The Hard Sell: Crime and Punishment at an Opioid Startup by Evan Hughes. This book traces an Opioid startup and its hard fall. The book is set to be a Netflix release in 2023. called Pain Hustlers.
This book tells a story of widespread, flagrant abuse selling opioids. In fact, the company’s leaders looked sideways as profits soared. I found this to be an important book as the American opioid crisis remains critical, however the message is a bit weaker after reading five other books about the crisis. The press however have made this story relevant.
John Kapoor created pharmaceutical firm Insys Therapeutics. The company was certainly not the first to sell opioids. In fact it was competing with the Sackers’s Purdue Pharma. However Insys developed a unique approach to deliver fentanyl (called Subsys) quickly in to the body.
Subsys was sprayed under the tongue. The drug’s fentanyl impact began in less than 5 minutes, almost as quickly as taking the drug in an IV. Yet when not measured accurately, a single dose will kill you. And it did indeed kill a lot of people.
However, Insys simply pushed their innovation. To drive success Kapoor hired a number of aggressive young executives. The story reveals how Mike Babich, hired from Chicago-based Northern Trust who became a cut throat sales leader.
Dirty sales tactics
Mike’s talent was high pressure sales tactics and he built a team who played without rules. As Evan shows the shallowness of Babich is no further evident than hiring an exotic dancer who was recently divorced with child custody legal challenges and payments literally jumped at the chance to make a lot of money regardless of who died or became addicted. Insys employees certainly acted immoral, as one leader was romantically involved with multiple women including the Director of HR.
Targeting ‘weak’ physicians
Evan documents how Insys sales targeted and exploited physicians who were willing to push Subsys for enormous profits. In addition, Insys even created an internal department that was dedicated to committing insurance fraud. Many were in need of money so a $200 per week bonus was helping them out personally while professionally committing fraud.
“You don’t always tell the truth, right? Absolutely not,” he replied. I’m in sales. I worked for Dr. Kapoor.
pg. 539
Even Insys internal call center lied repeatedly to insurance companies. Why? Because Subsys was developed for advanced cancer patients. Any prescription request would be automatically denied when a patient was not suffering from cancer. Employees lied repeatedly telling insurance companies the prescription requests were for cancer patients.
Wall Street’s new darling
Kapoor and Babich turned this sales angle to become a huge success on Wall Street. Yet, it would be internal sales and support employees who became whistleblowers. Evan then visited with patients. These stories are very similar to those in my previous reads.
The New York Times article about the company:
Way off the rails
Insys followed the Sackler lead in paying physicals to speak at medical conferences promoting Subsys. However Kapoor went as far as to refer to these payments as bribes when regarding his investments (physicians) and demanded to see how the bribes were driving more business.
In conclusion, Evan is providing insights to the inner working of an Opioid startup as the crisis grew. Here the truth is stranger than fiction. Yet, this startup went off the rails as millions of Americans became addicted, overdosed, or died as a result.