The Pain Machine

What looked like a bad corporate skit with a dancing fentanyl bottle was actually the blueprint for John Kapoor’s billion-dollar criminal enterprise.

[Speaker 1]: Okay, so picture this scene. It’s August, 2015. We are at a sales conference in Arizona. The lights are flashing, the music is pounding. [Speaker 2]: And on stage, there is a mascot dancing. But it’s not a sports mascot. It is a human-sized bottle of fentanyl spray. [Speaker 1]: A giant bottle of fentanyl. Dancing. [Speaker 2]: Right. And the soundtrack isn't top 40. It’s a rap video produced by the employees of a pharmaceutical company. And the lyrics aren't about cars or money. They are about medical dosage. [Speaker 1]: The hook of the song-and I can't believe this is real, but it is-goes like this: "I love titration, yeah, that's not a problem. I got new patients and I got a lot of 'em." [Speaker 2]: At the time, if you were in that room, it probably felt like a bad corporate skit. Just sales reps blowing off steam. [Speaker 1]: But looking back? That video wasn't a skit. It was a confession. [Speaker 2]: Exactly. That video became a key piece of evidence in a federal trial that did something historic. It used the RICO statute-laws written to take down the Mafia-to take down a pharmaceutical billionaire. [Speaker 1]: We’ve all heard about the opioid crisis. We know the broad strokes. But today, we aren't looking at the general tragedy. We’re looking at the specific machinery of how one family, the Kapoor family, and their company, Insys Therapeutics, turned a niche cancer drug into a billion-dollar criminal enterprise. [Speaker 2]: And the angle here isn't just that they sold drugs. It's how they engineered a system of bribery and fraud so sophisticated that for a long time, nobody could stop it. [Speaker 1]: So let's start pulling on this thread. Because to understand how you get a dancing fentanyl bottle, you have to understand the man who paid for the party. [Speaker 2]: John Nath Kapoor. [Speaker 1]: Right. And if you look at his resume before all this, it is the quintessential American Dream story. Born in India, modest background. He comes to the U.S. in 1972 with a scholarship and, as the lore goes, five dollars in his pocket. [Speaker 2]: And he’s brilliant. He’s not a street dealer; he holds a Ph.D. in medicinal chemistry. By the 1990s, he’s already sold a hospital products company for nearly a billion dollars. He is a legitimate titan of industry. [Speaker 1]: But then, in 2005, something happens that changes the trajectory. And this is the emotional catalyst for everything that follows. [Speaker 2]: His wife, Editha, dies of metastatic breast cancer. It was a brutal battle. Kapoor watched her suffer. He later said, "Nobody understands pain. They think pain is just pain. My wife went through it." [Speaker 1]: So, ostensibly, he founds Insys Therapeutics to solve that problem. To solve "breakthrough cancer pain"-those sudden, intense spikes that standard meds can't handle. [Speaker 2]: And on the surface, that’s a noble mission. In 2012, the FDA approves their drug, Subsys. It’s a fentanyl spray that goes under the tongue. It enters the bloodstream almost instantly. For a dying cancer patient in agony, this is a mercy. [Speaker 1]: Okay, but here is where the math doesn't add up. And this is the part I kept getting stuck on. If you are strictly selling to cancer patients with breakthrough pain who are already tolerant to opioids... that is a very small market. [Speaker 2]: [pauses] It’s a tiny market. [Speaker 1]: Right. So you have a billionaire founder who is used to massive returns.…