Unpacking The Real Life Story Behind Netflix’s Pain Hustlers

Set in Florida, David Yates’ Pain Hustlers is a revealing tale of the capitalistic deceit and corruption in America’s pharmaceutical industry. The Netflix crime drama inspired by Evan Hughes’ book of the same title highlights the sad realities necessitating the need to hold opioid manufacturers accountable, as much as it justifies monitoring corporate and individual healthcare practitioners. Although bashed for its unserious depiction of the opioid epidemic, the film anchors a meaningful premise rooted in a real-life story of greed and criminality.

Starring British actress Emily Blunt and American actor Chris Evans alongside Andy Garcia, Catherine O’Hara, and Chloe Coleman, Pain Hustlers rekindles interest in the true story behind the rise and fall of an Arizona-based pharmaceutical company that traded on the Nasdaq Stock Market. The film follows a single mother trapped in a criminal prosecution after helping to rescue a bankrupt pharmaceutical company. But then, that’s the screenwriter’s (Wells Tower) fictionalized account of what transpired.

Is Lonafen A Real Drug?

Pain Hustlers' Lonafen is based on Subsys

The Netflix crime drama revolves around Lonafen, a fentanyl-based medication that saves a dying pharmaceutical company, Zanna Therapeutics, at the expense of patients. Developed by Andy Garcia’s Dr. Jack Neel after his wife’s death, Lonafen proves to be effective for quick pain relief but only appropriate for cancer patients. However, Zanna’s sales associates push the drug for whatever pain, conniving with greedy doctors to prescribe the addictive medication to as many patients as they can.

Pain Hustlers’ Lonafen isn’t a real drug, but it’s based on Subsys, which is also a fentanyl-based medication. The sublingual spray pain medication of Insys Therapeutics was approved by the Food and Drug Administration (FDA) in 2012 for treating breakthrough pain in adult cancer patients. But then, Insys indulged in unlawful marketing practices, paying kickbacks to physicians who eventually started prescribing the addictive opioid painkiller to patients without cancer.

While the scandal that followed Evan Hughes’ exposure of Insys’ illegal activities brought the pharmaceutical company to ruins, Subsys is still in use. The company won its appeal to sell Subsys to BTcP Pharma LLC, another company that committed to marketing the drug for only cancer patients. Even at that, FDS’ medication guide for the drug stipulates that users must be opioid tolerant. “Do not use Subsys unless you are regularly using another opioid pain medicine around the clock for your cancer pain and your body is used to these medicines,” reads an excerpt from the guide.

Are Liza Drake And Pete Brenner Real?

Emily Blunt's Liza Drake and Chris Evans' Pete Brenner in Pain Hustlers

Pain Hustlers is a fictionalized account of the Insys Therapeutics scandal. Nevertheless, it’s based on Hughes’ eponymous book that exposed the inside operations behind the Insys saga. From the company leaders to the foot soldiers marketing Subsys, Hughes’ book provides a detailed account of the structure and prominent figures behind the scandal. Emily Blunt’s Liza Drake and Chris Evans’ Pete Brenner are fictional versions of top sales executives at Insys Therapeutics. While the characters are not real, they embody the key players that helped the pharmaceutical company pull off its organized criminal enterprise.

Emily Blunt’s character, Liza Drake, finds herself at the center of a criminal prosecution after her quest for a better life drives her to seek employment with Zanna Therapeutics, where she helps set up the speaker programs. Disguised as a promotional project for increasing the brand awareness of Lonafen, the programs targeted practitioners, paying bribes and kickbacks for increased Lonafen prescriptions to patients, even when it’s medically unnecessary. She eventually grows a conscience and rats out Zanna to the authorities. The Pain Hustlers’ character is a blend of several figures in Hughes’ book but strongly aligns with Maria Guzman.

Guzman is a former Insys sales representative in Florida who filed the 2013 whistleblower lawsuit that inspired a serious investigation into Insys’ activities. She sued the pharmaceutical company under the False Claims Act, providing details of the illegal means Insys utilized to increase prescriptions of Subsys. Guzman alleged that sex, money, and luxury items were used to lure doctors. “…Nothing was out of bounds in Insys’ efforts to persuade doctors to prescribe Subsys without consideration of what was best for patients…I couldn’t keep silent, knowing how these off-label prescriptions endangered so many,” stated the former Insys sales rep.

On the other hand, Chris Evans’ Pete Brenner in Pain Hustlers is akin to Alec Burlakoff, a former top executive of the pharmaceutical company. Like Pete, Burlakoff justified the activities of Insys even after the criminal enterprise started falling apart. He refused to plead guilty after he was indicted but eventually cooperated with the federal prosecutors. After joining Insys in 2012, Burlakoff piloted the speaker programs, mapping out schemes that targeted doctors who are susceptible to bribery. He told CBS that even though he’s Jewish, he went to church every Sunday for a year just to bag a churchy doctor.

Meet John Kapoor, The Real Life Jack Neel From Pain Hustlers

Insys founder John Kapoor and Andy García's Dr. Jack Neel in Pain Hustler

Cuban-born American actor Andy García portrays Dr. Jack Neel in Pain Hustler, a character based on John Kapoor, the real-life founder of the opioid manufacturer. Kapoor became a billionaire five months after Insys’ public offering in May 2013. Originally from India, the American pharmaceutical entrepreneur came to the United States in 1964. He obtained his Pharmacy degree in India before securing a scholarship to attend the University at Buffalo School of Pharmacy and Pharmaceutical Sciences. He acquired his Ph.D. in 1972 and worked his way up to an executive position in the pharmaceutical industry. Before founding Insys Therapeutics in 1990, he worked with companies like Invenex Pharmaceutical and LyphoMed.

A serial entrepreneur and investor, Kapoor privately funded Insys’ development of Subsys and committed to doing whatever it takes for the company to succeed. He orchestrated the scheme that bribed practitioners to prescribe Subsys, paving the way for the newcomer drug to go up against larger competitors. This, in turn, skyrocketed Insys’ shares from its IPO price of $8 per share to $44 within months. Along with four other Insys executives, Kapoor was convicted of racketeering conspiracy in May 2019 and sentenced in January 2020 to 66 months in prison, with three years of conditional supervised release. He was also ordered to pay forfeiture and restitution, amounting to over $59.7 million.

Pain Hustlers ends with Dr. Jack Neel’s arrest, but the movie doesn’t depict Kapoor’s incarceration. He served two years at Federal Prison Camp, Duluth, before regaining his freedom in June 2023. His company filed for bankruptcy in June 2019 after agreeing to a global resolution to settle the criminal and civil charges brought against it. In all, Insys Therapeutics agreed to pay a $225 million settlement: $195 million for its violation of the False Claims Act, $28 million in forfeiture, and a $2 million fine.

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