- Fake Pain Pills Killed Prince and Thousands More Americans
- Norco vs Vicodin: Main Differences and Similarities
- Norco vs Vicodin Side by Side Comparison
Fake Pain Pills Killed Prince and Thousands More Americans
Following his death, investigators discovered “a sizable amount of narcotic medications” throughout Prince’s residence. One cluster of pills, marked “Watson 853,” contained fentanyl in concentrations high enough to cause pulmonary distress and death.
It’s not known exactly how long Schulenberg had been prescribing Percocet indirectly to Prince, or when or how the musician obtained the counterfeit Vicodin that killed him. After the incident on the plane ride back from Atlanta, records suggest Schulenberg attempted to treat the musician’s withdrawal with the non-narcotic drugs clonidine and hydroxyzine (an antihistamine sometimes used to treat anxiety). It’s a common, but often ineffective cocktail for weaning opioid dependent people off drugs.
While the origin of the fentanyl pills that killed Prince remains a mystery, his fatal overdose coincided with a spike in fatal and nonfatal overdoses across the country attributed to counterfeit Vicodin laced with fentanyl. In the weeks prior to his death, fentanyl disguised as various brands of acetaminophen/hydrocodone (the drug combination found in Vicodin) sickened dozens in Northern California.
Just weeks before Prince’s death, the Drug Enforcement Administration (DEA) launched an anonymous tip line in San Francisco seeking information on the pills’ source. The drugs that killed Prince could have come from there and bought by someone close to him on the street.
One of the main sources for fentanyl pressed into pills has been Canada, as The Daily Beast recently reported. Canada has also emerged as a primary pipeline for fentanyl pressed into pills for delivery in the U.S. market.
According to The Partnership for Safe Medicines, Canadian authorities have shut down more than 20 fentanyl labs since 2013. And since 2015, numerous overdose outbreaks attributed to counterfeit Xanax or opioids that contain fentanyl or fentanyl analogues have been reported in the U.S.
Among the many oddities surrounding this case is the fact that, according to investigators, Prince had ten 5 mg Percocet in his possession when he died—likely prescribed at some point by Dr. Schulenberg. What compelled the musician to take the Vicodin instead we may never know (the discovery of pills broken into half suggests he had taken it before).
But one thing that is indisputable is that had Prince simply continued in the care of Schulenberg until Kornfeld arrived and was encouraged to continue taking only the Percocet the physician had been fined for providing him until he was safely in treatment, there is a very strong possibility he would be alive, and maybe even drug free, today.
There appears to be a new type of counterfeit drug distribution in the US—but one that has a quite distinct distribution “channel,” so to speak. A just published article in the Annals of Emergency Medicine details the case of a northern California patient who apparently routinely purchases Norco (hydrocodone/acetaminophen) tablets on the street, in order to treat (so the patient said) chronic back pain. But on a certain day, the tablets she purchased were in fact fake drug that contained fentanyl—a synthetic opioid analogue that is 100 times more powerful than morphine. The patient became nonresponsive and was revived by emergency medicine personnel with naloxone, the go-to antidote for opioid overdose. The emergency personnel identified the fake drug based on the discontinuity between what the patient said she had ingested and what a serum analysis revealed—the presence of fentanyl.
Norco is a brandname of Watson Pharma (now Actavis); according to the article, the fake drugs “bore the usual Watson imprint but were beige instead of white.” (The article makes reference to other instances of opioid overdosing that implicate Mallinkrodt’s hydrocodone/acetaminophen product, with pills embossed with “M367.”) China is believed to be the source of most of the fentanyl-laced knockoffs.
It has long been known that drug abusers, purchasing prescription drugs on the street, will seek out branded products on the assumption that their effects are well understood. Typically, these drugs are stolen or diverted from legitimate distribution channels, or sold by patients who received legitimate prescriptions. Less well-recognized is the ability of drug counterfeiters to introduce their products into this street market. Most cases of drug counterfeiting in recent years in the US involved drugs improperly imported and distributed through legitimate distribution channels, such as the fake Avastin that showed up in 2012; street Norco is clearly not such a case. Nor is it likely that the street drug will flow into legitimate drug distribution channels—but it is possible.
The Annals case study is but one instance of the wave of opioid overdoses and deaths that occurred in northern California in late 2015 and 2016; in one form or another, illegitimately manufactured fentanyl is now a common element of drug abuse outbreaks. In turn, fentanyl (which has FDA-approved therapeutic applications) is only one of a growing variety of synthetic opioid analogues, together with heroin, now reaching crisis levels of abuse. The Annals study makes the point that medical personnel treating overdosed patients cannot assume that the cause of the overdose was the compound indicated by the drug’s appearance.
Migraine attacks can last for hours—or even days. They can cause intense pain, nausea, and vomiting. They can make you sensitive to light or noise, and they can affect your life and work.
To treat migraines, you may get a prescription for an opioid (narcotic) or a barbiturate (sedative) called butalbital. These are pain medicines. But you should think twice about using these drugs. Here’s why:
These drugs can make headaches worse.
Using too much pain medicine can lead to a condition called MOH, or medication overuse headache. Two kinds of pain medicine are more
likely to cause MOH:
- Drugs containing opioids—such as hydrocodone (Norco, Vicodin, and generics) or oxycodone (Percocet and generics).
- Drugs containing butalbital (Fioricet, Fiorinal, and generics).
They are not as effective as other migraine drugs.
There are other drugs that can reduce the number of migraines you have and how severe they are—better than opioids and butalbital. Even in the emergency room—where people with severe migraines often ask for opioids—better drugs are available.
They have risks.
Opioids and butalbital can cause serious withdrawal symptoms if you stop taking them suddenly. People who use high doses for a long time may need to be in the hospital in order to stop using them.
Opioids, even at low doses, can make you feel sleepy or dizzy. Other side effects include constipation and nausea. Using them for a long time can lower your sex drive and cause depression and sleep problems.
They can be a waste of money.
Opioids and butalbital pills do not cost a lot. But why spend money on drugs you don’t need?
Also, if these drugs cause side effects and more headaches, you may have to go to extra doctors’ appointments. This will take time and may cost you money.
What drugs are good for migraines?
If you have migraine attacks, try one of the drugs listed below. They all work best if you use them when the migraine is just beginning.
- Start with a non-prescription pain drug that combines aspirin, acetaminophen, and caffeine (Excedrin Migraine, Excedrin Extra Strength, and generics). Or try non-steroidal anti-inflammatory drugs such as ibuprofen (Advil and generic) or naproxen (Aleve and generic).
- If these drugs do not help, or your headaches are more severe, try one of the prescription migraine drugs called triptans, such as sumatriptan (Imitrex and generic).
- If triptans do not work, try dihydroergotamine nasal spray (Migranal). This drug works even better as an injection (DHE-45 and generic). You or your doctor can do the injection.
If you have migraines often, or if they are very severe, ask your doctor about drugs to prevent headaches.
When are opioids or butalbital useful for migraines?
Your doctor may suggest an opioid if none of the treatments listed above help, or if you have bad side effects.
It is not clear if butalbital should be used at all for treating migraines. If your doctor prescribes butalbital for your migraines, ask why. And ask if there are any other drugs that would work.
Limit the use of all pain medicines.
- Do not use prescription pain medicine for headaches for more than nine days in a month.
- Do not use non-prescription pain medicine for more than 14 days in a month.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
© 2016 Consumer Reports. Developed in cooperation with the American Academy of Neurology.
Norco vs Vicodin: Main Differences and Similarities
Norco and Vicodin are two brand name pain relievers used to treat moderate to severe pain. Both Norco and Vicodin are Schedule II opioid analgesics that contain a combination of hydrocodone and acetaminophen. While the exact mechanism of action is unknown, hydrocodone is believed to work by interacting with mu opioid receptors. Acetaminophen achieves its analgesic properties through various central actions. Both drugs are potent pain relievers with many similarities. Their main difference lies in formulation and strength.
Norco is the brand name for hydrocodone and acetaminophen oral tablets. All Norco oral tablets contain 325 mg of acetaminophen. However, Norco can contain varying strengths of hydrocodone at 5 mg, 7.5 mg, or 10 mg. Norco is metabolized primarily in the liver and eliminated through the kidneys. Therefore, dose adjustments may need to be made in those with liver or kidney impairments. The average half-life of hydrocodone is about 4 hours while the average half-life of acetaminophen is approximately 3 hours. Norco is typically dosed every 4 to 6 hours as needed.
Vicodin also contains hydrocodone and acetaminophen. Unlike Norco, all Vicodin oral tablets contain 300 mg of acetaminophen. Vicodin comes in strengths of 5 mg/300 mg, 7.5 mg/300 mg, and 10 mg/300 mg. Other than this difference, Vicodin is virtually the same drug as Norco with the same metabolism, elimination, and half-life. Vicodin is usually dosed every 4 to 6 hours with a maximum daily dose of 6 tablets for the 5 mg/300 mg strength and 8 tablets for the 7.5 mg/300 mg and 10 mg/300 mg strengths. Like Norco, dose adjustments may need to be made for liver and kidney impairment.
Norco vs Vicodin Side by Side Comparison
Norco and Vicodin share several similarities as opioid medications that contain the same active ingredients. These similarities can be further examined in the comparison table below.
|Common Side Effects|
|Is there a generic?|
|Is it covered by insurance?|
|Average Cash Price|
|SingleCare Discount Price|
Mixed agonist/antagonist analgesics
CYP3A4 and CYP2D6 inhibitors
Beta blockers (propranolol)
|Can I use while planning pregnancy, pregnant, or breastfeeding?|
Both Norco and Vicodin are commonly prescribed opioid analgesics used to treat moderate to severe pain from a number of conditions. There is very little difference between both medications as they contain the same combination of hydrocodone, an opioid, and acetaminophen, a non-opioid analgesic. Their only difference lies in the amount of acetaminophen present in either drug. While Norco tablets contain 325 mg of acetaminophen, Vicodin tablets contain a lesser amount at 300 mg of acetaminophen.
Both medications need to be dose adjusted in the elderly as well as those with liver and kidney dysfunctions. Because of their abuse potential, these medications should not be mixed with other opioids and should only be taken under the supervision and direction of a physician. This information is meant to provide an educational comparison of two opioid medications so that you and your physician can determine which treatment may be best to treat your pain.