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Percocet is a mix of an opioid and the medicine in Tylenol

Naloxone is a key tool in fighting the opioid epidemic

CNN  — 

Percocet is a painkiller that’s part of a family of drugs known as opioids. Though some are derived naturally, such as heroin or morphine, others are synthesized in a lab, including hydrocodone and oxycodone. Percocet is the brand name of a drug that mixes oxycodone and acetaminophen, the generic name for drugs such as Tylenol.

These narcotics have the same cellular structure. Opioids such as Percocet latch on to opioid receptors in the brain. They can create a sense of euphoria and numb pain, but they can also slow breathing.

Percocet is commonly prescribed to patients suffering from pain, whether from a cesarean section or a broken bone. Opioids vary in the length of time between when they are taken and when the user feels an effect. Oxycodone, the opioid in Percocet, is relatively fast-acting.

As is true of all medicines, opioids are not inherently good or bad, said Dr. Caleb Alexander, an associate professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health and the co-director of the school’s Center for Drug Safety and Effectiveness.

“The value of Percocet or any medicine depends upon how its applied, how it’s used,” he said. “And so, for the right patient at the right time, it’s a remarkable medicine. But unfortunately, it’s been vastly overused, as have all opioids.”

Percocet side effects

Those who take the drug may experience both short- and long-term effects. In addition to euphoria and pain relief, Percocet may cause drowsiness, constipation, depression, memory problems, decreased testosterone, cardiac problems, bone problems, addiction and death.

Percocet addiction

Percocet is classified as a Schedule II drug by the federal Drug Enforcement Administration, which means it a drug with “a high potential for abuse, with use potentially leading to severe psychological or physical dependence.”

Alexander said it is difficult to obtain accurate statistics on the number of people misusing Percocet because it not uncommon for individuals with an addiction to switch between opioids.

“The opioids as a class are more similar than they are different,” he said.

Dr. Sarah Wakeman, the medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital, said national drug surveys often lump prescription drugs into one category rather than separate them by brand name.

According to the National Institute on Drug Abuse, an estimated 54 million people in the United States have used prescription drugs for nonmedical reasons at least once.

The simplest definition of addiction is use despite consequences, Alexander said.

And while Percocet and other prescription opioids are highly addictive, individuals can have varying risks of addiction based on hereditary and environmental factors, said Dr. Anna Lembke, an associate professor and the chief of addiction medicine at the Stanford University School of Medicine.

Risk factors for addiction

Some hereditary risk factors include personal or family history with addiction to either opioids or other substances, including alcohol, and co-occurring mental illness, while environmental risk factors include early childhood trauma, poverty and unemployment.

“One of the biggest risk factors for addiction that’s often overlooked is simple access,” Lembke said. “If you have more access to a drug, for example to a doctor’s prescription, you are more likely to be exposed to that drug and more likely to get addicted.”

Nevertheless, individuals who have none of these risk factors may still become addicted, she added.

Dependence and withdrawal

Not everyone who uses Percocet becomes addicted to the drug; however, anyone who takes it for an extended period of time will eventually develop dependence, a term that refers to specific physiological changes in the brain, Alexander said. Only a subset of dependent people will become addicted, for reasons scientists do not completely understand, he added.

Dependence is not necessarily a lifelong condition, but if an individual dependent on Percocet stops taking the drug, they may experience withdrawal symptoms. People addicted to opioids may also experience these symptoms if they attempt to suspend use.

Withdrawal symptoms include craving the drug, upset stomach, restlessness, anxiety or irritability, rapid heart rate, sweating, aches or pains and dysphoria, a state of unease.

Misuse and abuse

Abuse and misuse of Percocet may look different for different people, but the definition of misuse is using the drug not as it is prescribed, in this case as a treatment for pain. Examples of misuse include taking the drug recreationally, changing the delivery method by crushing and snorting it, and hoarding and binging pills. Lembke said that going to multiple doctors for the same or a similar prescription, a practice known as “doctor shopping,” constitutes another form of misuse.


Because Percocet contains two drugs, there are two potential ways to overdose, Wakeman said.

The first is by overdosing on oxycodone, the opioid component of Percocet. The drug affects the part of the brain stem that controls the urge to breathe, so an overdose results in slowed or stopped breathing. Without enough oxygen, your body’s tissues and organs will become damaged. Ultimately, this kind of damage to the brain is what results in death.

Signs of an overdose include blue lips and nails, gurgling or infrequent breathing and unresponsiveness. Wakeman said she trains people to rub their knuckles along the breastbone of a person suspected of having overdosed, which will wake sleeping individuals but not ones who have overdosed.

The other way to overdose on Percocet is by ingesting too much acetaminophen, which causes liver toxicity at high enough doses.

“For Tylenol, we get concerned at any amount over 4 grams a day,” Wakeman said. Depending on the strength of Percocet prescribed, the maximal daily dose varies from six to 12 tablets.

Percocet in pop culture

Songs like “Slippery” by Migos and “Mask Off” by Future have more in common than their thumping beats and peak on the Billboard Hot 100; both make reference to recreational use of Percocet.

Experts say they are concerned about the glamorization of drug misuse in songs like these, particularly for young people.

“Even a mention in popular culture has the potential to normalize consumption of that drug for young people, to make it seem as if consuming that substance is not taboo and also kind of fashionable or hip,” Lembke said. “When names like Percocet make an appearance … in popular culture, it then has the potential to normalize use and increase use among that younger generation that’s prone to want to experiment anyway.”

Rappers also make reference to recreational drug use, most notably Lil Peep, who died of a drug overdose in November and had posted about taking Percocet as well as the depression and anxiety medication Xanax.

Fighting the opioid epidemic

The Trump administration has laid out a plan to tackle the ongoing addiction epidemic. The plan will focus on bolstering law enforcement; improving education and prevention with an advertising campaign; funding treatment through the federal government; and helping those with addictions find jobs, Director of the White House Domestic Policy Council Andrew Bremberg and White House counselor Kellyanne Conway have said.

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    Naloxone, an opioid overdose reversal drug, has been highlighted as a tool in fighting the opioid epidemic. The drug can reverse an overdose, essentially giving someone a chance to be treated for addiction. Emergency medical technicians have long had naloxone on hand, and it has been passed out among needle-exchange programs and harm-reduction groups to help heroin addicts.

    Recently, there has been a movement to get it into the hands of more people, including first responders, such as police officers, as well as family and friends of addicts.

    According to the Centers for Disease Control and Prevention, since naloxone has been made available in 1996, there have been more than 26,000 overdose reversals across the country.