Percocet is a powerful opioid drug, a combination of oxycodone and acetaminophen, that is prescribed to treat pain. Since opioid drugs are habit-forming when taken regularly, it is not recommended to take Percocet for long periods of time. The drug is, however, commonly misused, as the National Survey on Drug Use and Health (NSDUH) indicates that in 2014, there were nearly 4.5 million people currently abusing prescription pain relievers like Percocet.
When Percocet is used continually, alterations are made to brain chemistry. For example, when Percocet enters the brain, it causes an increase of the neurotransmitter dopamine, which is responsible for enhancing feelings of pleasure. It also slows down some of the autonomic functions of the central nervous system like respiration, body temperature, blood pressure, and heart rate. With repeated exposure, the brain can become accustomed to Percocet’s interaction in its system and stop producing and transmitting its chemical messengers like dopamine normally. Drug dependence forms, which in turn can lead to difficult withdrawal symptoms when the effects of Percocet wear off.
The American Society of Addiction Medicine (ASAM) reports that 2 million Americans suffered from dependence to prescription opioids, including Percocet, in 2015.
Percocet Withdrawal Timeline and Associated Symptoms
According to the manufacturers of Percocet, Endo Pharmaceuticals, the drug has a half-life of about four hours. This means that after four hours, the drug is half as active in the body as it was initially. After about double that amount of time, so eight hours or so, the drug will be mostly inactive. At this point, withdrawal symptoms may begin. The National Library of Medicine (NLM) classifies opioid withdrawal symptoms into early and late-onset symptoms.
Early opioid withdrawal symptoms include:
- Muscle aches
- Increased tearing of the eyes
- Runny nose
Late-onset opioid withdrawal symptoms
- Abdominal cramps
- Dilated pupils
Percocet withdrawal can cause irregular heart rate, strained respiration, elevated blood pressure, restlessness, back and joint pain, depression, trouble feeling pleasure without the drug, possible suicidal ideations, irritability, weight loss and reduced appetite, weakness, and significant drug cravings.
The majority of withdrawal symptoms occur during what is considered “acute” withdrawal, and the Substance Abuse and Mental Health Administration (SAMHSA) publishes that this stage commonly takes 4-10 days for opioid drugs.
A typical breakdown of the timeline for Percocet withdrawal may look like this:
- Within 8-12 hours after last dose: Early withdrawal symptoms may begin to appear.
- 1-3 days after stopping Percocet: Withdrawal symptoms will peak and be at their worst.
- 4-10 days after the last dose of the drug: Withdrawal symptoms will start to taper off.
- A few weeks to months after stopping Percocet: Some withdrawal symptoms like drug cravings, insomnia, depression, and anxiety may linger. This is often referred to as “protracted withdrawal,” and it normally only occurs in cases of severe dependency.
Several things can influence the severity and duration of Percocet withdrawal, and most hinge on the level of dependence a person has to the drug. Those who have been taking Percocet for a long time or taking high doses more often are more likely to be significantly dependent on it. Metabolism, genetics, and other biological factors, such as the presence of any co-occurring disorders or a family history of addiction, also factor in. Environmental factors, like stress levels and strength of support systems, are also influential. Abusing other drugs in conjunction with Percocet may complicate withdrawal, prolonging the overall timeline.
Percocet withdrawal can be extremely uncomfortable physically and intense mentally. For this reason, acute withdrawal is often managed via medical detox. Percocet is not generally stopped suddenly, without medical intervention and aid, in an effort to minimize withdrawal. Instead, Percocet may be slowly tapered, or weaned off, over a set period of time to avoid the shock to the system that stopping it cold turkey may induce.
Percocet may also be replaced with a longer-acting opioid drug that can be taken less frequently and in lower doses, and doses of this medication are then tapered slowly over a set period of time. Methadone and buprenorphine products are often used for this purpose. The U.S. Food and Drug Administration (FDA) lists methadone and buprenorphine as approved pharmaceuticals for the treatment of opioid dependence and addiction.
Both methadone and buprenorphine are opioid agonists, and they work on many of the same receptors in the brain that the oxycodone component of Percocet does. Longer-acting opioids, like these drugs, don’t need to be taken as frequently as they keep the opioid receptors activated for longer. Buprenorphine is also considered only a partial agonist of these receptors, and it does not provide the same euphoric “high” that Percocet can. Partial agonist’s effects are somewhat blunted, and even if they are abused, they have a “plateau effect” after a certain amount is taken; as a result, the drug’s effects will level off.
Methadone is available as a pill that is dispensed by federally regulated clinics to be taken once a day to keep cravings and withdrawal symptoms at bay; buprenorphine is marketed in both pill and sublingual filmstrip forms. In May 2016, buprenorphine was also introduced and approved in the form of an implantable drug called Probuphine that can deliver continuous low doses of the partial opioid agonist for up to six months, the Washington Post publishes.
Other medications that specifically target certain withdrawal symptoms, like insomnia, gastrointestinal upset, anxiety, autonomic central nervous system functions, and depression, are also helpful in managing symptoms during detox. Medications are a useful component of medical detox that can help to ease specific symptoms of Percocet withdrawal and shorten the overall timeline.
While medications can be key during withdrawal, the supportive care offered by medical detox programs can also be vital. During withdrawal, professionals monitor clients as the Percocet is processed out of the body. Vital signs are monitored, and supportive care is given to promote emotional stability. Nutritional deficiencies and sleep deprivation can be managed with the introduction of healthy meals and structured sleeping schedules. Mental health is assessed, and trained professionals can begin to treat any co-occurring disorders that necessitate simultaneous and integrated care during detox.
On average, a medical detox program lasts about 5-7 days; however, each person is different, and the timeline can vary accordingly. During medical detox, a person typically stays on site for the duration of the program. Directly following detox, the person should proceed into an addiction treatment program that focuses on therapy. If replacement medications are used, the person may continue taking those medications under medical supervision as they continue into comprehensive treatment.
As soon as a client becomes stable, they can begin to focus on what may have led them to misuse Percocet in the first place. They will learn alternative methods for coping with stress and tools for preventing future relapse. The journal Social Work and Public Health publishes that an integration of behavioral interventions and pharmacological tools is highly beneficial in the treatment of addiction and drug dependence.
While detox is not a standalone tool for the management of Percocet dependence and withdrawal, it can be extremely helpful in establishing a strong and stable foundation for long-term recovery.