systems, and the binding of oxycodone to the receptor creates effects in each of them. Activating these receptors in the respiratory system decreases breathing rate and depth of respiration, as well as decreases the cough reflex. In the digestive system, Percocet and other opioids reduce the frequency and strength of the gut’s movement. In the cardiopulmonary system, opioids slow heart rate and lower blood pressure. In the dermatological and related systems, opioids reduce production of sweat, saliva, tears, and mucus. The side effects of Percocet—respiratory depression, constipation, sedation, dry mouth skin, among others—are primarily due to these actions.
Oxycodone doesn’t fit the mu-opioid receptor perfectly like endorphins do, but it is such a potent molecule that it still creates powerful effects, much more powerful than those of the natural endorphins. If the brain is constantly exposed to oxycodone or other opioids, it shuts down production of endorphins and begins to acclimate itself to the frequent and immediate availability of oxycodone, eventually establishing this state as its new normal. It is at this point that physical dependence on Percocet has developed.
Physical dependence is defined by the presence of tolerance and withdrawal. Tolerance is the need to increase the dosage of a drug to create the drug’s original effects; stated another way, tolerance results in a decreased effect from the same amount of an administered drug. Medications and drugs that create tolerance often result in withdrawal symptoms when the drug is abruptly stopped or access is removed. It is important to note that physical dependence is a consequence of any drug that replicates natural body processes. This phenomenon is not confined to controlled substances. Steroids, beta-blockers, and several types of antidepressants exhibit similar effects and must be tapered off to prevent withdrawal symptoms.
Withdrawal from Percocet appears similar to other types of opioid withdrawal, although it may vary in timing or severity. Opioid withdrawal signs and symptoms result in a flu-like state, essentially the opposite of its side effects:
- Runny nose, coughing, salivating, tearing, and yawning
- Lack of temperature regulation
- Dilated pupils
- Cold, clammy skin
- Digestive tract discomfort, nausea and vomiting
- Loose stools or diarrhea
- Muscle and bone aches
Most opioid withdrawal peaks within three to four days, but it can last several weeks or months.
Identifying Addictive Behavior with Percocet
Percocet misuse is very common, and it falls into a category of substance use disorders called opioid use disorder. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (commonly abbreviated as the DSM-5) acts as the gold standard for the definition and diagnosis of opioid use disorders for health care professionals and includes the following criteria:
- Percocet use for longer than in intended or in larger amounts than intended
- Unsuccessful attempts to stop using Percocet or cut down its use (or persistent desire to do so)
- Spending great time and resources engaged with the drug, using it, or recovering from its effects.
- Cravings for the drug
- Continued use of Percocet despite negative social and interpersonal consequences directly resulting from such use
- Continued use despite known physical or psychological harm directly resulting from such use
- Recurrent use of Percocet in risky or hazardous situations
- Recurrent use of the drug resulting in loss of function at school, home, or work.
- Reducing or stopping important activities due to Percocet use
- Tolerance: the same amount of Percocet, over time, produces less effect, or it takes more to Percocet to produce the same effect.
- Withdrawal: experiencing symptoms typical of the opioid withdrawal syndrome
Only two of these 11 criteria are needed to diagnose any type of opioid use disorder, and six are required to diagnose a severe opioid use disorder (excluding tolerance and withdrawal if the drug is being taken for a medical condition). Percocet addiction is best thought of as a synonym for severe opioid use disorder, with its central feature being a loss of control over the use of the drug.
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Opioid withdrawal is not fatal, but it can be incredibly unpleasant. Thus, the treatment of Percocet addiction, as with other opioids, usually begins with medical detoxification. Medical staff monitor vital signs for 48 to 72 hours—the length of time usually required for opioid withdrawal symptoms to begin. If necessary, supportive medications such as clonidine can be administered, or opioid replacement medications like buprenorphine (Suboxone) can be utilized to slowly taper off the medication, provided that the patient is in at least some withdrawal. Medications like buprenorphine may be used long-term (this is called medication assisted treatment, or MAT, which results in a medically acceptable physical dependence that can allow a patient to avoid the other symptoms of a substance use disorder or addiction).
Mental health professionals help patients seeking treatment to identify and address conditions that have sometimes been masked by the use of substances, such as depression, attention problems, anxiety disorders, or other conditions. Identifying these conditions is not only important for treating them, but doing so helps make addiction treatment more effective.
When addressing problematic usage of Percocet, cognitive behavioral therapy (CBT) is the psychotherapy of choice. CBT helps people change their behaviors by showing them how to challenge and re-evaluate their thoughts and emotions. It can be performed in groups or in individual sessions and is adaptable to a variety of settings.
Participation in a 12-step-based program, which helps foster important qualities like honesty, self-awareness, accountability, and integrity, demonstrates the best evidence for treating addictive behaviors, along with CBT. Other behavioral approaches with some evidence for effectiveness include motivational interviewing (which aims to inspire a patient to make changes through nonconfrontational and nonjudgmental interviews), and mindfulness-based stress reduction techniques, which help people stay dialed into and connected to their own thoughts, feelings, and behaviors as they are happening.