In October of 2017, Dr. John N. Kapoor, chair and CEO of Insys Inc., was charged with racketeering, conspiracy to commit fraud and conspiracy to break Anti-Kickback laws, after it was discovered that he and the board of executives had developed an “off-label” marketing scheme for one of the most addictive opioids out there. Subsys, a sublingual spray whose main ingredient is fentanyl, was originally approved by the FDA for extreme cases of cancer-related pain. Dissatisfied with this arrangement, executives developed a plan involving illegal sales and marketing methods. Sales teams were trained to employ tactics such as bribery, in order to persuade doctors to prescribe the medicine to non-cancer patients.
The large-scale kickback scheme affected states from Alaska to Alabama, effectively bolstering the already out-of-hand opioid epidemic, which killed more than 42,000 people in 2016. Twenty-thousand of those deaths were related to fentanyl and fentanyl analogs, leading some to assert that this synthetic opioid is behind the dramatic increase in opioid-related overdoses. The drug is 50 times stronger than heroin and, with recent “improvements,” the drug can be as much as 10,000 times stronger.
Kapoor and other executives have pleaded not guilty and are seeking a settlement with the US Department of Justice. Brian Kelly, attorney for Kapoor, said the following in a statement to the press: “[My client] is innocent of these charges and intends to fight the charges vigorously.” Kapoor is no longer CEO of Insys but has opted to remain on the Board. If he’s found guilty he could face a sentence of 40 years for the racketeering and fraud charges. The anti-kickback charges would amount to thousands of dollars in fines and an extra five years in prison.
According to a CBS report, in 2016, Insys made 18,000 payments to medical professionals in an attempt to push the sale of its fentanyl-based drug. Those payments amounted to $2 million. To bypass scrupulous healthcare providers, the company set up a “reimbursement unit,” which helped gain authorization from insurers and pharmacists. They also employed methods involving mail and wire fraud.
In a statement, Acting United States Attorney William D. Weinreb compared the company to drug cartels: ““Today’s arrest and charges reflect our ongoing efforts to attack the opioid crisis from all angles. We must hold the industry and its leadership accountable – just as we would the cartels or a street-level drug dealer.”
Former Employee Speaks Out
Former sales employee, Patty Nixon, has been a vocal opponent of the company, having referred to Kapoor as “an evil man.” She was terminated after she stopped coming to work because she felt guilt for the sales tactics used by Insys representatives. Nixon described her role in an interview with NBC: “My job responsibilities were to contact insurance companies on behalf of the patients and the doctors to get the medication approved and paid for by their insurance company.” Nixon persuaded insurers that fentanyl was necessary for medical reasons, so the company would pay for the expensive drug, which can cost between $3,000 and $30,000. “It was a complete bold-faced lie,” Nixon confessed.
The Sources of Drug Addicition
The rise of drug addiction, it would seem, is not something that is strictly linked to drug cartels and street pushers. The line drawn between cartels and “legitimate companies” is blurry and indistinct, as indicated by Weinreb. Take the story of Trey Laird. He went in for appendix surgery and to ease his pain he was prescribed large quantities of opioids. “My body would feel sick. It was like totally the most horrible flu you ever felt if I didn’t take the pill.” He continued, “To be able to walk out of the hospital with 90 pills and then to have two refills on that prescription — so to be able to get 270 pills without ever seeing a doctor – in retrospect, is pretty ridiculous.”
Kapoor and his associates will go to trial in January of 2019. The DOJ projects that a settlement of $150 million will be reached.