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Pain Hustlers vs. the True Story of the Insys Opioid Scandal

Historical Accuracy (Q&A):

Is Pain Hustlers based on a true story?

Yes, but only loosely. The heavily dramatized Netflix movie was inspired by the Insys Therapeutics scandal, which revolved around the company's pain relief spray for cancer that included fentanyl as its highly addictive core ingredient. The movie was inspired by Evan Hughes' 2018 New York Times Magazine Article "The Pain Hustlers", which he later expanded into the book The Hard Sell: Crime and Punishment at an Opioid Start-Up. However, the core plot of the movie is fiction and does not appear in Hughe's article. In addition, director David Yates, best known for directing several of the Harry Potter films, gave the film a comedic tone that Hughe's article doesn't have. "This isn't the Insys story in detail at all," Yates told TIME magazine.

What was the Insys scandal?

Like in the Pain Hustlers movie starring Emily Blunt and Chris Evans, Insys Therapeutics sales reps bribed doctors with financial incentives to prescribe the company's fentanyl-based drug Subsys. Insys created a "speaker program" in which doctors were paid to promote the highly addictive drug. For example, according to The Guardian, Insys "paid nearly $260,000 to two New York doctors who wrote more than $6m worth of Subsys prescriptions in 2014." The drug was only authorized to be used as a pain-relieving medication for cancer patients and those on the verge of death. However, Insys encouraged doctors to prescribe the drug to a wide range of people, including those outside the scope of its approval who were suffering from other types of pain. This resulted in a rise in opioid addiction.

What was the name of the real-life medication?

A Pain Hustlers fact check reveals that the real-life medication created by Insys Therapeutics that inspired the movie was called Subsys. It was a sublingual liquid form of fentanyl, meaning that you applied it by spraying it under the tongue. The movie changes the name of the drug to Lonafin. However, minus the name change, they are essentially the same. The drug company's name is also changed. Insys Therapeutics becomes the fictional Zanna Therapeutics in the film.

Photo: CNBC

Are the Pain Hustlers characters based on real people?

No. While some of the characters share certain similarities with the real people who were part of the Insys scandal, the characters in director David Yate's Insys movie are fictional. Evan Hughes' article does mention Insys Therapeutics hiring a woman who used to be an exotic dancer, a detail that likely inspired the movie's main character, Liza Drake, portrayed by Emily Blunt. Yet, there are still no one-to-one correlations with real people. Most of the characters are either completely fictional or are loose composites of numerous people from real life. Chris Evans' character, Pete Brenner, takes on some of Alec Burlakoff's traits, the man who is focused on in Hughes' article.

Were Insys sales reps rewarded with massive commissions?

Yes. It's true that sales reps earned exorbitant amounts of money, making it easier to ignore the moral conundrum they were in. While conducting our Pain Hustlers fact vs. fiction analysis, we learned that according to Statnews (and court records), one Insys sales rep in Alabama had a base salary of $40,000 but received over $700,000 in commissions from 2013 to 2015.

Is there a real-life counterpart to Andy Garcia's character, Jack Neel?

While Jack Neel is largely fictional, his closest real-life counterpart is Insys founder John Kapoor, a billionaire who started his company in 1990. For the crime of bribing doctors, Kapoor was sentenced to five-and-a-half years in prison in 2019. To settle the federal government's case, Insys agreed to pay $225 million. The company eventually went bankrupt.

Did the real story behind Pain Hustlers take place in Florida?

No, at least not specifically. The Insys movie makes it seem like the bulk of the story unfolded in Florida. However, the Insys scandal happened across the country, with salespeople working throughout the U.S. Insys Therapeutics, the real-life company, was actually based in Chandler, Arizona.

Is the story of an Insys employee having a daughter with a brain tumor taken from the true story?

No. Liza Drake (Emily Blunt) having a daughter with a brain tumor and epilepsy in the Netflix movie is the creation of the filmmakers and acts as a bridge between the character and the patients she's trying to sell her employer's drug to.

Did Insys Therapeutics create a rap video to promote their fentanyl-based medication Subsys?

Yes. It may sound hard to believe, but while researching the real-life events the movie was based on, we learned that Insys Therapeutics created a Subsys rap video to encourage sales of their highly addictive, fentanyl-based medication. You can watch the Subsys music video.

What other movies and series have been made about the opioid crisis?

Netflix's Pain Hustlers joins two other recently-produced stories about the opioid crisis, the 2021 Hulu series Dopesick starring Michael Keaton and the 2023 Netflix series Painkiller starring Matthew Broderick. Director David Yates told TIME that he wanted to give his film an edge that he felt was missing from those two earlier stories. "We always felt we wanted it to be as subversive and as naughty and as different as we could compared to those," he said. The result is a story more reminiscent of The Wolf of Wall Street. We're taken along on the wild ride that the employees experience, only to be finally confronted with the true cost of it all. In this case, customers' lives.

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