A combination prescription opioid painkiller, Percocet is tightly regulated by the Drug Enforcement Administration (DEA) as a Schedule II controlled substance, the highest level of control for a drug with approved medicinal use. Containing both the powerful opiate oxycodone and the over-the-counter analgesic acetaminophen, Percocet is commonly diverted and abused with the potential for drug dependence and addiction.
In 2014, the National Survey on Drug Use and Health (NSDUH) reports that over 4 million Americans (aged 12 and older) abused prescription pain relievers within 30 days of the survey. Opioid drugs fill opioid receptors in the brain and block pain sensations while increasing levels of dopamine and therefore pleasure as well. Functions of the central nervous system involved in the stress response, such as respiration, blood pressure, body temperature, and heart rate, are all decreased with Percocet use.
This sends all of the drug into the bloodstream at once and can more rapidly cause a person to become dependent on it. The American Society of Addiction Medicine (ASAM) publishes that around 2 million people in the United States (aged 12 or older) suffered from a prescription opioid substance use disorder in 2014.
A drug dependence is when the brain’s chemical makeup and even some of the circuitry is changed from regular interference of these substances. When someone takes Percocet regularly, for example, levels of some of the brain’s chemical messengers are disrupted. Dopamine floods the system and is not absorbed at previous rates. Dopamine is involved in mood regulation and feelings of happiness, and drugs like Percocet interfere with the way it is normally produced, moved through the brain, and reabsorbed. With regular use, a kind of shortcut can be created, meaning that when the drug is not present, it may be more difficult to feel pleasure through normal activities. This can lead to significant emotional distress as well as cognitive difficulties. Physically, functions of the central nervous system are used to being suppressed by Percocet use, and when the drug is removed, these autonomic actions may rebound. These negative side effects that occur when Percocet stops being active in the bloodstream are withdrawal symptoms.
Specific Detox Timeline for Percocet
Percocet contains the opiate oxycodone, which is considered a short-acting drug with a half-life of 3-5 hours, the journal Clinical & Translational Oncology reports. Drug withdrawal begins when a substance loses effectiveness in the body and stops actively working. In the case of Percocet then, withdrawal begins within 6-10 hours on average.
Opioid withdrawal syndrome can be difficult, and it is not recommended to stop taking a drug like Percocet suddenly, or “cold turkey.” The makers of Percocet, Endo Pharmaceuticals, warn that regular use of the drug for more than a few weeks (even when taken exactly as directed for medical purposes) can create dependence, which requires that the drug be slowly weaned off to avoid withdrawal symptoms.
Percocet detox typically follows the following symptom timeline:
Most physical symptoms peak during this time, including:
- Joint and back pain
- Dry mouth
- Dilated pupils
- Racing heart rate
- High blood pressure
- Shallow breathing
- Muscle weakness
Typically, most symptoms will wane at this point, although some symptoms may remain and persist for a few weeks or months, including:
- Trouble feeling pleasure
- Emotional numbness
- Sleep difficulties
- Weight fluctuations
- Memory and concentration issues
On average, detox typically lasts 5-7 days and sometimes up to 10 days for Percocet. Several factors can influence the severity and duration of Percocet withdrawal, however. Abuse of any other substances like other drugs or alcohol can impact withdrawal as can medical or mental health conditions that may co-occur. Genetics, biology, and environmental factors can impact how significant a person’s dependence on Percocet may be, which in turn influences withdrawal. Percocet withdrawal may be unpredictable and uncomfortable, and for this reason, medical detox is deemed the safest and most secure route to get off the drug.
In addition, medications are often used during opioid withdrawal that affect the overall detox timeline. If replacement medications are used, a complete detox, in which the person has no opioids in their system, may not occur for months or even years.
Safety of Medical Detox
In 2011, the Drug Abuse Warning Network (DAWN) published that more than 150,000 people in the United States sought emergency medical care in an emergency department (ED) for a negative reaction resulting from the misuse of oxycodone (the active opioid ingredient in Percocet). A major complication that can arise during detox is relapse, or a return to drug use after being sober for a period of time. A relapse is especially dangerous at this point because individuals may return to abusing Percocet at levels they did before, and their body may no longer be able to handle it. Fatal overdose is a potential side effect of Percocet relapse during or after detox. The Centers for Disease Control and Prevention (CDC) warns that the United States is in the midst of an opioid overdose epidemic with six out of every 10 drug overdoses in 2014 involving an opioid drug.
Medical detox can help to prevent the likelihood of relapse and overdose as a result. It is performed in a secure and specialized facility where substance abuse, mental health, and medical providers all work to ensure that relapse is avoided and withdrawal is managed safely.
Pharmacological tools are often used to smooth withdrawal and manage the possible symptoms. This can help to lessen the severity of withdrawal symptoms. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the US Food and Drug Administration (FDA) approves buprenorphine medications for use during opioid dependence and addiction treatment. On its own, buprenorphine products like Subutex work to replace Percocet as they stay in the body longer, keeping opioid receptors at least partially activated to keep withdrawal symptoms from being as significant. Buprenorphine is a partial opioid agonist that has a similar mechanism to other opioids, meaning that it can stave off withdrawal symptoms without producing the “high” that Percocet does. Buprenorphine is also often combined with the opioid antagonist medication naloxone (Zubsolv, Suboxone, and Bunavail) after the initial detox period is over in order to help prevent relapse. The antagonist part remains dormant unless the medication is abused, altered, or other opioids are introduced.
Antidepressant medications, sleep aids, and medications that help to regulate some of the autonomic central nervous system functions like blood pressure and heart rate can be helpful during medical detox also. Clonidine, for example, a blood pressure medication, is commonly used off-label during opioid detox to control withdrawal symptoms, the journal Practical Pain Management publishes.
Overall, medical detox provides the most comprehensive and highest level of care to safely remove Percocet from the body and regain healthy physical balance before entering into an addiction treatment program.