by Pedro Miranda

Created on: July 10, 2010

Contrary to popular belief, Percocet and Oxycontin are not the same drugs.

Percocet is a combination of oxycodone, a synthetic opioid analgesic (pain killer) and acetaminophen (Tylenol). It’s most common use is for the treatment of pain, both acute as in post surgical pain, and chronic, as in advanced cancer, and some other chronic pain conditions. Like all opiates (Drugs derived from opium) there is a potential for tolerance and dependence. Tolerance is the need for larger doses of the drug to achieve the same effect; dependence is the need for the drug unrelated to the original indication for its use. For instance, a person has had his appendix out and has been prescribed oxycodone as a treatment. He may develop dependence on the drug and then feel actual pain if the drug is not supplied, despite having recovered completely from his surgery.

Oxycodone is more likely to cause dependence than other opiates like codeine or hydrocodone (Vicodin) because it causes more euphoria than the others. It is this euphoria that makes oxycodone such a popular street drug, and leads to widespread abuse. Why do doctors prescribe it so much then? Because its analgesic effect is more potent than the other two, and thus it is more effective; in addition, when used for acute pain, such as trauma or surgery, because it is used for such a short period of time, the potential for addiction is very small.

When it is used for the treatment of chronic pain, a problem appears: As the patient develops tolerance for the drug, larger doses are needed to treat the pain; the patient perceives the tolerance as an increase in pain, as the drug becomes less effective. He or she will then ask the doctor for more medicine in order to control the pain. There is no way for the physician to know if the request is legitimate or if the drug is being used recreationally, or even sold in the black market. Pain is a symptom, and as such, subjective. We cannot measure or prove it.

Oxycontin is just a sustained release preparation of oxycodone. It consists of a tablet where the drug is wrapped in a cover that releases the medicine over a 24 hr period. This slow release means that the drug cannot be used acutely for pain. When used for surgical pain, it cannot be taken as needed but must be taken on a regular schedule, every 24 hrs. This is the opposite of the way painkillers are taken; if you wait for the pain before taking Oxycontin, it will not work. When used for acute pain, Percocet, or Oxycodone are prescribed also for breakthrough pain. Where the main advantage of Oxycontin resides is in the treatment of chronic pain: Because of the slow release of the opiate, the euphoria that makes Oxycodone such a popular drug of abuse is not present; thus, when tolerance develops and the breakthrough pain appears, the physician can increase the dosage without worrying about the potential for abuse.

You can trust addicts to find a way around design barriers. It did not take long for addicts to find out that if they peeled the outer layer of the tablet off, it would work just like Oxycodone, thus the street name for the tablet “Peelers.” In fact, it would work just like an ultra potent version of the drug since a single tablet contains as much drug as 6 or 8 of the regular Oxycodone or Percocet tablets. Enough to cause death, when the most potent dosage (now withdrawn from the market) was misused in this fashion.

The take home message is this: Oxicontin (contin-continuous) Slow, long acting, for chronic pain. Oxycodone: Fast and short action, for acute pain and, in chronic cases, for pain that breaks through the long acting drug.

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