Prescription Drug Abuse: An OC Woman’s Effort to Wake America Up

Submitted by By Deirdre Newman:

The statistics are sobering:

• One person in the U.S. dies every 24 minutes from a prescription drug overdose. (Natalie Costa, Producer, Behind the Orange Curtain)
• Children as young as 12 begin experimenting with prescription drugs right out of their home medicine cabinets. (Natalie Costa, Producer, Behind the Orange Curtain)
• In 2009, drug overdoses from prescription painkillers claimed more than 39,000 lives, exceeding traffic accidents for the first time ever as a significant cause of preventable deaths. (The Los Angeles Times)

The prescription drug overdose crisis, declared an epidemic in 2011 by the U.S. Centers for Disease Control and Prevention, continues to escalate. While taking on Big Pharma may seem like the modern day equivalent of Sisyphus pushing an enormous rock uphill, that has not deterred Natalie Costa, owner of The Performer’s Academy in Laguna Hills, CA. When her teenage daughter lost a childhood friend from an overdose of the painkiller Opana in 2010, Natalie sprung into action.

She enlisted director Brent Huff, who teaches at the acting and modeling school, to produce a wake-up and call-to-action documentary, Behind the Orange Curtain, which has already accrued several awards, including “The Best Documentary Feature” at the 2012 Metropolitan Film Festival in New York City.

“Many people are unaware that there is a prescription drug problem in this country that is affecting young men and women,” Costa said. “They are unaware that this prescription drug problem turns quickly to a heroin problem. My goal is to educate parents to the fact that this is a national epidemic and can affect anyone who abuses these medications or takes them recreationally.”

The Making of the Film

Costa did not put a brake on her efforts when the film came out. She went on to create a website, “Nataliewho? Speak the Truth Even if Your Voice Shakes,” (http://nataliewho.net/), which features articles about the drug abuse epidemic, as well as a blog and information for parents about drugs and addiction.

The latest article profiles the arrest of a candidate for the New York City Comptroller position, who is charged with illegally distributing prescription pills. In the article, Manhattan U.S. Attorney Preet Bharara states, “Prescription drug abuse is the fastest-growing drug problem in this country, resulting in more overdose deaths than heroin and cocaine combined…”

Costa knows that it doesn’t matter what part of the county one lives in – the epidemic is as close as the nearest medicine cabinet or street pusher.

“I always say that this problem does not discriminate. It doesn’t matter if you live on Park Avenue or the park bench,” she said.

Costa contributed the initial seed money for the documentary and turned to the Internet to secure the remaining requisite funds, via Kickstarter. The original plan was to make a short film with interviews from 15 parents. But the production team was deluged with so much information and so many parents who wanted to tell their stories that it decided to expand the project into a full-feature documentary. An abridged version is also available for screenings at public awareness events. The film has recently launched on iTunes and Amazon Instant Viewing.

The documentary incorporates firsthand accounts from those who have either lost loved ones to drug addiction or dealt with the epidemic head-on,  including CEO’s, pastors, first-responders, fire captains, physicians, interventionists, sober living facilities, the DEA and Coroner’s offices. Lack of government legislation, the billion dollar pharmaceutical industry, and the need for parental guidance on proper drug use are all points that the film touches upon, prompting viewers to consider the complexities of solving what has become a nationwide issue.

During the documentary filming, Costa took her 18-year-old daughter to a shoot at the Orange County Coroner’s office. One of the body bags bore the name of another friend of her daughter’s who had died earlier that week. Costa’s daughter walked away and stood there, stunned, with a blanket wrapped around her.

“I snapped a photo, which is the photo on the (promotional) poster,” Costa said. “She stated on her Facebook page later that day, ‘It’s not the bodies that I saw today, it’s that these kids – my friends—are making stupid choices and winding up here. It’s incredibly sad.”

So, why are so many kids experimenting with prescription drugs? According to Costa, it’s based on a few things: The label of “prescription” makes it seem far safer than illegal drugs like cocaine and heroin; teenagers feel infallible; and there’s always someone in any group of partying teens who wants to take it to the next level.

“They are not taking into consideration that they could wind up with an addiction problem,” Costa said. “Mixing prescription drugs and alcohol is a cocktail for death.”

OxyContin, Opana and Heroin

Two of the synthetic opiates most typically abused are OxyContin and Opana.

OxyContin, introduced by Purdue Pharma, has reaped more than $27 billion for the company since it was introduced in 1996, according to the L.A. Times.

An. Aug. 11 article in the Times shows that Purdue Pharma has kept a database of “hundreds of doctors suspected of recklessly prescribing its pills to addicts and drug dealers, but has done little to alert law enforcement or medical authorities.”

Switching from prescription drugs to heroin became more pervasive when Purdue Pharma, under pressure, made OxyContin harder to abuse, according to Candice Till, the Clinical Director of Newport Academy in Orange County. Newport Academy is a comprehensive, integrated treatment program for teens suffering from mental health, behavioral health and substance abuse issues.

In 2010, Purdue Pharma put a coating on the OxyContin pills, so they couldn’t be snorted, crushed, or smoked. As a result, the cost of the remaining pills on the secondary market skyrocketed, Till said.  So, heroin became the replacement drug – same high, but with a lower cost.

Opana’s story is a fight between the original manufacturer and generic copies. Endo Pharmaceuticals, Inc., created the original Opana, and then reformulated it, purportedly to prevent abuse and misuse. The first generic version came to the market in January from Impax and two other companies have applications awaiting review for their generic versions, according to a May 11 article in the L.A. Times. But the FDA does not require these generics to have coatings, according to Costa, which leads to the original problem of making them easier to snort, smoke and inject.

In May, the FDA rebuffed a petition by Endo to remove the generics from the market and prevent new ones from coming out. The FDA did not buy Endo’s claim that the original formulation was withdrawn for reasons of making it safer or more effective, according to the FDA’s determination statement.

The statement went on to say that the agency “continues to encourage the development of abuse-deterrent formulations of opioids to help reduce prescription drug abuse and to positively affect public health.”

“The science of abuse deterrence is relatively new, and both the formulation technologies and the analytical, clinical, and statistical methods for evaluating those technologies are rapidly evolving. Abuse-deterrent properties must be supported by sound science taking into consideration the totality of the data for the particular drug at issue,” the FDA stated.

The L.A. Times article mentions that the head of the prescription drug task force for the Los Angeles County Sheriff's Department, “predicted that the FDA's decision would fuel popularity of the generic form of Opana on the street.”

Education and Awareness

While Till said the drug industry is far too powerful to take on personally, Costa is not afraid to be in-your-face. She thrives on that kind of communication, as she knows that’s exactly what it takes when dealing with something as insidious as prescription drugs and heroin, especially when pre-teens and teenagers are affected.

A case in point: When designing the logo for Behind the Orange Curtain, Costa was adamant that images of needles and pills be included, because she felt these images reflected the harsh reality of the epidemic. When she hears about “the stigma of the needle” – the reaction from those who cast aspersions and dirty looks on parents whose children have been or still are drug addicts, she encourages the parents to “tell them all to go to hell.”

There’s no embarrassment in addiction, she argues. “Being embarrassed or being held hostage to the stigma of addiction and ‘the needle’ serves no one and no purpose,” she wrote in a recent blog post.  

Current and pending legislation to tackle the epidemic

Kentucky is one state that appears to be bucking the trend of prescription drug abuse in the U.S., thanks to a law passed last year, according to an Aug. 9 article in the Herald-Dispatch, a newspaper based in West Virginia.

The article states that the 2012 law enhanced the state's prescription monitoring system, focusing on pain management clinics. Since the law took effect, 20 non-physician-owned, pain management clinics have closed and the four more have been ordered to shut down, accused of not complying with state regulations. In addition, the monitoring system has registered thousands more medical providers, the article states.

As a result, the state saw a decline in the number of overdose deaths attributed to prescription or illicit drugs, from 2011 to 2012, the first year-to-year decline in more than a decade, according to the article. However, not surprisingly, the state has also seen an increase in deaths from heroin overdose, as prescription drugs have become harder to procure.

Costa would like to see a prescription drug monitoring program enacted in every state and at the federal level. California Senate bill 809 is currently under consideration. It would update the state’s monitoring system to operate in real-time, with mandatory use by all prescribers. The bill asked that Big Pharma be taxed to help fund the program, but the industry’s powerful lobbyists were able to get that part eliminated from the bill, Costa wrote on her website.

However, there is now some relief in 13 states for friends of those who have overdosed. New Jersey was the most recent state to pass the 911 Good Samaritan law, which enables friends of someone who is overdosing or having an adverse reaction to drugs to call authorities without fear of arrest or prosecution.

“When a group is in party mode, there generally isn’t clarity of thought,” Costa said. “Most would panic and leave their friend in a room, on the side of the road, or at the beach. Several of the parents in the documentary lost their child because their friends were afraid to make a call.”

Education and awareness are imperative, Costa says, providing the following tips for parents:

• Experimentation starts in middle school with marijuana and alcohol.  
• Children do not need you to be their friend – they need parents.  
• It is important that you pay attention to their friends, their activities, their social media outlets and their appearance.  
• It is important the medications at home be locked up.  It may not be your child snooping through your medicine cabinet, but one of their friends.  
• If you are suspicious that they are up to something, get a drug test at your local pharmacy and surprise drug test them.  These tests are inexpensive and accurate.  They cannot negotiate their way out of a positive result.  
• Google the “Urban Dictionary” and get familiar with the current drug terms.  Molly, whips, ladders, bars, “getting barred out”, scripts, MDMA, foils, tar, Taylor Gang, etc.  
• Tell them to use the “my mother/father drug tests me” line with their friends.  It takes the pressure off of them having to say no to their friends.  “My mother is really on my case, she drug tests me every time I turn around.”  It’s a little white lie that could just possibly save their life.
• Don’t live in denial.  This problem is in every school, every city, and state across this country. Not being informed and proactive serves no purpose.  
• Demand that your community, schools (especially middle schools) and elected officials hold seminars for parent education and use resources like the DEA and public health organizations.  They will attend and tell you the truth about the problem.  

“Remember  -- if your children go to school with children who have older brothers and sisters, the kids know who is doing drugs,” Costa said. “They know what is going on.  The parents need to arm themselves with information and a prevention plan.”