One Opioid-Pushing Executive Down, 1,210,392 to Go

Former billionaire and pharmaceutical executive John Kapoor and four co-defendants were found guilty Thursday of racketeering conspiracy in a landmark opioid crisis case, according to NPR.

Kapoor, the founder of Insys Therapeutics, was found guilty of running a national bribery scheme in which he apparently paid doctors to prescribe fentanyl-based opioids to patients and then lied to insurance companies, ensuring the often unneeded treatments would be covered.

The verdict, reached after 15 days of deliberations, makes Kapoor the highest ranking former pharmaceutical executive to face trial for charges related to the opioid crisis. His guilty verdict could bolster other cases against pharma executives.

“Today’s convictions mark the first successful prosecution of top pharmaceutical executives for crimes related to the illicit marketing and prescribing of opioids,” U.S. Attorney Andrew E. Lelling said in a statement. “Just as we would street-level drug dealers, we will hold pharmaceutical executives responsible for fueling the opioid epidemic by recklessly and illegally distributing these drugs, especially while conspiring to commit racketeering along the way.”

“This is a landmark prosecution that vindicated the public’s interest in staunching the flow of opioids into our homes and streets,” he added.

It’s rare that the government charges executives at Kapoor’s level as criminals, says former federal prosecutor Brad Bailey.

“That’s always unusual. That’s always an attention grabber,” Bailey told NPR. “The big issue is the use of racketeering charges, which had been originally designed to go after the Mafia.”

NPR details Kapoor’s scheme:

Insys allegedly targeted doctors with a track record of liberally prescribing opioids, inviting them to participate in a “speakers program.” According to the government, doctors were paid handsomely even if nobody showed up for the lectures, but only if the doctors wrote a lot of prescriptions for Subsys. Often, prosecutors say, this meant patients who didn’t need the medication were prescribed it anyway.

Insys then allegedly set up a call center where drug company employees pretended to be from doctor’s offices. Jurors heard phone calls in which Insys employees made up diagnoses to ensure that insurance companies covered Subsys, which can cost tens of thousands of dollars a month.

Not good!

Kapoor’s defense tried to claim ignorance of these crimes and blamed other executives, but that strategy didn’t shield him from guilt.

Now, Kapoor’s former company Insys is barely limping along. It has also faced lawsuits from the insurance company Aetna and an investigation by the Justice Department, which ended last year with the company paying a $150 million fine. Company stocks have fallen 90 percent since 2015, according to Bloomberg.

Over the past decade, the number of deaths related to opioids in the U.S. has skyrocketed, from 18,515 in 2007 to 47,600 in 2017. Most recent opioid deaths are connected to the drug Kapoor’s company produced: fentanyl. In 2016, deaths from fentanyl surpassed deaths from opioids like oxycodone, and the toll has shot up even higher in the years since.

Kapoor isn’t the only executive facing criminal charges for his role in the crisis. Last week, the Justice Department announced that former Rochester Drug Co-Operative Inc. CEO Laurence Doud III and his former chief compliance officer William Pietruszewski are facing criminal charges for failing to file DEA reports of suspicious opioid purchases.

This is heartening, and represents a step in the right direction. But some experts worry that going after crimes alone will leave out many who were complicit in the crisis.

“A lot of what pharmaceutical companies did in the context of the opioid crisis that we are dealing with now was not, in fact, illegal. It was maybe unethical, but it was not illegal,” Leo Beletsky, a professor of law and health at Northwestern University told NPR.

“We need to think much more deeply about how we regulate the pharmaceutical industry and how we prevent these kinds of practices from occurring in the first place,” Beletsky says.

Sadly, that kind of regulation is most likely a far off dream. In the meantime, other executives are facing civil lawsuits.

Last month, 600 cities, counties, and Native American tribes sued eight member of the Sackler family for their role in pushing opioid medications that fueled the crisis.

“Eight people in a single family made the choices that caused much of the opioid epidemic,” the suit says. “They got more patients on opioids, at higher doses, for longer, than ever before. They paid themselves billions of dollars. They are responsible for addiction, overdose, and death that damaged millions of lives. They should be held accountable now.”