“Selling drugs is a relationship business. It’s best to do it in person. That is why, on a summer evening in 2012, Alec Burlakoff was out for dinner with Steven Chun, the owner of Sarasota Pain Associates. Burlakoff was a sales manager for Insys Therapeutics, an Arizona-based pharmaceutical company with only one branded product, a new and highly potent opioid painkiller called Subsys. Chun was a doctor who prescribed a lot of opioids.
The location was a moderately expensive seafood restaurant in Sarasota, Fla., with linen tablecloths and large windows overlooking the bay. The sun was still high in the sky. Gleaming powerboats lined the docks outside, and a warm breeze rippled the water. On one side of the table were Burlakoff and Tracy Krane, an Insys sales representative. Krane was a newcomer to the industry, tall with dark brown hair in a bob. Burlakoff, then 38, with a slight frame and a boyish restlessness, was her new boss. He had years of experience in the opioid market. Colleagues marveled over his shameless push to make the sale, but he had a charisma that was hard to resist. Even people who didn’t trust him couldn’t help liking him.” . . .
“As a result of Insys’s approach to targeting doctors, its potent opioid was prescribed to patients it was never approved to treat — not occasionally, but tens of thousands of times. It is impossible to determine how many Subsys patients, under Kapoor, actually suffered from breakthrough cancer pain, but most estimates in court filings have put the number at roughly 20 percent. According to Iqvia data through September 2016, only 4 percent of all Subsys prescriptions were written by oncologists.
Jeff Buchalter, 34, a decorated Iraq war veteran, was one off-label Subsys patient. His doctor, William Tham, a paid Insys speaker, prescribed the drug to treat pain stemming from Buchalter’s wartime injuries, eventually raising the dose well beyond the maximum amount indicated by the F.D.A. Buchalter was taking it 12 times a day, not four to six, and alternating between the two highest doses, a medical chart from Tham’s clinic shows. Eventually, he had to be put under sedation in intensive care at Fort Belvoir, Va., while he went through withdrawal from Subsys and other prescription drugs. “I am frankly astonished at the amount of opioids the patient has been prescribed,” a hospital specialist noted in his records. Buchalter is suing Insys and Tham. (Tham’s lawyer, Andrew Vernick, told me, “He has done nothing wrong in this case, and he is not involved in any of the allegations that have been raised against Insys throughout the country.”)
Buchalter said Subsys gave him relief from pain, but it changed him into someone he did not recognize. He had always defined himself as a hard worker with integrity. With his eyes darting around the room as he spoke, he told me he became an addict, his day revolving around the next dose: He slept under his desk at the office, where boxes of Subsys filled the drawers, and his house went into foreclosure. Buchalter looked troubled and tired when we met. His hands were visibly dirty. “I’ve been absent from my life for years,” he told me. “What I remember is who I was when my daughter was born, and when I was a soldier.”
“SEVEN FORMER INSYS EXECUTIVES NOT ONLY FACE CRIMINAL PROSECUTION BUT STAND ACCUSED OF RACKETEERING UNDER THE RICO ACT, A LAW MORE COMMONLY INVOKED AGAINST ORGANIZED-CRIME FAMILIES AND DRUG GANGS. THE INDUSTRY WILL BE PAYING ATTENTION.”
DL: The head of Insys John Kapoor, and 6 other execs, are now arrested for bribes and racketeering.
David Lindsay Jr. Hamden, CT Pending Approval
Great reporting by Evan Hughes, thank you. I pray that many of these criminals see many years in jail, or worse.
My son Austin Lindsay died of an opium overdose in August of 2011. He was brilliant but lazy young scholar, and petty drug dealer. His new love of opiates apparently came about because of his struggles with obesity. A “friend” stole a bottle of 100 opiate based tablets from a pharmacy, and gave them to my son, who found that they created a nausea that cut his appetite. He lost 70 or 100 pounds, and on the outside, he regained normalcy. But, apparently, he had a new craving, that didn’t go away as fast the the pounds that he had lost.
After reading this article, for the first time, it occurred to me to be possible that the pharmacy allowed bottles of opiates to be stolen. I’m probably just a bitter, heart-broken parent, but this story awakens a new set of questions.
David Lindsay Jr. is the author of “The Tay Son Rebellion, Historical Fiction of Eighteenth-century Vietnam,” and blogs at TheTaySonRebellion.com and InconvenientNews.wordpress.com, where his topics include The Drug Wars.