On Thursday October 6, 2017, John Kapoor, the billionaire founder and CEO of Insys Therapeutics Inc., was arrested on charges which allege that his pharmaceutical company had “bribed doctors to prescribe a fentanyl-based cancer pain drug” manufactured by Insys. (Reuters, 2017, October 6). The charges also allege that Insys’ upper-management sought to defraud insurance companies by submitting claims on patients who were prescribed the drug but did not have cancer.

I first heard about this case on the premiere of Megyn Kelly’s Sunday Night program which aired on NBC on June 4, 2017. In the program, one of Kelly’s reporters had interviewed a single mother who worked as a sales rep for Insys. She alleged that Insys had developed a fentanyl-based drug that could be delivered to patients as a sublingual spray. This method of delivery made it easy for end-of-life cancer patients to self-administer. Since fentanyl is a powerful pain analgesic, it was considered helpful in alleviating pain for these Stage 4 cancer patients. However, the sales rep who was interviewed on the Megyn Kelly program went on to explain how she was pressured by Insys management to encourage doctors to prescribe their fentanyl-based opioid product to other pain patients, not just those with Stage 4 cancer for whom the drug was initially meant for, thereby increasing profits for Insys.

It is now common knowledge that prescription opioids (e.g. OxyContin) have fueled the current opioid epidemic and have become the “gateway drug” to illicit heroin use. The progression goes something like this: patients who are experiencing pain from accidents, having a tooth pulled, or from surgery are often prescribed an analgesic painkiller. Although most patients will then stop using these analgesics once their pain subsides, this is not the case for a percentage of patients who develop a tolerance to the analgesic and for those who are taking the opioid drugs on a continuous basis for chronic pain conditions. 

As patients develop tolerance and therefore need more and more of the opioid to alleviate pain, they often begin to doctor-shop or seek out pill mills to sustain their supply. When their supply runs out or doctors no longer will write additional prescriptions, their patients turn to the street buy prescription opiates illegally. However, there’s the caveat. In most regions of America, one 80 mg OxyContin pill can cost upwards of $40, so an alternative is to then turn to heroin which is cheaper and more plentiful. 

This progression is well-described in Sam Quinones’ outstanding book Dreamland which describes how and why the United States is currently experiencing a devastating opioid epidemic which has resulted in thousands of overdose deaths.

So, by unethically marketing their fentanyl spray to non-cancer patients, and allegedly bribing doctors with kickbacks, Insys Therapeutics Inc. had increased their market and sales exponentially but in doing so, has also contributed to the nation’s opioid epidemic. 

We see this same scenario being played out over and over again as described in a recent article "Empire of Pain" in the New Yorker in which the pharmaceutical manufacturers who produce opioid-based analgesics find markets among those who chronically abuse these drugs. Is there a place for opioid-based medications in modern medicine? Yes, of course, there is. Ask anyone who has been through surgery, who has suffered an accident, or even those who have a wisdom tooth pulled. 

However, when corporations seek to profit off the misery of those who become addicted to those drugs, are they any better than foreign drug cartels? Ask any of the nearly 60,000 parents, siblings etc who lost loved ones due to opioid overdoses in 2016 alone.

References

Keefe, Patrick Radden (2017, October 30).  Empire of Pain: The philanthropic family that profited from OxyContin. The New Yorker.

Quinones, S. (2016). Dreamland: The true tale of America’s opioid epidemic. New York: Bloomsbury Press.

Reuters (Oct 6, 2017). Billionaire Insys Founder Charged in U.S. Opioid Bribe Case.

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