Jurors on Insys Therapeutics Opioid Drug Case Say They Were ‘Troubled’

Hank Locke has been around Boston his entire life, and he’s seen and heard a lot of scams and schemes, but he said he couldn’t believe his ears when he heard the schemes devised by an opioid drug company to market their drug aggressively through bribery and other measures – essentially catapulting the opioid epidemic to new levels.

Locke, Jury Foreman Mikeljohn Freitus, and author Jack Kelly (who ran for at-large Council a few years ago) have been appearing publicly to talk about the Insys Therapeutics case and the implications of that case on other opioid drug manufacturers.

Locke, who lives in Charlestown, was tapped for federal jury duty earlier this year, and after more than 100 potential jurors were weeded through, he was chosen to sit on the groundbreaking case against Insys Therapeutics – a maker of Subsys, a highly addictive sublingual fentanyl spray intended for cancer patients experiencing breakthrough pain. It was the first case of its kind where criminal charges were brought against executives and sales managers of a company accused of illegally marketing opioids.

Five were convicted by Locke and the rest of the federal jury on May 2 for charges of bribery and defrauding private and public insurance. It was a scheme uncovered by insurers whereby the company was bribing doctors to prescribe the drug for non-cancer patients – essentially addicting hundreds and hundreds of people with high doses of the drug delivered right to their front door.

“This was the first case in the country that sought charges and convicted the owner of the company making and marketing opioids,” Locke said. “What I saw over four months of my life on that jury was blatant disregard for what they were doing to people. They could care less who knew what they were doing. They were doing this out in the open. One vice president had an email we saw that said it didn’t matter what they do because the money they made would pay for the fine they would eventually get. It was one of the most fascinating experiences of my life. I grew up in Charlestown and know what goes on there. I’ve done a lot, heard a lot and this was incredible what these guys did. It was just so callous.”

In fact, during the trial at Boston Federal Court, Locke said he and several jurors would show up the next day clearly bothered by what they had witnessed – that being the patients who had unknowingly become addicted to these powerful opioids through the scheme concocted by the company and the doctors that were bribed.

“These people had no chance,” Locke said. “One woman came home and found a box of Fentanyl on her porch in a parcel. Her doctor said it was her new medicine and told her how to use it by spraying it. She didn’t have a chance. There were a couple mornings I came into the jury room and told everyone I couldn’t sleep. A lot of the jurors felt the same way. Most of us were on the same page.”

According to the U.S. Attorney’s Office, from May 2012 to December 2015, the defendants conspired to bribe practitioners, many of whom operated pain clinics, in order to induce them to prescribe Insys’ fentanyl-based pain medication, Subsys, to patients often when medically unnecessary. Subsys is a powerful, rapid-onset opioid intended to treat cancer patients suffering intense breakthrough pain.

The defendants used pharmacy data to identify practitioners who either prescribed unusually high volumes of rapid-onset opioids, or had demonstrated a capacity to do so, and bribed and provided kickbacks to the practitioners to increase the number of new Subsys prescriptions, and to increase the dosage and number of units of Subsys. The defendants also measured the success of their criminal enterprise by comparing the net revenue earned from targeted practitioners with the total value of bribes and kickbacks paid. The defendants used this information to reduce or eliminate bribes paid to practitioners who failed to meet satisfactory prescribing requirements, which they determined to be the net revenue equal to at least twice the amount of bribes paid to the practitioner.

The bribes and kickbacks took multiple forms. In March 2012, Insys began using “speaker programs” purportedly intended to increase brand awareness of Subsys through peer-to-peer educational lunches and dinners. However, the programs were used as a vehicle to pay bribes and kickbacks to targeted practitioners in exchange for increased Subsys prescriptions and increased dosage. In most instances, the programs were shams.

The defendants also conspired to mislead and defraud health insurance providers who were reluctant to approve payment for the drug when it was prescribed for non-cancer patients.

Kelly, who has authored a memoir of his opioid addiction and recovery process, said the Insys case and Locke’s experiences were astounding, and proof of what everyone has known for years – that corporate executives have preyed upon the masses with opioids to make money.

“My story is representative of what happens when these tactics are used against people,” he said. “I didn’t stand a chance. This case is the opioid experience in a nutshell. We could take people to a couple of local cemeteries and I could point out a couple hundred whose lives were lost in my generation because of this. It is the loss of a generation…This case and Hank’s involvement is the smoking gun we’ve all know about, but now we have the concrete evidence.”

Locke said he has a lot to talk about, just explaining the free-wheeling business model that was used by this company to make money. He said the drug was a great drug for its intended purpose, but the company wanted to make money – not relieve people with terminal cancer.

“It was a great drug for what it was approved and invented for,” Locke said. “It’s a great drug for cancer patients who are dying, but (the owner) couldn’t really make money on that. He invested $70 million of his money in the company and he need Subsys to be approved off-label so he got doctors to approve it off-label. That’s what they did. Then the money started rolling in.”

Locke and the rest of the jury, after deliberating 14 days, convicted Insys founder and former Executive Chairman John N. Kapoor, 76, of Phoenix, Ariz.; Richard M. Simon, 48, of Seal Beach, Calif., the former National Director of Sales; Sunrise Lee, 38, of Bryant City, Mich., a former Regional Sales Director; Joseph A. Rowan, 45, of Panama City, Fla., a former Regional Sales Director; and Michael J. Gurry, 55, of Scottsdale, Ariz., the former Vice President of Managed Markets, of a RICO conspiracy.

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