God Damn The Pusher

Subsys®, a product of Insys Therapeutics

The song is by Hoyt Axton, of all people. But it was made famous by Steppenwolf.

Oh but the pusher is a monster
Good God, he’s not a natural man

The dealer for a nickel
Lord, will sell you lots of sweet dreams
Ah, but the pusher ruin your body
Lord, he’ll leave your, he’ll leave your mind to scream

That 1968 song – featured in the movie Easy Rider  – famously drew a distinction between marijuana and heroin. It comes to WC’s mind now because the opioid crisis, fueled by appallingly excessive prescription use, is very much just another kind of drug that has been pushed on America in the name of profit.

After years of horrible carnage, a small amount of retribution may be happening. Individual executives – not the corporation, rather its leaders – are being tried in a RICO case. RICO, the Racketeering Influenced Corrupt Organizations Act, allows criminal prosecution and civil penalties for racketeering activity performed as part of an ongoing criminal enterprise. Such racketeering activity may include drug trafficking.

In a Boston U.S. District Court trial under way now, the Department of Justice is seeking RICO convictions against five senior managers at Insys Therapeutics:

• John N. Kapoor, a onetime billionaire and founder of Arizona-based Insys Therapeutics, and its President.
• Michael Gurry, the former vice president of managed markets.
• Joseph Rowan, a former regional director.
• Richard Simon, a former national director of sales.
• Sunrise Lee, a former regional director.

Two former officers of Insys have already copped pleas and are testifying in the RICO trial: Alec Burlakoff, a former Insys vice president who pleaded guilty to a count of racketeering conspiracy; and Michael Babich, the former CEO of Insys, pleaded guilty to a count of conspiracy and a count of mail fraud.

Well, now if I were the president of this land
You know, I’d declare total war on The Pusher man
I’d cut him if he stands, and I’d shoot him if he’d run
Yes I’d kill him with my Bible and my razor and my gun

God damn The Pusher
God damn The Pusher
I said God damn, God damn The Pusher man

The Food and Drug Administration had only approved Subsys, a fentanyl-based product, for final stage cancer patients with intractable pain. Insys engaged in a national marketing effort to promote Subsys sales for so-called “off-label” use.

The tactics used by Insys to encourage doctors to prescribe Subsys varied. Some doctors were paid “speaking fees” but never had to give presentations. Some of those speaking fees amounted to hundreds of thousands of dollars. Some doctors were hosted at “conferences” that amounted to extended parties. And there was also former regional sales director Sunrise Lee, who would give those doctors lap dances. Ms. Lee’s CV seems to have involved mostly strip club work; she had no professional degrees and no other experience in marketing.

WC will follow the trial of the Insys defendants with interest.

It’s probably too much to hope that the Sackler family, which owns Purdue Pharma, the manufacturer of OxyContin, will face similar charges. Purdue’s marketing was much the same – perhaps without the benefit of Ms. Lee’s expertise – but its sales volumes were a hundred times larger. Purdue has paid $634.5 million in fines. But no one has been criminally prosecuted.[^1]

The opioid epidemic has now killed more than 200,000 people. From 2007 to 2012, the year Purdue settled civil claims with DOJ, Purdue sold enough OxyContin pain pills in West Virginia to supply every man, woman and child there with 433 pills each year, according to a report in the Charleston Gazette-Mail.

Insys Therapeutics and Purdue Pharma made and continue to make millions, so it must be okay. But WC just sees a better dressed, better-lawyered pusher. Still wrecking people’s lives, but with nicer offices. WC thinks it’s more evidence that the War on Drugs was a lie.

God damn the Pusher.

 

[^1]: Purdue knew almost immediately that its Oxycontin was being abused. An attorney named Rudy Giuliani and others persuaded the Department of Justice not to allow the U.S. Attorney for the District of Virginia to bring RICO charges against the Sacklers. Purdue makes so much money that the legal staff at the Drug Enforcement Agency felt out-gunned by Purdue’s unlimited resources.