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Percocet (Oxycodone Acetaminophen)

What is the chemistry of Percocet?

Percocet is the brand name for the combination medicine of oxycodone and acetaminophen.  It is an opioid painkiller.  The oxycodone part of Percocet is the opioid, the acetaminophen part of Percocet is the same ingredient as found in the over-the-counter pain medication, Tylenol.

Oxycodone and by default, Percocet are narcotic analgesics prescribed to relieve moderate to severe pain. The oxycodone in Percocet is a semisynthetic opioid about 1.5 times more potent than morphine.

Like other opioids, Percocet activates a pain-relief effect by binding to certain receptors in the brain, blocking the transmission of pain and other unpleasant sensations. If the drug is taken extensively for long periods, the brain—and, by extension, the body—becomes used to the “help” and shuts down some of its own natural pleasure-stimulating-pain-relieving functions, possibly leaving the user with difficulty experiencing pleasure in every day activities.  Continued use also leads to physiological dependence and tolerance and then to unpleasant withdrawal symptoms if the drug is stopped abruptly.

What is the history of Percocet? 

Percocet first became popular in the United States around the 1970s, as an alternative to Percodan, the combination oxycodone–aspirin painkiller, which had a blood-clotting side effect due to the aspirin. In the late twentieth century, Percocet was the prescription drug of choice to treat pain incurred through regular hard physical labor, such as coal mining. Partly because many of these users had little education and were poorly informed about addiction risks, the drug eventually became a major player in the twenty-first-century prescription painkiller addiction epidemic.

Percocet is classified as a Schedule II drug by the Drug Enforcement Administration, identifying it as having high potential for abuse and dependence.  Schedule II drugs have some accepted medical uses, but also the potential for severe addiction (Schedule I drugs have no legal use).

What are the side effects of Percocet use?

As an opioid analgesic, Percocet can produce side effects including development of tolerance, blurry vision, constipation, nausea and vomiting, drowsiness, dizzy spells, itching, dry mouth, heavy perspiration, and cognitive impairment. On occasion, more serious effects can occur, including apnea (the suspension of breathing), cardiac impairment, hypotension, and shock. When the drug is used for too long, accumulated effects may damage the liver or other vital organs.  In higher doses, Percocet may noticeably slow heart rate, cause severe dizziness, or make the pupils of the eyes constrict and the skin turn cold and clammy.

If your doctor suggests the use of Percocet for pain control, be sure to mention if you have ever had heart trouble, breathing problems, or drug or alcohol problems—and to check back immediately if you experience adverse symptoms after starting the medication.

How was Percocet intended to be used?

Percocet is best used for the relief of acute (not chronic) pain, such as may occur for a brief period of time after an injury or surgery. Like all opioids, it has high addictive potential and should be taken exactly as prescribed.

Percocet has occasionally been prescribed for migraine headaches, but this is not generally recommended as, aside from the risk of addiction, many people develop a syndrome called rebound headaches if taken more than 10 days per month.

How is Percocet used illicitly?

As with most prescription drug addictions, illicit use typically begins with taking “just a little” more than the officially prescribed amount. If you don’t feel Percocet is relieving your pain adequately, never adjust the dosage on your own: ask a doctor for advice.

Recreational users or those addicted to the point of using extensive amounts of Percocet sometimes break up the pills for snorting or using in injections.  People who take it by prescription are advised to always swallow tablets whole—chewing can release the active ingredients too fast, resulting in overdose or increased risk of addiction.

Fortunately, doctors have become more aware of the risks in prescribing Percocet and other opioids.

What are the signs of illicit use of Percocet?

Symptoms of abuse or addiction include: constant drowsiness, unexplained bursts of euphoria,  “pinpoint pupils” in the eyes, chronic constipation or nausea, “drunken” behavior in the absence of alcohol consumption, tolerance or dependence on the drug, requesting prescription refills with unusual frequency, becoming negligent of everyday responsibilities, “losing” money or personal property for unexplained reasons (which may indicate money is being spent for drugs), and giving up priorities such as work or family responsibilities.

Symptoms of withdrawal include: unusual anxiety or irritability, rapid breathing, runny nose, aches and pains, severe abdominal cramps, diarrhea, heavy perspiration, enlarged pupils, body tremors, and loss of appetite.

Symptoms of overdose include: pinpoint pupils, labored breathing, unconsciousness, skin turning pale and clammy, and bluish tinge to lips and fingernails. Call for emergency medical help if you experience withdrawal or overdose symptoms in conjunction with taking Percocet or another opioid—and, after the emergency is over, look immediately into addiction detox and treatment options.

How Does Recovery Centers of America Treat Percocet Abuse or Addiction?

For patients desiring detoxification and treatment for Percocet:

Detoxification from Percocet (or other similar opioid) dependence or addiction is profoundly uncomfortable if done without medical supervision and intervention, it can be life-threatening if the individual is also abusing other drugs such as alcohol or a class of medications known as Benzodiazepines (Xanax, Klonopin, Alprazolam, etc).

Withdrawal symptoms start as soon as 8 hours after the last dose, but they are typically not severe in the first 24 hours.  The time of onset, severity and duration of withdrawal symptoms will vary based on the amount of Percocet used, over what period of time, and the route of administration (swallowing pills, smoking, injecting).

RCA will monitor the patient round the clock, continually evaluating physiological and psychological symptoms and will use medications to control many of these symptoms.  Medications that may be used include those to wean off the Percocet and palliative or “comfort” medications such as Clonodine, Robaxin, Trazadone, Phenobarbital, Ativan (in case of seizure), Bentyl, Librium, Tigan, and others.

Physical/medical aspects of detoxification may last up to 10 days but is more typically 6-7 days before patients are medically stable.  This doesn’t mean they don’t still have symptoms, just that those symptoms may not require round the clock, constant medical attention.  Psychiatric symptoms and cravings can continue intermittently for many months.

At intake, RCA staff administer the assessment in a calm environment, providing something to eat and beverages to keep the individual comfortable.  If the individual finds it difficult to participate due to an inability to concentrate or onset of withdrawal symptoms, the assessment can be divided into smaller sections.  Comfort medications can be provided as soon as the nursing assessment is done.

RCA staff provide a clear orientation to the treatment choices, the process, program rules, and expectations for participation to ensure each patient knows their options and to assist in decreasing any externally related anxiety about the process.

A controlled tapering of the drug, alleviating most withdrawal symptoms with medications (as noted previously) and wellness services is the safest, most tolerable method, resulting in the least discomfort.

As with any disorder, it’s also very important to involve significant others.  During the initial assess­ment and intake processes, RCA identifies family members or significant others who will support the patient and their treatment goals and get them involved immediately.

After medical detoxification, treatment will include additional small group therapy sessions, individual sessions, educational seminars, and workshops.  For our patients struggling with Percocet or other opioids, additional services to assist with calming the body and the mind such as mindful meditation, yoga, progressive relaxation, and other therapeutic techniques are provided.

Through wellness seminars, life skills workshops, and various therapies, RCA focuses patients on developing a balanced lifestyle that includes restoring healthy eating and sleeping habits, participation in physical exercise and recreational activities, as well as building healthy relationships and a healthy support group to get them started on the road to long-term recovery.

Medication-Assisted Options

For patients who plan to detox fully from all opioids, injectable Naltrexone sold under the trade name Vivitrol, a form of long-term blocker, can be especially helpful. Naltrexone/Vivitrol are opioid “antagonists,” meaning they blocks the effects of opioid medications.  Vivitrol binds to the receptor that opioids use to provide pleasurable feelings and does not allow the opioid to have its effect. In fact, it’s strength in binding to the receptor is so much greater than the opioids ability, it will knock the opioid off the receptions even if they were there first.  Therefore, you should have 1-2 weeks without any opioid use to start Vivitrol, as using it will put an active opioid user into withdrawal.  Vivitrol has also been shown to decrease cravings for both alcohol and opioids.

For patients who start with detoxification/treatment and find that complete abstinence is not tolerable for them due to cravings or difficulty functioning without medication, outpatient opioid replacement therapy is another method of ensuring that the opioid receptors remain at least partially engaged in a measured way while reducing these symptoms. This includes the medications suboxone and methadone.

Percocet and Suboxone Treatment

The main/active ingredient in Suboxone is buprenorphine.  Buprenorphine is a partial agonist.  An agonist is a medication that binds to the receptor site – Percocet, heroin and other opioids are “full agonists,” they bind to the receptors and activate them fully producing the euphoria and pleasurable feelings users often seek.  Suboxone is a partial agonist, it binds to and activates the same receptors as other opioids, but has only part of the effect that a full agonist such as Percocet will have on the user. Suboxone remains active in the bloodstream for longer and does not produce quite the same euphoric effect as full agonists like Percocet. The pleasurable effects are not as intense if these partial agonists are taken in higher doses, and buprenorphine even has a ceiling so that after a certain amount is taken, it no longer increases in effect.

Interestingly, Suboxone also contains the medication naloxone (that’s where the “oxone” portion of its name comes from). Naloxone, when given alone, is an opioid antagonist (completely blocks the effects of an opioid). If the Suboxone is taken as prescribed, the buprenorphine (opiate agonist) will enter the body over time and the Naloxone (the opioid antagonist) will be inert, or have no effect.  If, in an effort to get all the opioid medication into the bloodstream at one time, the user crushes and injects the sublingual tablet, the naloxone effect is activated, it dominates, and the naloxone blocks the receptors, causing opioid withdrawal.  This decreases the likelihood that the Suboxone will be abused.

Percocet and Methadone Treatment

Methadone is another form of medication-assisted treatment.  A synthetic opioid, methadone is a longer-acting opioid replacement medication, it binds with the opiate receptors but without quite the euphoria as heroin and other opioids. Methadone is typically taken as a liquid medication and people taking it generally report to a clinic specializing in medication-assisted treatment at least 5 days per week.

Among other benefits, methadone maintenance gives patients a daily, stable dose of opioids, decreases the likelihood that users will be injecting drugs, therefore getting Hepatitis or HIV, eliminates the need to find ways to pay for opioids and helps people take the first steps toward getting back to normal life.  Although it is not entirely without its own health concerns, and dependence that is similar in strength to heroin, methadone is considered effective and safe and is included in the World Health Organization’s (WHO) list of Essential Medications.

One thing all treatment providers agree on – neither medications alone, not talk-therapy alone is the complete answer for achieving long-term recovery. Addiction is a brain disease that affects many aspects of a person’s physical and mental well-being as well as their personal, family and social relationships. RCA also includes behavioral therapies, pragmatic workshops, counseling sessions, and long-term support groups when helping those with opioid abuse and dependency issues.

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