THE HARD SELL

A journalist pulls back the curtain on the scandals that sent the first pharmaceutical executives to prison for their role in the opioid crisis.

Insys Therapeutics had the best-performing IPO of 2013 when the scrappy Arizona-based drug company took its stock public. But behind its investor-pleasing gains lay years of crimes involving the illegal promotion of its opioid painkiller Subsys, a liquid-spray form of fentanyl. Hughes gives a brisk and engaging account of the sales-obsessed culture fostered by Insys founder John Kapoor, which led a group of whistleblowers to file qui tam lawsuits. The illegal acts included creating sham speaker programs that paid kickbacks to doctors who prescribed Subsys and setting up a fake “reimbursement center,” where Insys workers lied to insurers to get them to pay for prescriptions. Some employees and prescribers later pleaded guilty and cooperated with government investigators; Kapoor and four other Insys executives were convicted at a trial on racketeering and other charges. The company also agreed to pay a $225 million settlement, but Hughes says that because Insys declared bankruptcy, victimized patients will see little cash: “The most that patients will get is a refund for their co-pays.” The author avoids an in-depth analysis of how Insys’ misconduct resembled that of the Sackler family’s more notorious Purdue Pharma, but implicit in his book are at least two answers for those who wonder why Kapoor went to prison and no Sacklers did: The privately held Purdue faced less scrutiny than the publicly traded Insys and from the start hired world-class lawyers, while Insys lacked even an in-house legal counsel until a government subpoena arrived. Some readers may wish that Hughes had compared the companies more directly and brought such issues into sharper focus, but he adds a valuable chapter to recent opioid chronicles such as Ryan Hampton’s Unsettled and Patrick Radden Keefe’s Empire of Pain.

A well-told story of opioid crimes by a company often overshadowed Purdue Pharma.