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A combination of the over-the-counter analgesic acetaminophen and the prescription-strength opioid drug oxycodone, Percocet is a controlled substance with the ability to produce drug tolerance and dependence even in individuals taking it with a legitimate and necessary prescription to control pain.
Opioid drugs bind to opioid receptors in the brain, changing the way users perceive pain. Dopamine levels are increased with the presence of Percocet. Dopamine is one of the brain’s chemical messengers that helps to regulate emotions, process rewards, and make decisions, and it is involved with motor control and memory and learning functions. With repeated use of Percocet, the brain can get used to the amount of drug taken and tolerance can form. Drug tolerance can then mean that in order for the drug to work as it used it, more of it will need to be taken at a time.
Regular use of Percocet can cause drug dependence as the changes made to the brain become more fixed. The brain can begin to rely on the presence of Percocet in order to keep functioning normally, and without the drug’s interaction, withdrawal symptoms can occur. Misuse of Percocet (i.e., taking the drug without a prescription, taking more of the drug at a time, taking it in any way other than it was intended to be taken, or taking it more often than prescribed) can increase the risk for drug dependence and addiction.
Percocet withdrawal can be intense. The U.S. Food and Drug Administration (FDA) publishes information in the prescribing data for the drug warning people who have been taking it for a few weeks not to stop taking it suddenly, or “cold turkey,” as significant withdrawal symptoms can occur. Instead, Percocet should be weaned off slowly, tapering down the dosage in a controlled manner over a set period of time, and the process should be supervised by a trained medical professional.
When Percocet is abused, large amounts are generally taken at one time. The drug may be chewed, crushed and then snorted, injected, or smoked to create a euphoric high. When a person takes high doses of Percocet, alters the drug to send it more rapidly into the bloodstream (e.g., smoking, injecting, chewing, or snorting it), or takes the drug for a long time, a significant dependence may build up. Withdrawal symptoms can then be difficult and even potentially dangerous, setting in within the first day of stopping use of Percocet, the National Library of Medicine (NLM) reports. At-home detox is not recommended, and a medical detox program is considered the optimal environment for allowing the drug to safely process out of the body.
During detox, a person can expect Percocet withdrawal to typically follow this general timeline:
Withdrawal begins within about 12 hours after stopping the drug. Symptoms include:
Withdrawal peaks between one and three days after last use. Symptoms include:
Acute withdrawal takes 4-10 days on average. It includes:
Protracted withdrawal can last a few weeks to months after stopping Percocet. Symptoms include:
The duration and severity of Percocet withdrawal syndrome are closely linked to how dependent on the drug a person is. The longer the drug was used and the higher the amount, the more significant the level of dependence is likely to be. Biological and genetic factors, such as metabolism, family history of addiction, and the presence of any co-occurring mental health and/or medical disorders, as well as abuse of other drugs or alcohol can be tied to the level of dependence and the severity of withdrawal as well. Environmental aspects, like lack of a good support system at home, high levels of stress, etc., are also significant factors.
As a chronic brain disease, relapse is a common factor in addiction. The National Institute on Drug Abuse (NIDA) publishes that relapse rates are 40-60 percent for drug addiction. Relapse after stopping Percocet for any length of time can be especially dangerous as the brain may have had time to reset a person’s tolerance levels. This means that if someone goes back to taking the same amount of the drug that they did prior to stopping use, it may overwhelm the brain and lead to a potentially life-threatening overdose.
Opioid overdoses are at an all-time high in the United States. The Centers for Disease Control and Prevention (CDC) reports that more than 15,000 people died from a prescription opioid overdose in 2015, and around 1,000 people are treated in emergency departments (EDs) for prescription opioid drug misuse daily. Without professional help, opioid withdrawal symptoms make it difficult to refrain from returning to drug use and are a significant risk factor for a fatal overdose.
Percocet withdrawal can be safely managed through medical detox. It is not recommended to try and detox from Percocet without the aid of a specialized detox program. A medical detox program can provide the safety and security needed while the drugs process out of the body, helping a person to become physically stable and setting up a strong foundation for an addiction treatment program that should follow detox. During medical detox, vital signs can be monitored and kept within safe levels, as respiration, heart rate, body temperature, and blood pressure are all disrupted by opioid abuse and withdrawal. Relapse, and therefore the risk for overdose, can be minimized as well. Opioids may be tapered off slowly to avoid the more difficult withdrawal symptoms that can occur when the drugs are stopped suddenly.
There are several medications that are FDA-approved to treat opioid dependence that can be beneficial during medical detox. Medications like methadone and buprenorphine are opioid agonists that can be used to replace other opioids, like Percocet, during detox to help minimize withdrawal symptoms, NIDA reports. Both are longer-acting opioid drugs than the active opioid in Percocet, oxycodone (which is considered fairly short-acting). These medications can therefore stay in the bloodstream longer and keep activating the opioid receptors in the brain to keep withdrawal symptoms and drug cravings at bay.
Methadone (Methadose and Dolophine) is dispensed through federally regulated programs to be taken orally, usually once a day. It is a full opioid agonist drug and can therefore be abused and lead to drug dependence in and of itself. Buprenorphine, on the other hand, is only a partial opioid agonist that has a ceiling effect when taken in larger doses, meaning that it stops being effective after a certain point. Buprenorphine can be prescribed to be taken at home and comes in sublingual tablet, buccal film, transmucosal products, and now in implant form (Probuphine). It is also commonly combined with naloxone, an opioid antagonist that acts as an abuse-deterrent, remaining dormant unless the drug is altered to be abused. These combination buprenorphine/naloxone products (Bunavail, Suboxone, Zubsolv) are generally used on a long-term basis, and clients are then gradually weaned off them.
Other adjunct medications can be used during medical detox to help with Percocet withdrawal symptoms. The blood-pressure medication clonidine is an adrenergic agonist drug that helps to balance out and mitigate some of the autonomic functions of the central nervous system that are impacted by opioid withdrawal, making it a common component of opioid detox programs, the journal Dialogues in Clinical Neurosciences publishes.
Other medical aids, like gastrointestinal medications, may help with the nausea and vomiting, and antidepressant and anti-anxiety drugs can help to control the mood swings, depression, and anxiety that are often main aspects of withdrawal. Sleep aids may also be useful. Vitamin and mineral supplements and fluids may help to improve physical and nutritional balance during detox.
Medical detox is typically a 5-7 day program where a person stays in a specialized facility 24/7 while Percocet processes out of the body. If the person is on replacement medications, the full withdrawal process may take significantly longer; however, the person proceeds into standard addiction treatment and aftercare during this time.