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The first effect of painkillers is, of course, to prevent patients from experiencing pain. Some people who had been in severe pain are so delighted to feel "normal" again that they may ignore signs of dependency and increasing tolerance, taking more and more of the drug.
However, in opium-derived painkillers such as oxycodone (OxyContin) and hydrocodone (Vicodin), the physical effects will mimic those of heroin or other opiates. The addiction itself is the primary physical effect, and the person may continue to function in society while engaged in an ever-increasing pattern of drug-seeking.
Painkillers also pose risks of liver damage and deadly overdose. With some drugs (notably Darvon and Darvocet, which are chemically related to methadone), an overdose is as little as four times the standard therapeutic dose.