The Real Story of the Outrageous Pharma Scandal that Inspired Pain Hustlers

Pain Hustlers, the new Netflix film that premiered on Sept. 11 at the Toronto International Film Festival, uses a structure like a documentary, featuring characters being interviewed by an unseen person and directly addressing the camera—but it isn't one. Instead, the movie starring Emily Blunt and Chris Evans, from director David Yates, is a heavily dramatized account of the rise and fall of a small opioid company that hawked a pain relief spray for cancer pain with fentanyl as the highly addictive main ingredient.

In condensing a sprawling story into about two hours, the filmmakers aimed to paint a picture of capitalistic corruption along the outskirts of the pharma industry, where beautiful sales representatives provided doctors with financial incentive, bribing them into writing as many prescriptions as they could despite the risks to their patients.

From Dopesick to Painkiller, a number of stories about the drug crisis have been told on-screen recently, but Yates wanted Pain Hustlers, which lands on Netflix Oct. 27, to have an edge that he felt other stories lacked. His goal was to both acknowledge the hurt and death this broken system caused, but also take viewers on a wild ride. "We always felt we wanted it to be as subversive and as naughty and as different as we could compared to those," Yates explained to TIME during an interview at TIFF. "Primarily we wanted to bring an audience into the issues and the opioid crisis overall."

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An outrageous tale, in more than one way

Pain Hustlers began as a 2018 article for the New York Times Magazine by Evan Hughes, chronicling the travails of Insys, founded by billionaire John Kapoor. Insys produced Subsys, the spray described above, which thrived through a "speaker program," in which doctors were paid to spread the gospel of their product to colleagues, essentially giving them money for prescribing a potentially very dangerous drug. Ultimately, in 2020, Kapoor would be sentenced to 66 months in prison for bribing medical practitioners.

"This was this kind of scrappy startup and they had this wild rags to riches tale," Hughes said. "I would use the word ‘outrageous’ to describe both the story and the film—and you could say outrageous in two senses of the word. There's outrageous in terms of wild, larger than life, chaotic, funny, but then there's the moral outrage of the story—all of that was taking place and all of that was being achieved against the backdrop of patients that were being hurt." 

Hughes' article caught the eye of the British director Yates who had spent decades working in the world of the Harry Potter films and was looking to do something grounded. "We have a national health service in the UK," he said. "Health is publicly funded and the idea is you don't profit out of fixing people, you fix people for the greater good, and in that sense reading an article about the fringes of the medical system whereby huge profits were being made with dubious practices made me intrigued."

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Taking dramatic license

At the time screenwriter Wells Tower started adapting the article into a screenplay, Hughes was working on his book, The Hard Sell: Crime and Punishment at an Opioid Startup, an account that tackles the scope of Insys' misdeeds. "My role was to be a sounding board and a consultant and help them ground the story in the truth," Hughes said. 

But Tower's script takes big dramatic license. For example, none of the characters on screen are strict one-to-one representations of Insys employees. "This isn't the Insys story in detail at all," Yates said. "It's inspired by that—the fringes of that industry and how they exploit one very marginal sector of the healthcare industry and make a fortune out of it." 

Emily Blunt plays Liza Drake, a composite of a number of figures that appear in Hughes' book. She's a single mother living in Florida and working as a stripper when she meets Pete Brenner, a sales rep portrayed by Chris Evans, leaning into his Boston accent, who drunkenly offers her a job while flirting at the bar of the strip club that is soon to be her former place of employment. 

Desperate for something else, she shows up at his office and, after Pete fudges her resume, she's hired by the eccentric John Kapoor-type figurehead (Andy Garcia) at the pharma company Zanna. Liza turns out to be a natural. She lures one slimy doctor (Brian D'Arcy James) into a speaker program and it spirals from there—she eventually has an army of beautiful young women marching into offices, and the company grows. That is, until Liza begins to develop a conscience. 

Anarchic fun, with a conscience

Yates explained he specifically wanted to tell a story about a single mother, which led to the creation of Liza. Even though Liza is an amalgamation, Hughes said she's representative of a swath of people. "It was made up of young people who were often in over their head and they were hungry for success and a lot of that is embodied in her. Even if the details come from hither and yon, they're real," he said. 

Meanwhile, Evans' Pete takes on some of the qualities of Alec Burlakoff, who is at the center of Hughes' original article. And even though Insys was operating all around the country, the movie bases the action in Florida. Yates said the trick was to have fun with the material, while still respecting the people who lost their lives because of Subsys and the opioid crisis at large. To that end, Yates and Blunt spoke to victims' family members and showed the film to Jim Langford of the Georgia Prevention Project. 

"We wanted it to be crazy and anarchic and fun,” the director said. But to truly honor the victims, it had to be more than a lighthearted jaunt. “By the end of the story, we wanted it to have a real heft emotionally.”