As an opioid combination drug containing oxycodone, Percocet follows the general withdrawal timeline and side effect profile of most opioids.
Opioid drug use can lead to both physical and psychological dependence when these drugs are taken regularly. When a person takes Percocet, alterations are made to the chemistry in the brain. Levels of dopamine are increased as the drug fills opioid receptors, blocking pain sensations and depressing functions of the central nervous system. With repeated use, the brain may become used to the presence of Percocet and require it to remain sufficiently balanced. A person may feel “out of sorts” without the drug and have difficulties feeling pleasure.
Drug dependence is often most recognizable by the difficult withdrawal symptoms that occur when the drug wears off and stops working in the bloodstream. With Percocet, the prescribing information warns that the drug should not be stopped suddenly as withdrawal symptoms can be intense. The National Highway Traffic Safety Association (NHTSA) publishes that opioid withdrawal symptoms typically begin within about 6-12 hours after the last dose of the drug.
In general, Percocet withdrawal usually follows this typical timeline:
Early withdrawal (from 6-12 hours after the last dose through to about 1-2 days later):
- Runny nose
- Excessive yawning
- Watery eyes
Peak of acute withdrawal (48-72 hours after last dose):
- Lack of appetite
- Trouble feeling pleasure
- Nausea and vomiting
- Chills and sweats
- Stomach cramps
- Raised heart rate and blood pressure
- Body aches
- Bone and muscle pain
- Muscle spasms
- Suicidal thoughts
Late withdrawal (from around 3-10 days after last dose):
Continued physical and psychological symptoms of acute withdrawal that slowly taper off each day.
Protracted withdrawal* (beyond the first week or so, potentially lasting a few weeks or months):
- Sleep disturbances
*not everyone suffers from protracted withdrawal
Percocet is not a drug that should be stopped “cold turkey” as withdrawal symptoms can be significant. Instead a medical detox program is highly beneficial. Detox programs usually last 5-7 days on average and manage the bulk of acute withdrawal symptoms. Full withdrawal may take weeks or months if replacement medications are used; however, clients may continue into therapy and comprehensive treatment while on the replacement medication.
The American Society of Addiction Medicine (ASAM) publishes that around 2 million Americans battled addiction to prescription opioid painkillers in 2015. Drug dependence and withdrawal symptoms are often side effects and components of addiction. Just as addiction is an individual disease, Percocet dependence will not impact everyone exactly the same; as such, withdrawal symptoms can vary in their intensity and duration as well.
The biggest factor influencing Percocet withdrawal is the level of dependence a person suffers from. Those who have been abusing Percocet for a long time and in large amounts are likely more heavily dependent on the drug. Percocet may be abused by swallowing the tablets, chewing them, or by crushing them to snort, smoke, or inject the resulting powder. Crushing these drugs and taking them intranasally or intravenously can increase the rate of dependence over standard oral ingestion routes. In addition, taking Percocet with other drugs can complicate withdrawal and heighten dependence. Other factors that influence the Percocet withdrawal timeline include:
- Biological aspects, such as metabolism, brain chemistry, etc.
- Genetic factors, including a personal or family history of addiction
- Presence of co-occurring mental health or medical disorders
- Environmental factors like low levels of support at home, high rates of stress, and exposure to traumatic events
As mentioned, Percocet can be dangerous to stop taking suddenly, as the physical side effects and psychological symptoms can be significant. Severe anxiety and depression can occur during withdrawal, and this may increase the odds for suicidal thoughts and actions.
Physically, Percocet serves as a central nervous system depressant drug. When it is suddenly stopped after dependence is created, autonomic functions may spring back. Heart rate, blood pressure, respiration, and body temperature can all spike rapidly, and tremors, hypertension, tachycardia, and respiratory distress may occur.
Cravings can be intense, potentially leading to a relapse, or return to drug abuse. A relapse after stopping Percocet for any amount of time can be especially hazardous, as the body will have started to rebalance itself and tolerance levels may change. Then, if a person takes the same amount of Percocet as they used to, a toxic buildup and subsequent overdose may be the result. The Centers for Disease Control and Prevention (CDC) warns that prescription opioid overdose is a national epidemic, as more than 15,000 fatalities involving a prescription opioid drug were recorded in 2015.
Medical Detox and Medications for Percocet Withdrawal
Typically, medical detox is deemed the optimal method for helping the body and brain to process Percocet out safely. A medical detox program is hosted at a specialized facility and staffed with trained medical and mental health professionals. Clients remain on site for a period of 5-7 days receiving continuous medical monitoring and supervision around the clock.
During medical detox, along with supportive care, medications are often used to help with withdrawal symptoms. Percocet contains the opioid oxycodone, which is a relatively short-acting opioid drug. During medical detox, Percocet may be replaced with a different opioid drug that is longer-acting. Then, this substitute opioid will be slowly tapered off in a controlled manner in order to avoid complications associated with sudden stoppage of an opioid drug.
The White House Office of National Drug Control Policy (ONDCP) publishes that there are three medications approved for the treatment of opioid dependence: methadone, buprenorphine, and naltrexone. Methadone and buprenorphine may be used during medical detox, as they are both opioid agonists. Naltrexone is often reserved for maintaining compliance with treatment methods later in recovery, as it may precipitate withdrawal if taken when opioid drugs are still in the system.
Methadone and buprenorphine are both opioid agonist medications, meaning that they work to activate opioid receptors in the brain as other opioids do. The difference is that they have a longer duration of action than most other opioids, which makes them an attractive substitute during detox. These replacement medications can be taken less frequently and in lower doses, and they still keep the receptors activated and withdrawal symptoms to a minimum.
Buprenorphine is slightly different in that it is only a partial opioid agonist instead of a full agonist medication. This, coupled with the way the opioid effects plateau after a certain point, may deter abuse of buprenorphine. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that buprenorphine, when used as part of a complete treatment program, can minimize opioid withdrawal cravings and side effects, and help to treat and manage opioid dependence.
Other medications are also used during medical detox to reduce withdrawal discomfort. For example, clonidine is routinely used during opioid withdrawal to reduce hyperactivity of the central nervous system, the journal Dialogues in Clinical Neuroscience publishes.
In addition to medications, trained professionals provide encouragement and support to help individuals remain abstinent as the drugs process out of the body. Adjunct therapies and complementary techniques, like acupuncture, massage therapy, and other holistic methods, may be helpful as well.
It is important to get enough sleep and eat nutritious meals during detox to allow the brain and body the proper conditions to rebalance properly. Supplements and vitamins can help to restore physical health and replenish depleted stores of nutrients in the body that are impacted by chronic Percocet abuse and resulting poor eating habits and possible malnutrition.
Medical detox is generally the frontline treatment for Percocet dependence and addiction, as it can provide a foundation of physical stability. After detox, therapy is essential to sustain abstinence and promote long-term recovery.