Pain Hustlers: Crime and Punishment at an Opioid Startup

by Evan Hughes

The inside story of a band of entrepreneurial upstarts who made millions selling painkillers—until their scheme unraveled, putting them at the center of a landmark criminal trial. • THE BASIS FOR THE MAJOR MOTION PICTURE PAIN HUSTLERS STARRING EMILY BLUNT AND CHRIS EVANS

"Unfolds with the velocity and verve of a Scorsese film…A tour de force."—Patrick Radden Keefe, New York Times bestselling author of Empire of Pain and Say Nothing

John Kapoor had already amassed a small fortune in pharmaceuticals when he founded Insys Therapeutics. It was the early 2000s, a boom time for painkillers, and he developed a novel formulation of fentanyl, the most potent opioid on the market.
 
Kapoor, a brilliant immigrant scientist with relentless business instincts, was eager to make the most of his innovation. He gathered around him an ambitious group of young lieutenants. His head of sales—an unstable and unmanageable leader, but a genius of persuasion—built a team willing to pull every lever to close a sale, going so far as to recruit an exotic dancer ready to scrape her way up. They zeroed in on the eccentric and suspect doctors receptive to their methods. Employees at headquarters did their part by deceiving insurance companies. The drug was a niche product, approved only for cancer patients in dire condition, but the company’s leadership pushed it more widely, and together they turned Insys into a Wall Street sensation.
 
But several insiders reached their breaking point and blew the whistle. They sparked a sprawling investigation that would lead to a dramatic courtroom battle, breaking new ground in the government’s fight to hold the drug industry accountable in the spread of addictive opioids.
 
In Pain Hustlers , National Magazine Award–finalist Evan Hughes lays bare the pharma playbook. He draws on unprecedented access to insiders of the Insys saga, from top executives to foot soldiers, from the patients and staff of far-flung clinics to the Boston investigators who treated the case as a drug-trafficking conspiracy, flipping cooperators and closing in on the key players.
 
With colorful characters and true suspense, Pain Hustlers offers a bracing look not just at Insys, but at how opioids are sold at the point they first enter the national bloodstream—in the doctor’s office.

Genres: Nonfiction, True Crime, Audiobook, Media Tie In

288 pages, Paperback

Published September 26, 2023

About the author

Librarian Note: There is more than one author in the GoodReads database with this name.

Reviews

[Lee Cochran · Rating 5 out of 5]

I thought Purdue and the Sacklers were pure evil but this book goes behind the scenes in a lesser-known trial. Fascinating, disgusting and saddening, but a must-read - though no one will trust Big Pharma again!

[Phil · Rating 4 out of 5]

Good book, but the film conveys the gist of this sadly true story more economically. Shocking insight into the lethal intersection where human greed exploits the desire to live pain free.

What’s up with the pain killer addiction these days BTW? When I was growing up in the Big 80s, weed and booze were widely acceptable choices for recreational fun. Now folks pop dangerous pills like it’s no big deal and too often it’s the last bad choice they make in life.

Modern day humans arguably are better off today when it comes to the many convenience at our disposal - food, shelter, transport, communication, entertainment- to make daily life easier than any generation in history has ever known.. Regardless, physical and mental misery abounds for many and dangerously addictive pharmaceuticals are too often prescribed and sought for relief. Quite the conundrum, and it only seems to be getting worse.

[Hannah Maynard · Rating 5 out of 5]

Eye opening.

[Hannah · Rating 4 out of 5]

This was a book club read at my job. I definitely recommend for other people in the healthcare profession to learn more about the lengths certain pharmaceutical companies could go to behind the scenes to rake in profit while patients suffer under their greedy hands. It all started with Kapoor and how his wrong doings became pervasive among all the team members he hired along the way at Insys Therapeutics. Some of the team members were reluctant in perpetuating his immoral tactics to ensure that patients are prescribed Subsys. However, most of the team became accustomed to viewing patients as dollar signs once they got caught up with their wealth. This led to the eventual downfall of the prescribers and their malicious involvement with Insys Therapeutics along with those working at Insys from the bottom to the top of their corporate ladder. The star deduction for me was that the writing could be monotonous at times and it was difficult to keep up with the trail of names in the beginning.

[Christine Sinclair · Rating 4 out of 5]

I saw the 2023 adaptation of this book on Netflix, starring Emily Blunt and Chris Evans. It is the shocking true story of a company called Insys Therapeutics, run by a Dr. John Kapoor. Kapoor developed a new drug called Subsys, which was a fast-acting spray opioid pain medication whose main ingredient was fentanyl. The drug was approved by the FDA for relief of breakthrough pain in cancer patients. He subsequently used several illegal methods to induce doctors to write countless prescriptions fot it, and became a billionaire from the profits. The misapplication of Subsys led to drug addiction and the death of numerous patients. Evan Hughes's meticulous research and reporting takes us inside the company, and the courtroom, to reveal the "crime and punishment of an opioid startup."

[Christina]

This is the story of the rise and fall of a pharma startup, Insys Therapeutics. It dives into their shady business practices and how they manipulated the system and gained millions with their main product, Subsys— basically a spray version of fentanyl. It was fascinating to read about this and learn about all the key players involved and just how far they went. It was unbelievable and also sad at the same time to think about all the people who were harmed by their actions especially in the height of the opioid crisis. Definitely recommend if you’re into this type of thing! I also have not personally watched the movie, but from my understanding it is the story of Insys, just in a more narrative/ story form vs this book!

[Nupur Dave · Rating 4 out of 5]

Pain Hustlers was an extremely eye-opening book that gives us an insight into one of the most secretive and corrupt fields - Pharmaceuticals. By reading about the evolution of Insys - from how it begun all the way to its demise - the reader is able to get an incredible lens surrounding the iffy regulations of Pharma. We can literally see how doctors are being payed to prescribe drugs, the lengths companies will go to to skirt insurance and regulatory practices, and how these behaviors are prevelant in the entire industry. While the downfall of Purdue Pharma and the Oxycotin story is well known, I doubt that most people know that they just got off with a fine - no one from the Sackler family has ever been put in jail. Every top pharmaceutical companies have participated in the illegal practices highlighted in this book.

By digging into the behaviors of top executives in Insys Therapeutics and corrupt doctors and "pill mills", Hughes is able to tell us a story that is usually locked away and hidden behind NDA disclosures. Although it was a small company, the Insys Therapeutics trial allows us a small insight into a corrupt industry and one of the worst health crises of all time. This book highlights why journalism is so important - from getting an inside look at the Insys trial, we are able to understand how not only the pharmaceutical system fails us - but also how the judicial system and government is fully unable to (or unwilling) to make actual changes to protect the citizens.

I believe that this is a MUST READ for anyone truly interested in the pitfalls of the pharma industry, but be prepared to lose your faith in the system.

[Vanessa Olson · Rating 3 out of 5]

Interesting story, and I appreciated that it was about a startup and not about one of the many more well known manufacturers. I could tell the research put into writing this was really good and that the author wanted to be fair while also reporting the facts.

The issue for me was that there was really no narrative here. There were a lot of characters we heard a little about, but not many that were compelling enough to carry an actual story. As a result, this felt more journalistic than like a book.

[Eric · Rating 3 out of 5]

It's a wild story but Hughes tells it far more narrowly than I would have liked. He relates the pharmaceutical companies' justifications of their profits without criticism before concluding that Insys would have avoided serious consequences if their criminality had been just a little less brazen. An exploration of that would have made for a more personally satisfying read, while the story Hughes tells gets the Hollywood treatment.

[Claire Kuwana · Rating 3 out of 5]

saw the ‘now a Netflix film’ sticker on the cover and assumed this would be amazing .. should have checked rotten tomatoes first as the movie has a 23% lol. Anyway this book was definitely well-reported but it’s quite a narrow story which felt almost wrong considering how widespread this crisis is. Biggest takeaway is Big Pharma is confirmed super evil but I could have gotten that same conclusion from perhaps a more interesting dive into the topic

[Vincent · Rating 4 out of 5]

4.5 stars.

One of those books I picked up and couldn't put down. Hughes has a great storywriting style that keeps the narrative constantly moving. I'd call it an entertaining read if it weren't for the fact that it's a true story and shows the grim reality of how human greed ends up bringing so much grief.

[Daisy Gan · Rating 3 out of 5]

Just met someone who was in health care admin major and they said a lot of their studies was depressing because of the legal issues behind problems like insurance. This true story demonstrates the money grabbing behavior. It’s sad to hear this is a true story. Everyday I am grateful I don’t have to constantly pay for an expensive medication or treatment.

[Kirsten · Rating 4 out of 5]

3.75/5.
A good book regarding marketing strategies of opioids at a startup that prioritizes money over all else. Does not necessarily “grab” you with its reporting the way some other books of a similar variety do, but is a worthwhile read nonetheless.

[Greg Kopstein · Rating 4 out of 5]

This is my third foray into books about the opioid and Big Pharma businesses. It’s certainly reminiscent of the other two I have read:

Empire of Pain
Dopesick

Interesting to a point, certainly shocking in scale and impact, this book is a necessary addition to research in this topic.

[Nick Martin · Rating 3 out of 5]

placeholder for the movie, adapted by Wells Tower

[Laura Jacqueline · Rating 4 out of 5]

Troubling. At least this time the CEO faced some consequences

[Harry Harman]

phd = poor, hungry, and dumb

Zanna Therapeutics was selling Lonafen, an opioid drug.

a dreamer, undervalued but incredibly capable

[Laura · Rating 5 out of 5]

This was a compelling story well told. Entirely frightening in terms of the indictment of the Pharma industry and some people lack of compassion for others and pure greed.

[Alejandro Labarca · Rating 4 out of 5]

Doesn’t even scratch the surface of the things that go on in the medical world. Harrowing, shows how people can be so involved in themselves that they lose sight of what’s important.

[Jack Riley · Rating 3 out of 5]

Basically wolf of wall street but about big pharma and its dry as hell 60% of the time

[Sandi · Rating 3 out of 5]

Interesting story but way longer than it needed to be.

[Joshua Hatfield · Rating 5 out of 5]

😵‍💫😵‍💫😵‍💫😵‍💫

[Noelle · Rating 4 out of 5]

I had never heard of this company, let alone this drug prior to reading this book. This story was devastating and just shows how damning the pharmaceutical business can be

[Jessie · Rating 3 out of 5]

3.5

[Felix Kwan · Rating 5 out of 5]

A great read. A cautionary tale of corporate greed, absence of governance and ethics and the resulting human consequences, ultimately destroying what could have been a great company.

[Laura Antero · Rating 3 out of 5]

Avaliação: 3.5 estrelas

[zahra · Rating 4 out of 5]

i hate big pharma but i love big pharma books

[babybat · Rating 3 out of 5]

These people that contributed to the opioid epidemic are disguising

[Stephanie Tallon · Rating 4 out of 5]

Very interesting read-especially as someone who used to work in the pharmaceutical industry. Explains a lot about an industry that remains a mystery to most

[Cat Naylor · Rating 1 out of 5]

DNF read like a textbook