Mixing Percocet and Alcohol

Prescription bottle of percocet fallen over on a counter

Percocet is a combination of oxycodone and acetaminophen. It’s a powerful pain reliever with anti-inflammatory properties. Percocet comes in four oxycodone strengths (2.5 mg, 5 mg, 7.5 mg and 10 mg), and each pill has 325 mg of acetaminophen. Oxycodone and acetaminophen are dangerous when taken with alcohol. Mixing oxycodone and alcohol can have immediate ramifications in the form of respiratory depression that can be fatal. Mixing acetaminophen and alcohol can also have long-term consequences for liver function. 

Why Do People Mix Percocet with Alcohol?

A recent study identified three main reasons why people mix opioids and alcohol: 

  1. 63.4% of people indicated that pain relief was their primary motive
  2. 11.2% wanted to relax
  3. 10.8% specifically aimed to get high. 

Up to 45% of people who report that they misuse prescription opioids also meet the criteria for alcohol use disorder (AUD). 

Chronic pain is a large problem among adults in the United States. Alcohol and opioids are frequently used in attempts to manage pain. In the United States in 2016, approximately 20.4% of adults (50 million people) suffered from chronic pain and an additional 8% (19.6 million people) suffered from high-impact chronic pain, which is pain that significantly inhibits the ability to participate in major life activities. 

Alcohol has the ability to reduce pain on its own, but it enhances the pain-relieving effects of opioids. For people with severe pain, using alcohol and opioids can be very tempting. However, regular use of oxycodone and alcohol rapidly induces tolerance, meaning that higher and higher doses of each drug are required to achieve the desired effect. 

Recreational use is a common reason why people use Percocet with alcohol. Because of the potentiating effect that alcohol has on the effects of oxycodone, many people take alcohol to enhance the euphoria that high doses of opioids cause. Alcohol and oxycodone have a greater effect when combined then they do when used on their own. Combining Percocet and alcohol causes a sense of euphoria that cannot be achieved by using either drug alone. 

Effects of Combining Alcohol with Percocet

The endogenous opioid system is a negative regulator of several physiological functions including breathing, heart rate and blood pressure. It ensures that the part of the brain that controls homeostasis doesn’t become hyperactive. When the opioid system becomes too active, it essentially shuts down the respiratory center in the brain. The result is slow, shallow breathing that can lead to coma and death. 

Opioids and alcohol are both central nervous system (CNS) depressants; they reduce the overall activity level in the brain, resulting in relaxation and sedation. Oxycodone is a potent opioid agonist, meaning that it strongly activates the endogenous opioid system. In addition to enhancing the oxycodone-induced increase in activity in the opioid system, alcohol increases activity levels of the inhibitory neurotransmitter GABA. Because these drugs act synergistically, when they are combined they can be so sedating that breathing stops. 

There are a number of side effects associated with combining Percocet and alcohol, including: 

  • Headache 
  • Dizziness
  • Dry mouth
  • Loss of coordination
  • Nausea or vomiting
  • Low blood pressure
  • Liver damage or failure
  • Respiratory depression
  • Heart attack
  • Impaired judgment

Side Effects in the Elderly

The elderly are particularly at risk for respiratory depression when they combine oxycodone and alcohol. A recent study compared the effects of different doses of alcohol and oxycodone on young and elderly people and found that elderly people are significantly more likely to have irregular breathing and apneic events (stop breathing) when they use oxycodone and alcohol than their younger counterparts. Increasing the doses of oxycodone or alcohol also caused more apnea. This result is significant because chronic pain is the most prevalent in older populations, so they may be at higher risk for inadvertently overdosing on Percocet and alcohol combinations.

Risks of Mixing Percocet with Alcohol

Because Percocet contains oxycodone and acetaminophen, the two active ingredients that can interact with alcohol, oxycodone and alcohol co-use can lead to respiratory depression. Combining these drugs can be so sedating that people essentially forget to breathe and, if they are conscious and aware of their situation, are unable to call for help.

Acetaminophen overdose (even in the absence of other drugs or alcohol) is the most common cause of acute liver failure. Because each Percocet pill has 325 mg acetaminophen, someone who has developed a high tolerance to oxycodone may take several Percocet pills. An estimated 63% of unintentional acetaminophen overdoses occur as a consequence of opioid and acetaminophen drug combinations. 

The outcome of acetaminophen taken in conjunction with alcohol depends on how alcohol is consumed. Counterintuitively, acute alcohol ingestion (binge drinking) seems to be protective against acetaminophen-induced liver failure, likely because the liver directs its full attention to metabolizing alcohol at the expense of all other metabolic functions. As a result, acetaminophen’s toxic metabolic byproducts are produced at a much slower rate, which allows them to be excreted before toxic levels can build up. Chronic alcohol use, on the other hand, changes how the liver metabolizes toxins, and this change actually increases the rate of acetaminophen breakdown. People with chronic alcohol use disorder who overdose on acetaminophen have increased liver necrosis and a worse prognosis than people who drink in moderation.

Treatment for Percocet and Alcohol Addiction

Percocet and alcohol are both highly addictive drugs. For most people, participating in a comprehensive rehab program is the most effective way to achieve sobriety. The detox period can be profoundly uncomfortable, even dangerous. Medically assisted detox is done under the care of professionals who can intervene in the case of complications and, when appropriate, provide pharmacotherapies that mitigate the severity of withdrawal symptoms. 

Following detox, participation in a comprehensive residential rehab program gives people a safe environment where they can successfully make it through the first days and weeks of recovery. Programs that can evaluate whether a dual diagnosis is appropriate may be the most effective for someone with an untreated mental health disorder. Outpatient programs follow a residential stay, usually beginning with an intensive program that gradually diminishes in intensity as recovery progresses. After outpatient, many people find that aftercare is an inspiring and motivating component of their long-term recovery.

Contact The Recovery Village Ridgefield to speak with a representative about how professional addiction treatment can help. You deserve a healthier future, call today.

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Dahlhamer James; et al. “Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016.” Morbidity and Mortality Weekly Report, September 14, 2018.  Accessed August 31, 2019.

Singh, Ashok K. “Alcohol Interaction with Cocaine, Methamphetamine, Opioids, Nicotine, Cannabis, and γ-Hydroxybutyric Acid.” Biomedicines, March 2019. Accessed August 30, 2019.

Dahan, Alber; et al. “Averting Opioid-induced Respiratory Depression without Affecting Analgesia.” Anesthesiology, May 2018. Accessed August 31, 2019.

van der Schrier, Rutger; et al. “Influence of Ethanol on Oxycodone-induced Respiratory Depression: A Dose-escalating Study in Young and Elderly Individuals.” Anesthesiology, March 2017. Accessed August 31, 2019.

Yoon, Eric; et al. “Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update.” Journal of Clinical and Translational Hepatology, June 2016. Accessed August 31, 2019.