When we talk about drugs like oxycodone,
you're talking about drugs that are
essentially heroin pills.
I was pretty convinced that we had a major problem
on our hands.
♪ (DRAMATIC MUSIC PLAYS) ♪
This is the first time I've ever seen this.
NARRATOR: Purdue didn't have any evidence that the drug was safe,
so the company obtained the help of a medical officer
in FDA to claim that OxyContin was not prone to abuse.
If you're Richard Sackler, if you're Purdue,
that means your army of sales reps can go out and say
that the FDA approved this.
They knew that OxyContin was being abused.
When you're in that much pain and you're addicted
at such a high dose, you're a trapped rat.
SPEAKER: Purdue ends up getting pursued by the authorities.
The Justice Department effectively agreed to bury
critical information.
PAUL PELLETIER: Purdue made about nine billion dollars
marketing OxyContin.
They paid 600 million to the government.
You are basically telling pharmaceutical companies
you have a green light to do this.
They paid the speeding ticket.
[TV static drones]
[bright tone]
[soft dramatic music]
♪ ♪
- [breathes deeply]
- Drug overdose deaths across the U.S.
have more than tripled since 1990.
- 40 people die every day
from prescription painkiller overdoses.
- The trajectory has simply been upward.
- It's America's silent epidemic.
- A plague in our country.
♪ ♪
[indistinct chatter]
♪ ♪
- Good afternoon. - How are you?
♪ ♪
- We have with us today Joe Rannazzisi.
He is retired from the DEA.
- The opioid crisis started with prescriptions.
Prescriptions and patient care--
this idea that we weren't adequately treating pain.
Drugs like OxyContin come on to the market
and thought provokers and medical experts
began to preach the gospel of the opioid.
♪ ♪
We started using the pain scale.
"Pain is the fifth vital sign."
They developed new medical terms like "pseudoaddiction."
Craziness.
Your body builds a tolerance, you need more drug.
As you need more drug, you need stronger drug.
As you get stronger drug, it's more expensive.
And instead of buying $150 worth of pills a day,
you're buying $20 or $30 of heroin bags a day.
- The problem encroaching on Colorado.
- Taking a toll on the Magnolia State.
- More and more lives in Farmburg County--
- Woodland Hills-- - West Palm Beach--
- Springfield area-- - Denver--
- Right now we have this wide-ranging
amount of fentanyl and fentanyl byproducts,
and it's killing a lot of people.
♪ ♪
- The synthetic opioid
is the deadliest drug in the United States.
- Five people OD'd on the same day in January.
- We lost three people last weekend.
- We didn't just wake up one day and say,
"Everybody just switch over to fentanyl."
It was a progression, and it was a natural progression.
- Here in Cook County, it's three deaths per day.
- Mississippi's seen close to 200 overdose deaths.
- Opioid deaths are up 20%
since the start of the pandemic.
- And overdose death is underreported.
We know that for sure.
So we really don't know how many people died.
- Hundreds of cities, counties,
and states across the country
have launched a wide-ranging lawsuit
targeting the pharmaceutical industry.
- To stop the behaviors.
To hold these folks accountable.
Enough is enough.
We've got people dying on our streets.
- We started seeing massive amounts of death.
Our prescriptions by 2012 were over 250 million.
The question is, why?
Are we the only people in the world
that know how to treat pain?
♪ ♪
No.
We consume that much
because our policies
are basically created by the manufacturers.
[ominous music]
♪ ♪
- So we've reached out to all the companies.
We have all the responses,
which we have woven into the story.
- Yeah.
Half the company's declined to comment
because of the ongoing litigation,
and then the other half, you know,
issued fairly lengthy statements.
- Purdue, Johnson & Johnson, all commented.
- What's their, you know, main defense right now?
- Yeah, FDA-approved drugs,
that they weren't doing anything illegal.
- Each point they pushed back on.
- Okay.
- You know, one of the remaining questions is,
are there gonna be any criminal charges against anybody?
And whether they're coordinated by the Department of Justice
or if they're individual investigations
by U.S. Attorneys Offices.
We're not quite sure,
but there's something happening.
[soft dramatic music]
narrator: The investigative team at the "Post"
began to follow leads to a very big story.
Some of America's largest pharmaceutical companies
were not only profiting from the opioid crisis,
they may have been manufacturing it.
The origin of the opioid story
began with the role of Purdue Pharma
and the family who controlled it--the Sacklers.
♪ ♪
- We have had many run-ins with the Sacklers recently.
Their main point of contention
is that they did not ignite
the opioid crisis singlehandedly.
Whether you believe that or don't believe that,
there is voluminous evidence that the crisis began
when OxyContin hit the streets.
Purdue led the charge, Sackler came up with the idea,
and everybody else followed.
- Other drug companies moved into that market
that Purdue had created.
They moved into that huge opioid
multibillion-dollar market.
- So other manufacturers began
making generic versions
of OxyContin--
oxycodone, hydrocodone,
drug distributors started sending
massive amounts of these drugs downstream
because there were corrupt doctors all over the country.
It became like the Wild West.
This was a new drug cartel that was being established
in the United States.
But instead of coming in from a foreign country,
there were drug dealers who were wearing suits
and lab coats.
I think that's it.
Go and do. - All right.
narrator: To penetrate the network
of corporate drug dealers,
the investigative unit at the "Post" needed help
from an inside source,
someone with firsthand knowledge
of the way the deals worked
and how they turned into crimes.
On a tip,
they contacted a retired DEA agent, Joe Rannazzisi.
- Eventually got him on the phone.
He was very animated, and he was very upset.
He had a lot of great information
and, essentially, we just kept on talking,
and I figured, "Okay.
"If he's not crazy and he's not making this up,
this is a really good story."
- I'd like to thank you for the opportunity to appear today
to discuss prescription drug diversion
and the critical role the DEA plays--
narrator: Before he left the DEA,
Rannazzisi repeatedly tried to warn Congress
about prescription drug abuse.
- The abuse of pharmaceuticals continues to be
a significant problem in the United States,
and it's based on pharmaceutical diversion
from the supply chain.
- He was in charge of the Diversion Control Division
at the DEA.
They make sure that pharmaceuticals
that are controlled substances like opioids
are not diverted to the black market,
that they stay within the supply chain,
from the manufacturer
to the drug distributors, which are the middlemen,
to the pharmacies on the retail level.
- Individuals and organizations have created schemes
within the health care delivery system that appear legitimate
but are nothing more than illegal operations
to facilitate the illegal distribution
of pharmaceuticals.
Pharmaceutical diversion...
- I've dealt with a lot of whistleblowers
throughout my career, and, you know,
some of them are a little crazy,
some of them are a little paranoid and conspiratorial,
but I really wanted to meet Joe to vet him more.
So I went out
to a little Greek restaurant in Northern Virginia.
I interviewed him for about two hours.
♪ ♪
- Look, I made a lot of my decisions over the years
at the Athena Pallas.
I could sit there and just think
and not have to worry about DEA and headquarters
and the phone ringing.
So, when I had important decisions to make,
I would go and find a table,
sometimes with somebody else, sometimes by myself,
and sit there and just try and work things out.
Scott Higham starts asking me questions,
and I'm telling him a story
about congressional and industry influence
and, you know, money going in
and the Justice Department folding and all this stuff.
And I don't know if Scott believed me or not,
but, you know,
Scott's from Long Island, and I'm from Long Island.
- We kind of talked the same talk, you know?
We come from the same place.
- We're on the South Shore of Long Island.
I always wanted to be a police officer
in narcotics, specifically.
- I've been around law enforcement my whole life,
as a kid growing up in a law enforcement family,
and so I got cops.
I covered them as a reporter
at "The Baltimore Sun" and in Miami.
- I studied pharmacy
at Butler University in Indianapolis.
I figured that being a pharmacist
is the quickest way to learn about the drugs.
Once I got my pharmacy degree,
I started applying to be a law enforcement officer.
And then I was subsequently hired by DEA.
- Log on to the Internet,
type in the keyword "medications,"
and you'll get hundreds of results,
many of them promising drug delivery--
- Right after 2000, 2001,
what we started seeing was Internet pharmacies.
A patient would get on the Internet, and he would say,
"Hydrocodone without a prescription."
And you'd get a million hits that would pop up.
And so you'd find one and go to that website,
and it would take you to a patient survey form,
and you would say, "I've got back pain."
The problem is, is no one ever saw the patient.
As long as they had any kind of credit card,
they were fine.
You had a doctor on the East Coast,
the patient or the drug seeker was on the West Coast,
the pharmacy was in the Midwest.
It was just a trafficking organization
that was hiding behind the veil of the Internet.
♪ ♪
- Without objection,
the bill was read a third time and passed.
[gavel bangs]
- As soon as Congress shut down the Internet sites
by passing the Ryan Haight Act,
almost overnight, we started seeing these clinics pop up,
and our people in Florida saying, "Yeah, all of a sudden,
we have all these clinics all over the place."
- I'm going down to Florida.
[Butthole Surfers' "Moving To Florida"]
- Florida is a very corrupt state.
[rowdy rock music]
It's a place
where a lot of people who want to get involved in rackets go
to make fast money.
♪ ♪
So the Mob is down there. Drug dealers are down there.
There's a lot of money laundering,
poor regulations.
There's a patchwork of law enforcement.
[engine revving]
- The regulations over the practice of medicine
and pharmacy in Florida were a lot more lax
than other states.
It provided fertile ground for these clinics to open up.
♪ ♪
Right around 2010 in Broward County,
they went from a very small amount of pain clinics
to 142, I think, in a period of a couple years,
two or three years.
- Palm Beach County has more pill mills than McDonald's.
- The sense was that
we were always just trying to tread water.
We needed more resources.
We needed more field investigations,
and we needed more lawyers.
When I started,
all of our focus had been on these pill mills.
There's one hallway is the doctor's.
And you go in,
and they often literally had a laminated menu,
and they would say, "It's a cash-only business.
You give me the cash for what it is you're looking for."
And then you take that prescription,
you go down to the other end of the hallway,
and it's a dispensary.
And it's all owned by the same person,
so they're running the doctor's,
and they're running the pharmacy.
- They were basically fronts for drug dealers,
for really corrupt doctors
who were selling prescriptions for cash,
trading prescriptions for sex.
- They actually basically just give 'em out.
- ♪ OxyContin, Xanax bars ♪
♪ Percocets and Lortab ♪
♪ Valiums, morphine patches, ecstasy ♪
♪ And it's all up for grabs ♪
♪ What you want? What you need? ♪
♪ Hit me up... ♪
- People would hop in their car,
they'd get onto Interstate 75.
It's a highway that runs up the spine of America
from Florida up through Appalachia
all the way through Ohio.
- ♪ Hit me up, I got you... ♪
- It was a very busy, very lucrative pathway
for narcotics in America.
It became known as the Oxy Highway.
♪ ♪
- I'm Doug Smith with Fox 13.
Can I talk with you about the clinic,
what's going on inside the clinic?
- ♪ Some people melt 'em down in a needle ♪
♪ And shoot 'em up ♪
- When I pass by here,
the frickin' line is around the corner.
- Patients would be lined up in the morning,
waiting to get into these pill mills
so they could get a cursory examination,
if any examination.
- We were in there less than ten minutes with a doctor,
walked out with a prescription for Vicodin.
- Mm-hmm.
- Is that the way it works inside?
- If you have proper, uh,
documentation and everything, we take care of you.
- We had no medical records. We had no X-rays.
Yeah. Who would that doctor be?
- I'm not quite sure.
But if you give me a call, I'll be checking into it.
- ♪ See, I'm a pill popper ♪
♪ So I'ma keep poppin' 'em ♪
- So a bad doctor who's running a clinic
writes a script not for a legitimate medical purpose.
Okay, you can't stop that guy from writing that prescription,
but a pharmacist could,
because if a pharmacist gets that prescription
and it shows red flags,
that pharmacist has a requirement
to resolve those red flags
before he dispenses the medication.
Now, what are these red flags?
Patient traveling 200 miles to a pharmacy.
You could be the greatest pharmacist in the galaxy.
No one's driving 200 miles for you to fill their prescription.
There's a reason for that.
We had to take action, and we had to do it very quickly.
We just started moving massive amounts of resources
down into Florida.
- They got task force officers.
They got every diversion investigator in the state,
and they ran undercover operations all over the place.
- There was one case. It was a female undercover.
Doctor said, "So how you feeling today?"
"Oh, I'm fine."
"So what are you here for? You here for your Oxycodone?"
"Yes.
Could I have some alprazolam, too?"
And he says yes, and he wrote the prescription.
He goes, "Would you like some methadone also?"
And she goes, "Sure."
That was the extent of the visit.
And you look at that, and you go,
"My God, this is not medi-- This is a crack house."
[soft dramatic music]
- Hi.
- First of all, turn that off, man.
I don't want to be recorded, okay?
Let's talk about that. - Are you a doctor?
- Excuse me? - Are you a doctor?
- Don't-- it don't matter who I am.
In a minute, I'm gonna snatch this camera from this, dude.
You don't even know, man. - Okay, sir.
- Follow 'em wherever they're going.
[tense music]
♪ ♪
- There was one store in particular
that was known by drug users as the go-to CVS.
A DEA investigator said to the pharmacist,
"What's going on here?
"Don't you see that all these people
"are coming with out-of-state licenses and out-of-state tags
"and they're lining up at your door at 8:00 in the morning?
Don't you think that's suspicious?"
And this pharmacist told the DEA, "Well, you know, look.
At 2:00, we cut off our sales."
And the investigator said,
"Why do you cut off your sales at 2:00?"
And she said, "Well, we want to save medication
for our real pain patients."
- Open the door! On the ground, on the ground!
- Go, go, go! - Get on the ground!
narrator: In 2011, there was a crackdown by the DEA.
Operation Pill Nation
involved more than 500 law enforcement officers,
resulting in seizures of 70 vehicles,
$19 million in cash, and 105 arrests.
- Doctor, do you feel like you were contributing
to addicts' addictions?
Was it worth it?
narrator: But the real problem wasn't on the street.
It was in the executive suites of pharmaceutical companies,
which had become addicted to the profits
opioids could deliver.
[cheers and applause]
- Please help me welcome John Kapoor.
[cheers and applause continue]
[soft dramatic music]
narrator: John Kapoor
was a veteran pharmaceutical investor
who saw a business opportunity in pain relief.
He started a company called Insys
to market a drug called Subsys.
It was a fast-acting spray device for fentanyl,
a synthetic opioid 100 times stronger than morphine.
- I know there are all kinds of definitions
for entrepreneurs.
The one that I think we all recognize most
is that entrepreneurs are risk takers.
♪ ♪
narrator: The FDA limited the use of Subsys
to a very narrow market--
cancer patients suffering so-called breakthrough pain.
To expand the market,
Kapoor was determined to find a way around the FDA's rules.
- You, as an entrepreneur, have to have a dream.
And then you work with passion
to make that dream come true. [applause]
narrator: That passion to make a dream come true
is what would lead Kapoor and Insys into the world of crime.
♪ ♪
- Every U.S. Attorney's Office
in every district in the United States
has someone who's supposed to specialize in health care.
Boston has always taken a lead role in that.
They've taken on some very high-profile
criminal investigators involving Pfizer
and GSK and several others.
And because our office has a reputation
for being successful with these types of cases,
we get a lot of whistleblower lawsuits filed in Boston.
[suspenseful music]
And so, in 2013,
I got a whistleblower complaint sent to me.
It laid out some of the things that were happening
at Insys Therapeutics.
♪ ♪
Subsys was launched in March of 2012,
and it goes into this very tight market.
And for the next three months, from March to early June 2012,
Kapoor is devastated,
and he calls it the worst effing launch
in the history of the pharmaceutical industry, right?
So he starts firing people.
Fires the VP of sales,
and he's trying to find a way to be profitable.
narrator: Kapoor hatched a plan to exploit a loophole.
While the FDA limited the drug to patients with cancer pain,
doctors were allowed to use their own judgment
about whether to expand the market,
so Kapoor leaned on his sales reps
to court doctors to write more scripts for Subsys
and to increase the doses.
Through emails and phone recordings,
prosecutors discovered a sales campaign
to lead doctors into raising the demand for fentanyl
by expanding the very definition of pain.
♪ ♪
- I assign two criminal prosecutors,
and they began working on the case in late 2013--
Fred Wyshak, who is sort of a legend in Boston.
He prosecuted Whitey Bulger. He's prosecuted the Mob.
- In all these types of cases, you need insiders.
It's very difficult
to penetrate a criminal organization
to the top of that organization
without insiders.
- Alec Burlakoff.
You must've identified him early on
in your investigation. - Absolutely.
Alec Burlakoff was a primary target of the investigation.
♪ ♪
- And so what in your mind makes a good salesman?
- One word--passion.
It's not deceit. It's not lies.
It's not not having a conscience.
It's passion.
♪ ♪
When I was hired,
there was a meeting that took place
where all the managers were there,
and, basically, everybody was yelled and ridiculed
and screamed at for the lack of sales.
They were abysmal, basically. They're nonexistent.
It's all on the rep
to ensure that this drug starts getting prescribed.
And none of it's doable... [chuckles]
Unless you break the rules.
But to tell the truth-- this job was made for me.
I mean, I was raised in a family
where you don't cry...
you don't lose, you don't take off work,
you don't miss school, you are not sick, you know,
and you get the job done.
[Billy Joel's "My Life"]
[upbeat '70s rock music]
♪ ♪
I grew up in a lower-class, middle-class neighborhood
way out on Long Island--
a small town called King's Park.
- ♪ I don't need you to worry for me ♪
♪ 'Cause I'm all right ♪
- There was a lot going on in my house.
Wasn't a place to have friends over.
- ♪ I don't want you to tell me it's time to come home ♪
- Never knew what kind of yelling and screaming
and fighting was gonna take place.
- ♪ I don't care what you say anymore ♪
♪ This is my life ♪
- I got a bachelor's in psychology,
a master's in social work.
- ♪ Go ahead with your own life ♪
♪ Leave me alone ♪
- I said, "You know, I'm gonna go work
for the best school that I can find."
And I did a search, and a private school came up
in Boca Raton.
- ♪ I never said I was a victim... ♪
- I did phys ed for two years.
After that, I was a guidance counselor.
It was a very small salary,
but I was hanging out with kids all day,
doing what I love.
- ♪ Don't get me wrong ♪
[music fades]
- The problem with working at this school
was that I put myself around very wealthy people--
all affluent, I mean, beyond affluent.
And I went out to the parking lot one day,
and I went to the parent
who was driving a Bentley convertible,
and he was smoking a cigar, and I said,
"Sir, you know, we have a no-smoking policy here."
Can you kindly put that out?"
And he took a puff.
He blew it right in my face, in my eyes and said,
"Petty rules from petty people."
It was literally from that moment
that I knew I had to go make some money.
[tense music]
I leveraged some of the relationships
that I had at the school-- a lot of doctors there.
One of the doctors basically said to me,
"Well, I'm a big prescriber of a product
that Eli Lilly promotes," at the time,
"And I can get you an interview."
And I jumped all over it, finished the school year,
and was on my way into pharmaceuticals.
narrator: Working for Eli Lilly,
Burlakoff's first pharmaceutical was Prozac.
He was named rookie of the year
for his big batting average with doctors,
but he was soon fired for handing out free samples
to hundreds of people, including one 16-year-old.
He hooked up next with Johnson & Johnson
and then applied for a sales job
for a company named Cephalon.
- And I never heard of Cephalon.
It's not like Johnson & Johnson or Eli Lilly.
So that was my first taste of small biotech.
And what does "small biotech" mean?
It means a lot.
The payouts, the bonus plan is "uncapped."
It's a very attractive word to a salesperson--"uncapped."
There's no ceiling-- - The more you sell...
- The more you sell, the more you get compensated, period.
By the time I walked out of the interview,
I called my wife and said, "I'm going to a new company."
♪ ♪
narrator: The product was Actiq.
It was a lollipop made of fentanyl,
whose potency carried an enormous risk of overdose.
For end-of-life cancer pain, Actiq made sense,
but that was a very small market.
To pump up sales,
Burlakoff had to convince doctors to prescribe it
for much more, from back aches to ankle sprains.
How to do that?
Through bribes packaged as speaker's programs.
- If you have pain that lasts all day...
narrator: Burlakoff would pay doctors to promote the drug.
In exchange, doctors would prescribe more and more.
It was a program that appealed to the founder of Insys,
John Kapoor.
- At the interview,
once I got into the nuances of the program
and what it took to be successful,
he just banged his fist on the table and said,
"That's our next VP of sales," and walked out the door.
♪ ♪
- I don't think there's any way to understand
what happened at a company like Insys
without referring to Purdue Pharma.
They were the pioneers.
They went out and had a mission
to change the mind of the medical establishment
about how dangerous these drugs were
and to persuade physicians not to worry too much
about the addictiveness of strong opioids.
Insys used Purdue's playbook.
You have a very strong, powerful product,
and you incentivize your sales reps
with the understanding
that they're going to be compensated based on volume,
and they go out with an incentive to sell.
- For many of you out there,
you have not had the opportunity
to experience the excitement
or, more importantly, the achievement
of being on this stage.
[ominous music]
♪ ♪
- So John Kapoor hires Burlakoff,
and he makes him the head of the Southeast district--
Florida, Alabama.
With Kapoor's permission,
he hires his buddy from college,
this guy called Joe Rowan, as a sales rep.
Rowan has a very close relationship
with a doctor in Mobile, Alabama, named Xiulu Ruan,
and Ruan's known to be running a pill mill operation.
So they start to bribe Ruan in August of 2012.
[engines revving]
And immediately there's a massive turnaround
in the success of the drug in the Southeast.
[engine accelerating]
A pharmaceutical company has a right
to try to educate people, right?
So they do what's called
non-research payments to doctors.
They give you money, and in exchange,
you go and you talk about the drug to colleagues.
By itself, it's not illegal.
What happens with Insys is that
they start paying exorbitantly huge number
of speaker programs,
and they use the speaker program
basically as a way to cover
for the bribes that they're paying.
Kapoor, ultimately,
he invested between $3 million and $4 million a year
on the speaker program at its height.
They were bribing people at that level nationwide.
- So it was basically,
"Here's some money. Write some scripts."
- Yes.
It was actually-- Well, you say "basically."
That word makes me nervous,
because if I said "basically" to Dr. John Kapoor,
he'd say, "Basically, you're fired."
[chuckles] There is no "basically" here.
It's very clear, concise. It's very direct.
- As an entrepreneur,
don't get arrogant, even if you're successful.
You should believe in yourself,
and one important thing is stay humble.
[laughter, upbeat music playing]
- We are so professional! - Oh, are you videotaping this?
[laughter] Turn that shit off!
- What, what--
[cheering] The best region at Insys!
- ♪ Rack City, bitch, Rack, Rack City, bitch ♪
♪ Rack City, bitch, Rack, Rack City, bitch ♪
♪ Ten, ten, ten, twenties and them fifties, bitch ♪
♪ Rack City, bitch, Rack, Rack City, bitch ♪
♪ Ten, ten, ten, twenties and them fifties, bitch ♪
♪ I'm a motherfucking star ♪
- The key to increasing sales of Subsys
was to build a relationship with a doctor.
When you go into the office
and they meet you for the first time,
it's a test.
They're gonna look you in the eye, and they're gonna say,
"Hey, Alec, how you doing? So you have Subsys?
What's that indicated for?"
And you have some reps say,
"Oh, it's indicated for... [mumbling] breakthrough pain,"
or they say, "It's indicated for breakthrough pain...
[mumbling] in cancer patients."
Something like that.
My play is I look 'em dead, directly in the eye,
and I laugh, and I go, "Doc,
"you know exactly what this drug's indicated for.
"It's indicated for breakthrough pain
"in cancer patients 18 or older that are opioid tolerant
"on 24-hour, around-the-clock medications.
"Why do you ask me that question?
"You know I can't talk to you
"about anything outside of that indication.
"However, you also know you are the doctor
"and you can do whatever you damn well please.
So is this game over yet? Are we done?"
And they go, "Hey, how can I help you?
What can I sign for? What's your sample?"
Blah, blah, blah. Or, "You have 30 seconds."
I love when they say I have 30 seconds.
"I have 30 seconds what?
"To sell you a schedule II opioid?
"'Cause I'll probably do it, and the sad part is
"you'll probably have no idea how to manage the side effects,
"the drug interactions, the precautions, the warnings,
"the respiratory depression,
"and everything else that's gonna come along with it.
"So let's both do each other a favor.
"You name the restaurant. You name the time.
"You name the date.
"I don't care where it is. I don't care what it costs.
"I will be there.
"You stay as long as you want or as short as you want,
"but I can't sell this drug to you in 30 seconds.
It's irresponsible."
Now, back then, did I really care about being responsible?
No.
- So, look, Alec Burlakoff's a lot to take.
I mean, he is a car salesman on steroids.
But there's an honesty to what he's saying that is--
a frankness to what he's saying that's unique.
- Cut me off if I'm rambling, 'cause I know I am,
but there's four categories.
There's blue, yellow, green, red.
Blue is analytical. - Hmm!
- That means if you don't have a scientific, double-blind,
placebo-controlled study with a lot of patients
that proves your data is right, you're not getting a sale.
What does that mean to me?
It means I don't call on analytical doctors
'cause I don't have any studies like that.
Then you have your yellow. That's your amiable doctor.
They want to be friends with everybody.
They want everybody to love them...
- You're the best!
- Which means if you're selling a drug
and there's five other competitors,
they just go on a rotation.
"This one gets Subsys. This one gets Lazanda.
This one gets Abstral." And then we go back around.
Guess what.
They're out because they're just sharing the wealth.
So now you got your green,
which is kind of like your earthy type of doctor.
- Renewable.
- Like, God forbid you do a lunch and not recycle.
You'll never go back there again.
But then you got your reds.
Reds are your businessmen.
They own their practice. They run their practice.
They manage their books. - [grumbling]
- They see a crazy number of patients.
It's all about efficiency.
In fact, when you as the rep walk in there,
they run to you with a pen to sign,
and they're running away at the same time
because they don't have time to talk with you
because they're treating patients, making money.
And if he's a red and he's a businessman,
I got to show him the WIFM.
What is the WIFM?
[cash register bell dings] That's all they're thinking--
"What's in it for me?"
"Buddy, will you stop talking about the freakin' drug?
"Will you stop talking about saving the patient?
"Will you stop talking about the science,
"and will you please tell me what's in it for me?
Because you're wasting my time."
Those are the reds.
Those are the doctors you want to find,
and those are the doctors you want to move in,
live, eat, and breathe with.
It was a seven-day, 24-hour-a-day job.
They call me at 3:00 in the morning,
they want to go out, I go.
They want me to go to temple on Saturday, I go.
They want me to go to church on Sunday, I go.
You go through the step-by-step process.
Okay, did I take him to dinner? Check.
Did I take him to a hockey game? Check.
Did I take him to a nightclub? Check.
- ♪ Shake up the dice ♪
♪ Throw down your ice ♪
♪ Bet it all, playa, fuck the price ♪
♪ Money ain't a thing, throw it out like rice ♪
♪ Been around the world cop the same thing twice ♪
♪ Rub on my tits, squeeze on my ass ♪
♪ Give me some, unh! ♪
♪ Step on the gas ♪
♪ Pop the cork and roll up the hash ♪
♪ You know what we about, sex, drugs, and cash ♪
- I mean, this is uncapped bonuses.
This is your opportunity.
You wanted to put the money in the doctor's pocket.
Didn't care about anything else.
Just wanted that bonus.
♪ ♪
- ♪ East Coast, West Coast, worldwide... ♪
- They start the bribe scheme in the summer of 2012.
By the beginning of 2013,
as the company is launching its first IPO,
they can now go and say that the drug is profitable.
And so right away,
investors look at it and said, "Something's going on here."
and they started investing.
By the end of the year,
Insys was the most popular pharmaceutical drug
to invest in.
It was the most popular IPO on Wall Street.
- ♪ Mafioso, that's how this thing go ♪
- The CEO, Mike Babich, was being interviewed on MSNBC.
By the end of 2014, the market cap was in the billions.
2015, Subsys was one
of the top five most profitable opioid products
in the United States.
- That product that we launched three years ago today,
this year will do close to $300 million.
- You can make a lot of money
getting doctors to prescribe a medication
to people who don't need it,
who they're not just gonna lose a couple thousand dollars.
They're gonna lose their life.
[music fades]
[birds singing]
[Muzak playing over phone]
♪ ♪
[laughter]
- So one whole piece of the case
is we're gonna bribe doctors
to write as many scripts as we possibly can,
but then they very quickly realized
written scripts without payment doesn't help anybody.
- The drug's expensive. - Very expensive.
So there's different dosages of the medication.
For the highest dosage, 1,600 micrograms,
at times, I believe it was going
for more than $15,000 a month.
And insurance companies,
Medicare in particular, have rules.
And in this case, Subsys, you know,
has to be prescribed for the treatment
of breakthrough cancer pain in cancer patients.
- If you're an insurer and you're trying to figure out
whether or not you're willing to pay for a drug,
one of the things you're gonna look at is,
are they prescribing it for what the label says it's for?
Right?
"The label says it's for cancer patients.
"This patient doesn't have cancer.
Why are we paying for this?" Right?
And so they started misleading them.
- What they set up is this Insys reimbursement center,
the IRC, and what they would do
is they would work with doctor's offices
to get prescriptions for Subsys approved.
People would go, they would clock in,
and they would put the headset on and get assigned files,
and they would just call and lie.
The insurance company would say,
"Are you calling from Dr. Smith's office?"
"Oh, yes. I'm right here in sunny Florida."
But really, they blocked their outgoing caller ID.
They were in Arizona in a cubicle the whole time.
So a patient goes to see a doctor,
the doctor prescribes Subsys,
somehow the office at the IRC needs to know enough
about the patient to be able to call
on the patient's behalf and lie.
So the sales reps had to convince the doctors
to agree to give them access
to patients' personal information
and various pieces of information
about their diagnoses.
Let's say a doctor just wrote Subsys for back pain
or for neck pain.
What Insys did was say...
One of the tactics that they figured out worked
was talk really fast...
Give them a lot of information at once,
sound like you know what you're talking about.
And they would spin these stories
that just weren't true.
[dramatic music]
They had a list.
If you're calling Humana,
these are the lies you need to say.
If you're calling Blue Cross Blue Shield,
say this.
And then insurance companies, they used the algorithm.
So, if the answer triggered the right way,
it would lead them down a decision tree
to approve or not approve.
And Insys knew this and took advantage of this.
- Yes, um...
- So you'll hear these callers anticipate
not only the next question, but the next three questions.
- So if Insys knows the algorithm,
they've, like, broken the code.
- They've broken the code. They cracked the code.
And they could call all day, every day
and get these approved.
- Okay, the medication's been approved until one year...
- It's approved. It's approved.
- The request is approved through March 13.
- So you can go ahead and call it in to the pharmacy.
- This was something driven from John Kapoor,
driven at the top--what the success rate was on the IRC,
how they were doing.
- The lies, the deceit.
There's nothing they wouldn't say to get the drug approved.
And Dr. Kapoor's philosophy was very simple.
"The doctor prescribes it. He puts pen to pad.
"That patient will get the drug.
Do you understand me?"
- John Kapoor insisted
that their approvals be something like 90% to 100%,
which according to the testimony was way beyond
any kind of industry goal or standard.
- I've been through this before.
I'm looking at this, and I'm going, "Okay.
Clearly, we're breaking the law."
- That medication's intended for the use and management
of breakthrough pain in cancer patients.
Dr. Volking is treating the breakthrough pain
as 338.29.
[serious music]
♪ ♪
- The opioid crisis today is just that.
It's a crisis. We all have to work together.
Because our prescriptions by 2012 were over 250 million.
250 million in the United States.
Everybody who's registered
to handle a controlled substance
has a requirement under the law
to maintain effective controls against diversion.
Manufacturers-- "Well, we just make the drugs.
We don't prescribe 'em."
Distributors--"Well, we're just logistic companies.
We don't prescribe or dispense."
Pharmacies--"We just take valid prescriptions
"written by doctors
and dispense the medications as ordered."
Doctors--"We're just treating our patients."
And then it goes to the patients.
By the way, those are the guys that are dying.
And everybody's pointing the fingers at each other,
but all downstream towards the doctors.
I don't want you to think
that I have a problem with doctors.
In fact, most of the doctors, the vast majority of doctors
are doing exactly what they're supposed to do.
But there are bad doctors
that were doing really bad things
with controlled substances.
I can't stop them.
But the pharmacists can,
because the pharmacists don't have to fill the prescriptions
But if the pharmacist continues
to fill the prescriptions,
the Controlled Substances Act supplies a check
at the distributor-to-pharmacy level.
♪ ♪
- When the manufacturer makes the pill,
they're not allowed to sell it directly to a pharmacy,
so they sell it to one of these three companies
almost exclusively--
McKesson, Cardinal Health, and AmerisourceBergen.
And those three companies own
something along the lines of 90% of the opioid market.
- When I first started doing this investigation,
I had never heard of these companies.
I had never heard of McKesson.
They are not only
the largest drug distribution company in America,
they are the fifth-largest company in the United States.
These companies keep very low profiles.
They don't want to be in the press,
and they do a very good job
of just staying off the radar screen.
♪ ♪
- Hello? Can I help you? - How you doing?
- What are you shooting? - The trucks coming in and out.
- What are you shooting for? - It's for a documentary.
- Nope. Cannot do that. Nope, not here.
- The distributors, the big three--
when an order comes in,
they have an obligation to have a system in place
that identifies whether the order is suspicious.
If the order is suspicious,
they need to stop the shipment.
- So, if you see a pharmacy
that's been ordering 5,000 tablets for the last two years
and now they're ordering 40,000, then 60,000,
then 100,000, that's suspicious.
You--there's no way you could say it's not suspicious.
But what we saw was
distributors not filing suspicious orders
and then continuing to ship.
♪ ♪
narrator: When distributors recklessly filled hundreds
of suspicious orders,
the DEA had the ability to shut them down
with a powerful weapon--
an ISO, or Immediate Suspension Order.
Nobody used that weapon more effectively
than a DEA lawyer named Linden Barber.
- DEA's regulation calls on distributors
to detect and report suspicious orders to DEA.
Those are, according to the regulations,
orders of unusual size, unusual frequency,
or those that...
narrator: One of the top lawyers
at the DEA's Drug Diversion Division,
Linden Barber worked closely with Joe Rannazzisi
in preventing companies from profiting
from opioid abuse.
- He was doing a lot of work with us,
trying to get the industry in compliance.
- Linden would be the first to get angry
about how many people died.
He had that drive, that push to file all these cases,
to cowboy it.
narrator: Late in 2007,
Barber, Rannazzisi, and the DEA
set their sights on Cardinal Health.
They shut down a key distribution center
with an ISO
for failing to report hundreds of blatantly suspicious orders
of narcotics.
A $130 billion company,
Cardinal settled the case by paying a $34 million fine.
In the final deal,
Cardinal did not admit wrongdoing,
and damaging evidence of public harm was suppressed.
- I didn't want to settle these cases.
I wanted to go in front of a court.
I wanted to present all the evidence.
I wanted to be transparent.
A $34 million fine does nothing.
That's a traffic ticket.
$34 million for Cardinal is nothing.
- It didn't take very long
before they basically were turning around
and doing the same thing.
Cardinal was distributing millions of pills
to two CVS pharmacies in Sanford, Florida,
right on the edge of a highway.
So people would cruise in, get their drugs,
and be out in, like, no time at all.
narrator: As part of the CVS case,
the DEA started investigating Cardinal once more.
Angered by a second Rannazzisi-led investigation,
Cardinal started an influence campaign,
using former Department of Justice officials
to lobby their old colleagues.
- You know, the revolving door and the swamp
is alive and well in Washington.
[all chuckling]
Jamie Gorelick was the Deputy Attorney General
during the Clinton administration,
so she was the second-highest-ranking
law enforcement official in the United States.
After she left,
she joined one of the biggest law firms in town here.
She is a exceedingly powerful woman,
and Cardinal Health had retained her.
She reached out to the then-Deputy Attorney General,
James Cole, and asked him
if they could take a look at this case--
you know, "Did they really have to come after them that hard?
"They're trying to do the right thing.
Is there a way that we can talk about this?"
And that got back to Joe,
that Jamie Gorelick had been involved.
- Look, as much as I understand
that Jamie Gorelick is a fine attorney,
I don't think she knows the Controlled Substances Act
better than me.
♪ ♪
narrator: In a series of calls and letters,
Gorelick pressed Cole to prevent the DEA from acting.
"Immediate suspension," wrote Gorelick,
"is a drastic and punitive enforcement tool.
"We would appreciate the opportunity
"to discuss this urgent matter with you
prior to any action by DEA."
Cole responded
by demanding an immediate briefing by Rannazzisi.
- I said, "Before we start,
"no one's ever wanted a briefing
"on why we're doing certain things.
What makes this case so special?"
And the response was, "'Cause I'm the Deputy Attorney General
of the United States, and I want to know."
And that really didn't answer the question.
And it just got very adversarial.
But once we presented the facts, they couldn't--
I mean, the facts were the facts.
These companies were an imminent danger
to public health.
♪ ♪
- Around that time, we're reaching, like,
170,000 people who had died from drug overdoses.
That is just a phenomenal number.
- Doing CPR!
- During this time period, I'm out on the road.
I'm talking to parents who've lost kids.
I'm talking to wives who've lost husbands.
I'm talking to people who've lost loved ones,
and they're all saying the same thing--
Why is this happening?
And my response is, "We're doing everything we can."
And then to sit there and go through an inquisition
about why I'm doing a certain thing,
to a company-- to at least one company
that was already charged with the same violation
several years ago, it kind of pissed me off.
And that's when I came back, and I call my team.
I said, "You know, this is war. We're at war now.
"You go out and serve those ISOs,
and we'll just see where it goes."
I was proud of the work they did.
Those guys busted their butts for, you know, months,
getting these cases together.
♪ ♪
- We were absolutely amped up.
If you want to do some real good,
if that's really what you want to do,
if you want to go out and you want to fight bad guys,
you're doing this kind of thing,
and you're thinking, "This is great."
- So, in February of 2012,
we issued the Immediate Suspension Orders.
narrator: A federal judge ruled in favor of the DEA.
The ISO went into effect,
shutting down the flow of drugs.
Ultimately, Cardinal agreed to stop shipping opioids
from one warehouse for two years
and paid a $44 million fine,
but the tactics of the DEA enraged Cardinal
and other big pharma companies.
- When the companies didn't like
that they were being held accountable,
they said, "Enough is enough."
And instead of complying,
they just decided to change the statute.
- Thank you, Madam Speaker.
I rise in strong support of HR 471,
the Ensuring Patient Access
and Effective Drug Enforcement Act,
bringing greater clarity and transparency
to the requirements for safe and secure distribution
of these medicines.
- Pharmaceutical companies have infinite gobs of money
to throw at politicians to change the laws,
and that is disgusting.
That's horrible.
That's not the way the law should work.
They should be changing their behaviors, not the rules.
[dreamy electronic music]
♪ ♪
- Tell me about Rachel's.
What kind of place was Rachel's?
- You know, high-end dance club
with five-star steak restaurant.
One day Alec comes in to the club.
It was slow, and I just saw this guy sitting by the stage.
And I do what I normally do--
is I sit down and I talk to people.
You know?
That's how I kind of feel them out,
see what kind of people they are,
and if they appreciate more of a conversation, you know...
[chuckles] Then I'm good, right?
Um, but, uh, we talked a bit,
and he told me that he was VP of sales
in pharmaceuticals.
He didn't take any dances till later on that night,
but he had offered to do a private dance with me.
And then he left, and I didn't--
I really didn't think he would come back,
but he came back and said, "Yep, let's do this.
We'll do the private dance."
And that's how it got started.
I get a call from him a couple weeks later,
and he tells me that he thinks
he has a regional sales manager's position for me.
And it seemed like it was the perfect job, honestly.
Just do what I do now, and it wasn't anything different.
- The first time I interviewed her,
I told her, "This is the industry."
And she says, "This is what I do every day."
- Dancing is how you get a clientele base
that would come in and see just you.
I can shoot the shit with men, you know?
You have to be able to read people by their body language,
what they talk about.
You have to be able to listen
so that you can find out how you relate.
- As far as psychology, quite frankly,
her prior employment is all about psychology.
I mean, you got to meet a customer, right?
Are you gonna spend an hour, two hours, three hours
wasting your time when he's not gonna give you a dollar?
Or are you going to know in five minutes
that this isn't your guy,
get up and start circling the place
and find your next opportunity?
- What's a whale doctor?
- We used that in strip clubs, too.
[chuckles]
- So what's a whale in a strip club?
- A whale is the guy with the money
and that likes to spend it.
When I worked at Insys, the whales were the guys
who were prescribing this medication,
this class of medication for a long time.
Those were the whales.
They know what they're doing,
and if you can get that business,
then you're good.
♪ ♪
Base salary for the regional sales manager was $80,000
before bonuses.
They called it Mid-Atlantic,
but it was Michigan, Wisconsin, Indiana,
Illinois, Ohio, Maryland, and Washington, DC.
♪ ♪
My sales team, we started off as the worst in the nation,
and we ended up the top region in the nation
shortly after I started.
- She's probably the best salesperson I've ever met.
And the best salespeople I hired
were the people who understood,
what is the most important thing to you?
Being number one in the country on that list
or making the most money?
I typically go with the person who says being number one
'cause I know they're sick...
like me.
Got to be number one.
[indistinct chatter]
- When I met Alec, I don't know, he seemed crazy,
but I thought he was brilliant.
After starting with the company
and communicating with him daily
and listening to him on the conference calls and--
that's when I really got to know him.
We became, you know, good friends
and developed a relationship,
even though I knew that he was married.
[dramatic music]
Which, I mean, we all say love can be blind, right?
♪ ♪
You know, I saw this man who worked really hard,
did things for people, gave people opportunities,
like myself.
♪ ♪
I was born in Hawaii, Honolulu.
Born into a very abusive household.
My parents got divorced
shortly after my brother was born.
And then shortly after that, my father actually took us.
We were on the, you know, run.
We were milk-carton children for a few years.
We lived all over the place--
Boston, San Francisco,
different parts of California, Chicago, Puerto Rico.
Sometimes two weeks to two months.
I never had a childhood.
I raised my sister and my brother
at a very young age.
You know, I'm ironing at five years old and cooking.
♪ ♪
Eventually the law caught up with him.
They found my mother. We moved to Michigan.
I ended up getting emancipated when I was 16.
You have to prove
that you can take care of yourself financially,
which I did, working three jobs,
going to school, a superior honor roll student.
Finished school, got married, and had a son
and started going to college.
And once I turned 18, I started dancing, too.
When you don't have anything and you don't have any support,
you've got to grind your way and, you know,
treat it like a business, and that's what I did.
You know, I pushed myself through school.
Initially, it was pre-med and then natural healing.
And I was board certified for medical massage therapy.
♪ ♪
Everybody used to call me Superwoman...
[chuckles] Or Supermom.
And I could do it all.
In 2012,
I went down to Florida with the kids
to try to make some money.
And it was that summer when I met Alec.
♪ ♪
[inhales deeply] I listened to him.
He said that I needed a four-year degree.
He knew I didn't have a four-year degree.
And so he helped me out with my résumé.
Just said that I had to, you know,
put that I had this bachelor's degree.
I trusted him.
- Part of what Alec Burlakoff did
is he pulled in three people who he knew he could trust
to implement Kapoor's strategy.
That is not easy to do.
It's not easy to hire people
who are gonna manage other people
to engage in criminal activity.
- You know, they targeted-- they targeted us,
people who were--
I call us the naive dreamers,
um...
where we still believed in the dream and worked really hard.
- Sunrise Lee, you know, there's this sort of narrative
that wants to portray her
as this person that worked at a club,
and that's true, but she was a much more
sophisticated criminal than that.
She's so successful, she's promoted.
She at one point was responsible
for a third of the country
in terms of all the sales reps and the sales managers.
And she has a conversation with the district manager,
and she said, "Listen,
"you got to make sure that you stay on top of these guys
"because they will stop writing
"unless you're there every day talking to them.
"You got to hold them accountable
for what they agreed to do."
which, of course, is the definition of a bribe.
♪ ♪
Kapoor wanted doctors to have twice the amount
of net revenue generated by their prescriptions
as they were given an honorarium in bribes.
- You got to tell the doctor, "Look, we are not Pfizer.
"We track every penny. I'm held accountable.
"If we come to an agreement that you're gonna speak
"and we're gonna pay you honorarium to speak,
"you must clearly understand that you will be expected
"to write double of what we paid you
"back in prescriptions.
"And if it's not there,
"we're gonna reduce your programs quickly,
"and then we're just gonna basically--
you're gonna disappear off the map."
[chuckles] Right?
The whole thig is disgusting.
- Kapoor, he had, like, a-- - A spreadsheet.
Excel spreadsheet.
In pharmaceuticals, it's a "no-no."
It's a forbidden. You don't do it.
For obvious reasons, right?
You start connecting the dots, and things don't look so good.
- It was the smoking gun.
They could look at a list of prescribers,
and they could say, "Here's what we've paid this person,
and here's their scripts."
And they could do the simple math to see,
"Are we making money or not?"
- That was a devastating piece of evidence
because it showed the true intent.
♪ ♪
- There was a doctor in Illinois named Paul Madison.
He was associated with a doctor
called in the media "Dr. Million Pills."
He had a practice with him.
There's one email describing Madison's office
as a "shady pill mill."
And what do they do?
Sunrise Lee, she goes in, and she flirts with him,
and she is seen giving him a lap dance.
- Never happened, okay? It just--it never happened.
It's not even allowed to happen at a dance club.
You would get booted out.
- They sign him up as a speaker,
and they start bribing him.
And that happened all around the United States.
And another doctor they worked with
was Gavin Awerbuch in Michigan,
who ultimately became the number-one prescriber
of substances in the United States at one point,
was paid for three different speaker programs a week.
A doctor suddenly isn't a doctor anymore at all.
They're working for Insys Therapeutics.
They're working for themselves.
They're working for money,
and the patient has no knowledge of it.
It is truly frightening.
[peaceful music]
[birds singing]
♪ ♪
- This is a Gallup poll.
America's ratings of honesty
and ethical standards in professions.
Does anybody know what the number-one profession is
in honesty and integrity?
Anyone, yell it out.
- Nursing. - Who said that?
Who said nursing? You did.
Think about that.
Nurses, medical doctors, and pharmacists
are one, two, and three.
You trust them. Everybody trusts them.
Why? Because you go there to get better.
You go there to get better.
Okay, that's important
because people trust their medical professionals,
so they'll do what they're told to do.
Okay? What's the bottom five?
- [shouts indistinctly] - [chuckles] Bingo!
Members of Congress are last.
[energetic orchestral music]
But this--ahead of 'em are stockbrokers,
advertising practitioners, telemarketers,
and car salespeople.
The bottom five.
♪ ♪
- More can and must be done to treat this growing epidemic,
and that is why we have all worked together
on HR 4709, the Ensuring Patient Access
and Effective Drug Enforcement Act of 2014.
- What is The Ensuring Patient Access
and Effective Drug Enforcement Act?
- Sounds great, doesn't it? [chuckles]
I mean, what could be wrong with that?
You know, you get--
patients get access to their medications,
and there's effective law enforcement.
So why would anybody be opposed to that?
This is one of these kind of non sequiturs.
It's like one of the most bizarre names for a bill
that does everything the opposite.
narrator: Instead of passing a law to protect patients,
members of Congress worked hard to pass a bill
that would undercut the DEA's power to stop companies
from recklessly flooding the country with narcotics.
To understand why,
it helps to look at how Cardinal had retained
a former DEA official who was perfectly positioned
to persuade Congress to do the wrong thing.
- The chair recognizes Mr. Barber.
Five minutes for an opening statement.
- Good morning, Mr. Chairman.
For the last 3 1/2 years as the director
of the DEA compliance and litigation practice
at Quarels & Brady,
I have dealt with registrants on a daily basis,
but prior to that, I was the Associate Chief Counsel at DEA.
I worked at the agency for 12 years--
- Linden Barber left the DEA
and formed his own practice
within a law firm here in town,
representing the very same companies
that he used to go after.
So around and around and around it goes.
- He brought with him the knowledge
of where the DEA enforcement regime is weakest,
and he started to advise his clients to that effect.
- If you have a DEA compliance issue
or you're facing a government investigation,
I'd be happy to hear from you.
[dramatic music]
- According to email traffic that we received,
there was an email between a couple of people
at the Department of Justice,
and one person said Linden Barber wrote this bill.
narrator: The bill completely changed the conditions
under which the DEA could issue a suspension order.
It redefined the term "imminent danger"
as a "substantial likelihood of an immediate threat."
♪ ♪
- In law, language is everything.
So it would be impossible for the DEA to show
that a drug distributor based in Ohio or Connecticut
or Upstate New York
posed an immediate threat of deaths
by sending drugs downstream to a community
in West Virginia.
It's just impossible.
You could show before it was imminent,
but you can't show now that it's immediate.
- So, if they passed the legislation,
there would be no more immediate shutdown
of narcotics distribution.
It could happen after a hearing,
but it couldn't happen...
[snaps fingers] like that.
- The Ensuring Patient Access
and Effective Drug Enforcement Act
provides much-needed clarity in the Controlled Substances Act.
And DEA's authority to issue immediate suspensions
will be protected from judicial curtailment
because there will be a clear legal standard.
- So, when Linden left
and then all these people that I loved
and loved working with, you know, begin leaving,
and they're leaving to go work
for who they claimed were the bad guys.
And they take that same righteous anger that they had
working for DEA,
and now they're using that righteous anger
on the other side.
I don't know how you do that.
- You know, if you go and work for the drug company,
that's you.
I mean, that-- if you want to--
I never criticize a man for how he's making his money.
- As a former counsel who appeared in federal courts,
assisted U.S. Attorney's office
in defending the suspension power of the agency,
having a clear legal standard is always best.
There are federal statutes
that were passed around the same time as the CSA
that contained a definition of imminent danger...
- I had a conversation with a key staff member
of the Energy & Commerce Committee,
who said, "We actually had somebody come up here
"and testify who used to work for the DEA.
"He was, like, a top lawyer for the DEA
"who said that the law needed to be clarified,
and it was really important."
And I said, "Who was that lawyer?"
And the staffer said, "It was Linden Barber."
And I said, "Do you know who Linden Barber is?
Do you know who he works for?"
He's like, "No. Who does he work for?"
I said, "He represents all of these companies."
[tense music]
It was kind of a stunning moment.
You don't really want to see
how the sausage is made on Capitol Hill.
♪ ♪
- Our bill seeks to facilitate greater collaboration
between industry stakeholders and regulators
in our nation's effort to combat prescription drug abuse.
- Distributors and pharmacists are finding
that he unnecessary adversarial regulatory environment
created by the DEA is putting effective enforcement outcomes
in jeopardy.
- The company's lobbyists
basically came up with a strategy--
"How can we stop the DEA from picking on us
and bothering us and hurting us?"
They zeroed in on this congressman, Tom Marino,
and also Marsha Blackburn from Tennessee.
You know, it's interesting,
'cause Tom Marino and Marsha Blackburn's districts
were both really hard hit by opioids.
- To every family member
who has lost a loved one to an overdose--
- The drug industry got them on board
to champion their cause.
- McKesson, Cardinal Health, AmerisourceBergen,
Purdue Pharma, CVS, all these companies
were lobbying heavily in support of this bill.
And most were paying Tom Marino, Marsha Blackburn,
Orrin Hatch, and a host of other members of Congress
a lot of money to get this bill passed.
- They're getting campaign money,
and industry lobbyists are writing the questions
for them to ask the DEA officials.
♪ ♪
- The chair recognizes Ms. Blackburn for five minutes.
- Thank you so much.
Mr. Rannazzisi--Am I saying your name correctly?
- Yes, ma'am. - I'm close enough, huh?
- Perfect. - Okay.
- You know, we all are concerned about patients
that are in pain that need medication.
- Numerous seniors in my district are complaining.
They call my office on a regular basis
'cause they can't get their pain medications.
- It's critical that patients
who desperately need these medicines have access
without undue delay.
- I mean, what are we doing to make sure
that these folks are heard from
and that the drugs are available?
- We do not want patients to go without their medication,
true pain patients that need their medication.
We don't want that.
But there is no--
- Tell me what you're doing about it.
- Sometimes it seems that
all the DEA cares about is the number of enforcement actions
and not real solutions to stop the abuse.
- That's not correct. - Provide us some data.
- If you would go on our website and look at the cases
that are posted on our website, both on the case--
- It would've been great
had you been prepared to provide that for us.
- Articulate what the efforts are that the DEA is engaged in.
- Besides the on-site investigations that we do,
the cyclical investigations to determine compliance
and to assist them in complying...
you know, besides the fact
that they call in and request assistance--
- Okay, well let me move on... - Questions?
- Then if it's laborious.
- I think you were ticking off--it's not laborious.
You asked me to tick off what I do.
And 16,651 people in 2010 died
of opiate overdose, okay?
Opiate-associated overdose. This is not a game.
We're not playing a game.
- Nobody is saying it is a game, sir.
- Well, yeah, kind of you did,
because you're questioning why we're doing this.
And all you had to do is go back and look at the cases
that we did in '11, '12, '13,
all these different cases.
Go through the documents,
and you could see what they were doing.
But for some reason, Representative Blackburn
decided that she didn't want the supply chain touched.
- And I guess it's kind of a Monday attitude sort of day.
So let me move on, okay?
I thought maybe you were doing a little bit to help.
♪ ♪
- Then Representative Blackburn and Tom Marino
were investigating me for attempting
to intimidate Congress.
- Joe Rannazzisi, a senior DEA official,
has publicly accused we sponsors of the bill
of "supporting criminals."
This offends me immensely.
♪ ♪
- What happened was we had a telephone call,
and we started arguing.
And I said, "If you pass this bill,
"it's going to stop us from doing our jobs,
"our ability to stop the hemorrhaging.
"And with all these people dying, well, you know,
"if this bill passes, that blood's on your hands.
It's not on mine."
♪ ♪
They filed a complaint
with the Office of the Inspector General.
Ultimately, that was the end of my career.
It was a management change.
A new guy came in,
replaced me with a guy who had no pharmaceutical experience,
and in 2015, after I retired, they replaced my whole staff.
Now, this is important 'cause this is the perfect storm
for bad policy and legislation--
regulatory pressure on powerful industry,
money, lobbying, and Congress.
And that's exactly what happened.
- Without objection,
the bill was read a third time and passed.
- They all passed it without even a vote.
It was just unanimous consent,
which just means that it will pass,
but if one member of Congress stands up
and says, "I'm against this,"
the bill stops dead in its tracks,
and they have to vote on it.
Not one member of Congress stood up and said,
"I object to this bill."
- This is bipartisan.
The Democrats and the Republicans
saw the importance in this and got together.
- People don't like to hear this, but...
nobody really realized what the language change meant.
- I don't think that they read it.
I think the vast majority of bills that get passed
on Capitol Hill--
legislators do not read those bills.
And they had no excuse for this one,
because it was, like, three pages.
And the key paragraph is on the first page.
They were just asleep at the switch,
and they gutted the DEA's ability
to go after these companies.
People were dying by the tens of thousands,
and their own representatives
are basically selling 'em down the river.
It's one of the most outrageous things I've ever seen
in the 35 years I've been doing this.
- Was there any controversy or any pause by President Obama
when the law went to his desk for signature?
- None.
It just sailed right through his office.
And it's--to this day, it's, like, the big mystery.
I mean, nobody would talk to us.
The head of the DEA wouldn't talk to us.
The head of the Office of Management and Budget,
which signs off on every piece of legislation,
wouldn't talk to us.
The top lawyer for the White House
wouldn't talk to us.
The president wouldn't talk to us.
It's incredibly unusual.
- Mr. President-elect...
narrator: The incoming Trump administration pledged
to do better than Obama, but when it came time
for Trump to announce his drug czar,
he named Tom Marino, the man who spearheaded
the law to protect the opioid companies.
[cheers and applause]
Following the passage of the Marino bill,
opioid prescriptions soared in some parts of the country.
Yet in many states, there were also countercurrents
that swirled in unpredictable ways.
As far back as 2012,
a building resistance to opioids was colliding
with a growing dependence on them.
- You have millions of people
who start using these drugs
and become dependent.
And then...
a series of things happen
that are good things that should've happened earlier.
States start tightening up regulations,
pill mills shut down,
doctors get a little more careful
about writing prescriptions.
These changes are good to one way of thinking,
in the sense that they make it harder
to buy and abuse pharmaceutical opioids.
But what that does is it drives all these people
who are already addicted on to the black market.
[insects chirping]
narrator: The illegal trafficking of narcotics
increased due to growing demand.
International drug cartels catered to those
who had become addicted to prescription pills.
As their need for narcotics increased
and doctors were more reluctant
to prescribe rising doses,
users turned to heroin
and a synthetic opioid 50 times more powerful--
fentanyl.
[tense music]
♪ ♪
- Fentanyl has been around,
you know, decades and decades
and still today has an extremely important use
medically within the medical community.
For the illicit side,
when OxyContin and these things kind of came into the market
in the 1990s and then people becoming physically addicted
to it unknowingly,
if we look at enforcement
against the pharmaceutical industry that took place
and against doctors and how things are being prescribed,
the people who utilized those drugs,
they now were kind of cut off in their supply.
And cartels and the illicit side of the markets
went to fill the void.
♪ ♪
This is the busiest port of entry in the United States.
So we're talking about thousands and thousands
and thousands of people that come through every day.
The San Ysidro port,
the first time fentanyl was really intercepted here
in bulk quantity was in 2014.
And since then,
it has just kind of grown out exponentially.
It's just part of almost daily intercept loads here.
I can tell you that there is Chinese-produced fentanyl
that has entered the United States through the port,
but there is also illicitly made fentanyl
from other locations that have come through the port.
[soft dramatic music]
♪ ♪
narrator: Since 2015,
fentanyl overdoses have been rising dramatically.
Rates have soared by 2,000% in San Diego,
where a federal task force
is seeking to prosecute dealers
for the deaths of their buyers.
♪ ♪
One case involved a 24-year-old college student
named Sarah Fuzzell.
Her parents called her their angel on Earth.
After getting hooked on prescription painkillers,
she battled addiction for five years
until the pandemic shut down her support network.
After dropping out of school,
she died of a fentanyl overdose.
♪ ♪
- The father of the girl who had passed away
had been reaching out, and he said that
when he received her property back,
her cell phone, when it turned on
and was powered up,
that the person that they believe
had sold the drugs to their daughter
was still communicating through the phone.
♪ ♪
They gave us the phone so we could utilize it
for investigative value.
- You almost have to manufacture the energy
to even want to reach out
to, like, law enforcement-- you guys--
because, you know,
the ultimate goal of wishing Sarah wasn't dead,
that's not a possibility to change that.
So, you know, there's probably some families
that just kind of quietly go away
just because there's so much hurt.
But we're wide open to doing anything that we can do
that will help. - Yeah.
So let me just give you kind of a quick rundown...
- Okay.
- Of kind of what took place.
[suspenseful music]
♪ ♪
We spent well over 40-straight man-hours...
♪ ♪
Between about 15 to 30 people at one time
getting this to go down.
♪ ♪
- Basically what we're doing
is we're targeting a suspected fentanyl distributor
who we believe is responsible
for a recent overdose drug death.
And, essentially, what we're doing
is we're trying to lure the distributor out
to this particular parking lot,
and then we're gonna place that person under arrest.
♪ ♪
[radio chirps]
So... - Oh, sweet.
[radio chirps]
♪ ♪
[radio chirps]
♪ ♪
- Yeah, Wasser to all code five units.
Try to set something up for tomorrow.
I think we've been pushy enough for the day,
and I think it's just best
that we back off for the moment, break.
- We had a hard time.
We set up for it.
We spent the entire day waiting,
and we never were able to make that contact.
- Okay.
We really appreciate
what you and your task force and all are doing, you know?
It's making a difference.
♪ ♪
- Every day
it is a continuous game of cat and mouse,
where, you know, the impact of the death
is one piece of this entire puzzle.
You have people who are nefariously producing it,
people who are buying, procuring chemicals,
moving that stuff around the world,
looking for people to perfect a new recipe
or way to market it in a faster way.
♪ ♪
narrator: To figure out the puzzle of the opioid crisis,
you have to look for ill-fitting pieces
all over the country.
In Lubbock, Texas,
the DEA opened an investigation
into a possible drug cartel operation
when the medical examiner reported a sudden rise
in deaths from fentanyl overdoses.
But something surprised the agents.
The likely kingpin turned out
not to be a professional criminal.
Instead,
all evidence seemed to lead to a local computer repair man
named Caleb Lanier.
♪ ♪
- I guess there's a couple times in my life
where I could've walked away, but it's so hard.
When the doctors start prescribing these drugs,
get you addicted to them,
it numbs you, and it's dangerous
because somebody that's depressed and has anxiety
and now doesn't feel the fears and doesn't--
they're going to do things like I did.
They are.
♪ ♪
I grew up in a little town called Clovis, New Mexico.
It's on the border of Texas and New Mexico.
About 40,000 people at the time.
Pretty normal family.
My parents did everything they could
to help me the best they could.
Three sisters that are all older than me,
so definitely got picked on a little bit from them,
but I knew they all loved me
and I had support, so, you know,
it wasn't a matter of me not having loved ones around me
or growing up in a rough neighborhood
or anything like that that led to the path that I'm at now.
♪ ♪
Now, I got ran over by a pickup truck in 2001.
Ran across my right leg, across my chest,
and up off my left shoulder.
Needless to say, from that point on,
I've dealt with pain my entire life--
physical pain, emotional pain as well.
It's hard to even talk about it.
I started taking very heavy opiates.
I was being prescribed
40 milligrams of OxyContin with 2 milligrams Xanax
from day one,
and that's huge amounts of opiates and Xanax together,
which is not supposed to be prescribed to begin with.
I became addicted pretty quickly.
♪ ♪
- He would go to a doctor in Portales, New Mexico.
I went with him a couple of times.
He would say, "Oh, I researched this medication,
and I'd like to try it."
And she said, "Okay, Caleb."
The first time, I didn't think anything of it.
And then after a couple of times
and him switching up medications
and her not even looking into it,
just prescribing him whatever he wanted,
I said, "Wow, I don't think
that she should be prescribing you whatever you want."
And he said, "Oh, no, she's my family doctor.
She trusts me. She knows I do the research."
And that was probably my first inkling
that, you know, something was wrong.
♪ ♪
- Pain has an issue
of causing people to become depressed.
I mean, it's just-- it's part of it, you know?
When you deal with it every day--
I explain it like a roller coaster,
and you're on that roller coaster,
and you're getting nauseous, and you're about to vomit,
and every time the roller coaster comes around,
you're looking at the guy that has that stop switch.
And you're like, "Stop this thing. I want off."
But there's no stopping. It's the rest of your life.
It wears on you.
You look at the things that you used to be able to do,
the things you want to do with your family,
the things you want to do with your friends,
and you can't do them.
[riders screaming]
I got where I was using so much
that I would go through my entire prescription
within the first four days of the month.
You're so tired of this roller coaster,
you'd rather just put a needle in your arm
and make the pain go away.
I started using heroin at that point.
Heroin worked for a short period of time,
but it was too expensive.
I had also been on fentanyl,
and that led to me finding it on the Internet.
[keys clacking]
[mechanical whirring]
- The first thing that we saw--
there was a shipment of fentanyl
that was destined to Lubbock, Texas,
that was seized by Customs and Border Protection
in November of 2015.
We started talking to Lubbock Police Department,
the sheriff's office, narcotics units,
and we discovered that they were also seeing an uptick
in fentanyl.
They were buying it in street-level sales.
And then we had several people that walked into our door
that were fentanyl users that had gone to drug rehab.
We took the intelligence from those individuals,
and we started extensive surveillance on Caleb Lanier.
And we discovered that, yes,
this is the person that's using the dark web,
reaching out to labs in China directly.
- [computerized voice] Hello, everyone.
We are the vendor of research chemical products.
Include 2-FDCK, etizolam...
♪ ♪
- He had a wood shed behind his house
that he used as a modified chemistry lab.
He was experimenting extensively
with different variants of fentanyl--
furanyl fentanyl, acrylofentanyl.
And he was tweaking them
and he was using them on himself
to try to figure out which provided the best high,
which lasted the longest,
and he figured out a way that he could maximize his profits
while he was also treating himself.
[soft dramatic music]
- I thought I was a good father.
I thought I was a good husband,
but it look back at it sober and realize it's insane.
Most heroin addicts might shoot up
two, three times a day.
I was shooting 20 times a day.
There was times I was so high, right,
that I would fall asleep while I'm counting $100 bills.
I would have to get my children
to help me count the money.
♪ ♪
- Lanier, he was a victim of the opioid epidemic,
but then he starting selling, distributing,
and he realized the profitability in it.
He could import 200 grams of fentanyl from China
for around $3,500,
and he was making over $300,000 in profit.
He started developing ways to launder his money.
He had a new business
that had a lot of cash deposits that weren't normal.
He started recruiting other people
to sell fentanyl in the street,
to gather money to take back to Lanier.
He became the leader of a drug-trafficking organization.
[siren wailing]
The fentanyl that they were bringing in the community
attracted a whole new branch of people
that normally wouldn't even be associated with opioids.
We had people from all walks of life
overdosing on fentanyl,
and we knew that if we didn't get
a handle on it really quick,
it was gonna be a bigger and bigger problem.
♪ ♪
- When you look at this problem,
it can look, from a distance,
forbiddingly complex, but, actually,
there's a mechanism that should be pretty easy to understand.
So what Purdue would say today--
what a lot of these pharmaceutical companies
say today is...
"Don't blame us for the opioid crisis.
"These people today, they're dying from heroin.
They're dying from fentanyl."
As though the roots of this thing,
it was some foreign invasion,
when the truth is that the pharmaceutical companies
got very good at getting people on to opioids
but not at getting them off.
- ♪ I love titration, yeah, that's not a problem ♪
♪ And I got new patients, and I got a lot of 'em ♪
- Titration, it's actually the responsible thing to do,
but not in this regard.
But, typically, what you're supposed to do is start low...
and titrate slow.
- You're supposed to titrate up to the appropriate level.
Now, this is something
that happens in medicine all the time,
and it's totally normal, right?
Start the low dose, play it conservative.
- It's simply about balancing the side effects with efficacy.
But at Insys, was the higher, the better.
It was called the effective dose campaign.
It was a campaign that was created by Dr. John Kapoor.
- What Kapoor said unequivocally
and what is in black and white in emails
is they knew that if you got
to a 400-microgram dose or higher,
they would stay on the drug longer,
and so they'd make more money.
- ♪ I love titration, yeah, that's not a problem ♪
♪ And I got new patients and I got a lot of 'em ♪
- In the context of this video,
it's like titrate means, like, goose up the dosage,
and then we're gonna make more money.
Is that the idea? - [inhales deeply]
Yes.
- They spent a lot of time and energy
trying to convince sales reps to do this,
and some of the more absurd aspects of the case
with this bottle,
of a 1,600-microgram dose of Subsys
dancing around to a rap
written over a popular A$AP Rocky song,
trying to convince the sales force,
"Go tell your doctor titration's not a problem."
[slowing down] - ♪ I love titration ♪
♪ Yeah, it's not a problem ♪
- That video was the worst possible move
we could've ever made.
We asked the sales force to put together a short video,
and then we would provide the award to the best video.
- All right, dude!
Dude, we killed it last year. - We demolished it last year.
Reps are gonna be gunning for us.
- Absolutely.
- So these two really sharp, good-looking guys,
you know, who look like models, supermodels...
Obviously, they went all-out.
And they're phenomenal salespeople, by the way.
When that video first came through email,
I'm watching this video, and I'm engaged.
I was enthusiastic
and actually was a little bit emotional.
I said, "I can't believe the effort they put in.
I'm touched."
- ♪ Okay, I got it, and just... ♪
♪ Yes, Lord ♪
- The person in the costume
dancing and singing and rapping, that's not me.
People who know me, they know I can't dance.
They know I can't rap.
Yeah, I'm a 5'8" Jewish guy.
I mean, it's just not happening.
Months later, they go,
"You got to put this costume on,
"and we're gonna reveal it at the end
that you're the guy in the costume."
[sighs]
Whoo!
Nine takes later, an hour and a half later,
this frickin' thing is done.
♪ I love titration, yeah, that's not a problem ♪
- Just in terms of shedding light
on the corporate culture, right?
John Kapoor is in the room
while this video is being played.
This is two years after they've received a subpoena
from the government looking into their practices.
- As all this was happening,
you took a pretty confident approach,
in terms of-- you gave a speech
at, like, a rep conference or something like that,
and one of the things you said up at the top was,
"Oh, any spies here?" - Mm-hmm.
- You referred to the investigation.
- Mm-hmm.
- You must've had an idea
that there was something worth investigating.
But why were you so confident that nothing was gonna happen?
- I wasn't confident. I was scared as heck.
I talked to my dad every night,
and I'm like, "How do I get out of this freakin' place?"
He's like, "Just leave."
And I'm like, "But they did this,
"and they did that, and they have this,
"and they told me to do this, and no matter what I do,
"I'm gonna be in trouble,
and they promised me all this money,"
and all these stupid things.
[groans]
I mean, from the moment I woke up in the morning,
my heart would be just pounding through my chest, you know?
And the whole drive to the office,
just pounding, pounding, pounding.
This is in Chandler, Arizona.
We moved, like, two or three times.
This was the final office that I was a part of.
You know, my kids were in a new school.
We're in a new place.
My wife's trying to get adjusted.
I forced 'em to make this move.
And the numbers come in while I'm driving to work,
always.
Literally, you're just holding your phone.
Boom. There it shows up.
213, 330, whatever.
"Alec, what plan of action do you have in place?
"Alec, do you have a flight booked?
"Where are you staying?
"Why is your flight not booked? Are you a moron?
"I don't understand.
The guy's down 18% from last week."
"Dr. Kapoor, can I speak?"
"No!
"Alec, you're VP of sales. Where are the prescriptions?
"They're not there?
"Pack your bags, grab your kids,
grab your wife, catch a bus home."
- People were getting fired left and right.
I don't know if it's different for anybody else,
but for me,
because I entered in knowing, if I don't produce,
that I'm dispensable at any point regardless
because I'm the one that didn't have the degree.
But the culture, definitely...
it wasn't an equal culture.
I heard about other relationships with girls
and executives,
and once they had expired... [chuckles]
then you're dispensable, right?
[downbeat music]
A lot of pressure.
"Do this or this."
The relationship with Alec didn't help.
It was very volatile.
What's very weird is Alec was saying things like,
"I'm out of time. I'm out of time."
And I was pressuring him to tell me what is going on,
and he pulled out a gun out of his glovebox,
and he was like, "You see? I'm carrying this gun."
He's like, "You don't know. I'm carrying this.
I got to protect myself."
- He had obviously been treated poorly
by the company.
I think that he became aware
that he was gonna be the scapegoat in the case,
that the other defendants were going to blame Burlakoff.
- The company told me nothing, ever.
I asked a million times,
"What happened with this doctor?
"Why did this doctor get arrested? What--
"I heard a patient passed away. What--"
"Ne--Alex, stay in your lane. What's your lane? Sales."
I think a lot of people who have been in legal situations
would understand what I'm talking about.
It's just no way to live,
wondering when the other shoe is gonna drop.
[suspenseful music]
♪ ♪
- He reached out again.
We were actually able to
get him telling us a location.
- We're gonna try to bounce him from 6th over to 4th,
kind of that roundabout over by Horton Plaza.
What's the last you've told him?
- I said I'm coming. - Oh, okay.
- So we wound up in downtown San Diego.
We set him in on a vehicle.
- 10-4 the ID.
So, basically, he's saying he spent his money on this,
that he needs her to be there before 1:30.
♪ ♪
He last relayed his location at 12:48 at 6th and Broadway
and says that he has no car.
All right, updated-- he's saying he's on his way.
I asked him where he was, and that was his response.
♪ ♪
Also said, "Just let me know where you parked
so I can come find you."
And then, "Oh, on my way."
- [exhales sharply]
- It's torture. [chuckles softly]
Just wait. The wait's always torture.
You think you'd get used to it, but it's just--
- All right, James, start moving in.
- Now. - Now.
- Lights. [engine revving]
[tires skidding]
[tense music]
♪ ♪
- San Diego Police! Let me see your hands!
Get on the ground! - Do it now!
- Drop to the ground right now! Don't move!
Put your hands behind your back!
Do not move! - Don't move.
- [barking]
- Say about 5:30 in the morning,
I was sleeping on the couch, and I woke up,
and went and said good morning to my wife.
[thump] And I heard 'em hit the door.
[wood splinters] Saying, "DEA."
They looked like they were fixing to kill somebody.
And I panicked and put my hands in the air,
and I watch as they come in with HAZMAT suits.
♪ ♪
- Everyone was very, very stressed,
and it wasn't the people, it was fentanyl.
It's 50 times more potent than what you would see
in normal heroin coming in from Mexico.
We had no idea how spread it would be throughout the house,
what efforts we would have to take to clean it up
and dismantle their labs.
We just had no idea.
During the search warrant,
we found several analogues of fentanyl
that DEA had never seen in the U.S. before.
- I had about 300 grams of pure acrylic fentanyl.
Sells for about $300 a gram,
so a lot of money's worth.
- When we hit 'em,
they were kind of at the peak of their organization.
They were probably selling
$25,000 to $30,000 a week in fentanyl.
- I don't know how he managed to do that.
I never even saw a package get delivered here.
He never left the couch,
and we didn't have people coming and going either.
So whatever he was doing, he was really quiet about it.
I'd never expected the raid.
When I saw those officers piling up on my porch
through my bedroom window,
I thought it was, like, a home invasion.
I was trying to call 911 from my phone.
I didn't know that they were police officers.
- I can still to this day
hear my wife and my children screaming.
[dry grass rustling in breeze]
Looking back at 'em,
and I said, "Please move me so they can't see me."
Fear? I didn't have that.
It was shame, but it wasn't fear.
If anything, I was relieved. Just take me to jail.
I was either gonna die from withdrawals,
or I was getting off of drugs,
and I didn't care which one it was.
- You have the right to remain silent.
You can refuse to answer questions at any time.
Anything you say...
♪ ♪
- We found fentanyl on him.
We went back to the hotel room that they stayed in,
and we were able to find more drugs there.
He's an addict himself, so he fuels his use by sales.
- Wow.
And, you know, at the end of the day,
everybody's a victim in this thing.
You know, other than the people that manufacture it
and, you know, make the big money from it.
You know, once you get past that,
once you get into the people that use,
whether they're dealers or customers
or whatever they might be,
everybody becomes a victim.
So I don't know if it's worse to die and finally be at peace
and not have to fight these urges every day.
I don't know if that's the worst
or if it's these people that live
that every day now have to be tortured
with this need to go out and find this stuff.
You know, it's just wrong.
I just don't understand how the pharmaceutical companies
get away with this stuff.
♪ ♪
You did a great job staying in touch.
We appreciate you. - You're welcome.
Have a good evening.
- You too. Bye-bye.
[line beeps]
[soft dramatic music]
♪ ♪
- I'd been working on the case
over the course of several years.
And suddenly, Alec Burlakoff left me a message,
and the message says, "I fired my lawyer,
and I want to come in, and I want to talk to you."
This is highly unusual. This has never happened, right?
You know, white-collar folks are always well-represented,
and the last think you want to do is go in and talk
to the federal government without a lawyer.
- I decided to fly from Arizona to Boston,
and I met with Mr. Yeager,
and there were a couple other people in the room.
And I basically proceeded to speak with them
for about four, five hours
and basically lied to them.
What I did was, is I told a lot of truths.
I just left myself out of it.
You can say it was based on a true story,
just left the names out, you know?
- And we just let him talk, you know?
We had evidence against him.
We knew that we were gonna prosecute him at some point.
We had, very early on, texts and emails
telling people to go bribe doctors,
that he personally was asking doctors to write prescriptions
in exchange for money paid by Insys.
So, when the conversation was over, I told him
I thought he just spent the last four hours lying to us,
it was nice meeting him, and he'd be hearing from us.
- I mean, I just felt-- my whole world,
I knew it was basically crashing in,
and it was gonna happen really slowly,
and it was gonna be very painful.
- You know, several months later...
he was charged and indicted.
♪ ♪
narrator: In October 2017, Burlakoff, Kapoor,
Sunrise Lee, and four others
were charged with leading a nationwide conspiracy
to profit by using fraud and bribes
to cause the illegal distribution of fentanyl.
In addition to bribing doctors, the charges included
defrauding insurance providers.
- Thank you, sir. [camera shutters clicking]
♪ ♪
- Any comment? - No.
narrator: The evidence against Alec Burlakoff
was so overwhelming,
his attorney asked him
to consider cooperating with the prosecution
in exchange for a deal.
♪ ♪
- I looked at him, tears started to come to my eyes,
and I said, "Yes, I will do it. I will plead guilty."
Because there is no way under any circumstance
that I would ever sit on the same side
or at the same table as John Kapoor, ever.
We all chose him to be our mentor,
and he was supposed to take us to the promised land
if we followed him loyally.
And look where he took us.
♪ ♪
narrator: From the bench, the presiding judge
called the crimes of Insys "an offense of greed"
for bribing doctors to prescribe an addictive drug
without regard for the best interests of their patients
and sentenced Alec Burlakoff to 26 months in prison.
Sunrise Lee wasn't able
to make a deal with prosecutors,
likely because she couldn't offer them an inside look
at decisions made in the executive suite.
She was sentenced to a year in prison.
- They painted this picture of me
you know, as a dancer, being uneducated,
and... [inhales deeply]
and just the stereotype of it all.
It stole a lot from me.
Everything that I've worked hard my entire life for.
[voice breaking] It's the first time ever in my life
where I haven't been able to persevere.
♪ ♪
[sniffles]
♪ ♪
narrator: John Kapoor was sentenced to 5 1/2 years.
In the courtroom, he had listened without expression
to the mother of a woman who had overdosed on Subsys.
"The actions of John Kapoor and his conspirators,"
she said, "had been a sentence of hell for our family."
♪ ♪
- All the decisions that these people are making at Insys
and, for that matter,
every other opioid company in the United States,
are made in the context of what is very clearly an epidemic.
You know, in 2012,
the first year of this criminal conspiracy for Insys,
I think there were something like 230 million, 240 million
prescriptions for opioids in the United States.
That's more than one prescription
for every adult American.
♪ ♪
- When we were doing our reporting,
"The Washington Post" sued to get this confidential
Drug Enforcement Administration database
that tracked all these prescription pills,
from the manufacturer to the distributor to the pharmacy.
It was a virtual road map,
a blueprint that would show us, give us so many insights
into understanding the opioid epidemic.
- Never in my wildest dreams did I imagine
we were talking about the kinds of numbers that came out.
♪ ♪
- We got nine years of data
and between 2006 and 2014,
100 billion pills had been sent out
to communities all across this country.
narrator: The opioid companies knew every pharmacy
in every small town where every pill was going.
From Maine to Mexico,
they could track the very abuse they were manufacturing.
The database ranked cities by pills per person.
In some places, close to one a day
for every man, woman, and child.
Did the companies really think
that all those pills were for back pain?
♪ ♪
- This is something that affects everybody.
It doesn't matter your color,
your nationality, your gender,
whether you're economically privileged...
or poor.
It doesn't matter.
As long as the opioid sales go up,
and opioid deaths will go up
and opioid treatment admissions are gonna go up.
That's where we are now.
And that's where we continue to be.
Okay, that said...
narrator: After Rannazzisi was forced out of the DEA,
he took his message on the road
to those who would listen
and he began to be a witness for towns and counties
trying to take action against the big drug companies.
One by one, they started suing the opioid manufacturers
and distributors for the damage done.
♪ ♪
With more than 2,500 lawsuits from all over the country,
a judge in Ohio convened
a multi-district litigation center
to consolidate the claims in one courtroom.
Late in 2019, reporters converged in Cleveland,
because in the first big case,
two counties in Ohio were resisting a legal settlement
with three major drug distributors
for their role in fueling the opioid crisis.
♪ ♪
It seemed that there might finally be a trial,
where the public would see evidence
of the corporate negligence that had cost so many lives.
Then at the last minute,
the companies took out their checkbooks
and paid to keep the evidence hidden.
- A settlement has been reached for our two counties
with the--
the three big defendants.
The settlement does not bring things to an end.
It is, though,
a very good development for the people of our counties.
- What was the sticking point last night?
Why did it take till midnight, 1:00 a.m.?
- Money.
They wanted to pay less. I wanted them to play more.
[laughter]
- Is there an admission of wrongdoing on behalf--
- No, but, you know, common sense tells me
when they paid over $323 million
to these two counties,
one might say that's a pretty good admission.
[indistinct chatter]
narrator: In cases like these,
lawyers like to represent that money paid
is some kind of justice, and in a sense, it is.
After all, the cost of addiction is high,
and the price of treatment centers and first responders
should be borne by the companies responsible.
But what of the lives lost?
How do you put a value on them?
♪ ♪
During the COVID pandemic,
opioid addiction and overdoses increased.
It was not surprising, then, that in the fall of 2020,
the families of those who had died
were stirred by rumors that the federal government
might bring new criminal charges against the Sacklers,
the family that had profited so much
during the opioid crisis and the company
that had started it all, Purdue Pharma.
♪ ♪
- This morning,
the Department of Justice is announcing a resolution
which will redress past wrongs
and will also provide extraordinary new resources
for the treatment and care of those affected by opioids--
narrator: Late in 2020, the Trump administration rushed
to make an announcement for the presidential election.
- Pleading guilty to three felony counts...
narrator: The Sackler family would pay a $225 million fine.
Purdue Pharma would plead guilty to kickbacks and fraud
and promised to pay fines totaling more than $8 billion.
- That number immediately gets repeated in headlines
all across the country.
The news goes out on the wires.
You think, "My God. $8 billion. That's massive."
But Purdue is in bankruptcy
and only has about a billion dollars,
which a whole bunch of creditors
are already fighting over.
That money is never going to get paid by the company
or anybody else.
It's a number, in some ways, I think,
that's been kind of designed to make headlines.
♪ ♪
narrator: Behind the headlines was an intricate plot.
In 2019, Purdue had declared Chapter 11 bankruptcy,
which allowed it to continue to operate
while paying fines to those seeking damages.
That led to a cruel irony.
The only way the company could pay damages
was to increase its sales of drugs, including OxyContin.
To pay for the damage done by opioids,
Purdue Pharma would sell more opioids.
[soft ominous music]
♪ ♪
- Shame on Purdue! all: Shame on Purdue!
Dead from greed!
narrator: While the company was charged with crimes,
none of Purdue's executives or owners were indicted,
and the Sacklers
refused to take any personal responsibility.
- Sacklers lie! all: People die!
narrator: That raised questions.
Starting in 2008,
just after Purdue pled guilty to a previous felony,
the Sacklers started taking more than $10 billion
out of the company
in complicated overseas transactions
and vaulted vast sums in their accounts.
- Of the $10 billion, roughly half went to taxes,
so that money, we do not have.
It was paid in taxes.
The family and the board acted legally and ethically.
- So I think that's not the right way to look at this.
The resolution here is very significant.
It involves, for the company, three felony guilty pleas.
For both the company and the shareholders,
it involves very sizable amounts of money.
♪ ♪
- If you talk to people
whose lives have been touched by this,
a lot of them will say, "It's not about the money.
"You could never generate enough money
"to make up for the human cost.
That can never happen."
What does matter to a lot of these people is truth.
[soft downbeat music]
♪ ♪
- And, finally, I'm gonna leave you with this.
We've talked about truths, talked about fiction,
and now we're gonna talk about reality.
Turn that up?
- I need an ambulance. My son's not breathing.
- What's the address? 10731?
- 31, yes. Hurry.
- He's blue? - He's...white.
- How old is he?
- Oh, God, he's dead!
- Ma'am, I need you to calm down. How old is he?
- [wailing] Oh, he's dead! - Ma'am?
Ma'am, I need you to calm down.
How old is he?
- [wailing and crying]
- Can you pick up on that? - [wailing and crying]
- Stop, please. - [wailing and crying]
- [impatiently] How old is he? - [wailing and crying]
- I know I could've fought my case more,
but I was done fighting.
I've been sentenced to 135 months in federal prison
for conspiracy to possess furanyl fentanyl
and fentanyl with intent to distribute.
I am currently in Federal Correction Institute
at Big Springs, Texas.
It's a low-security prison.
It could be worse.
I could be dead. [chuckles]
You know what I mean?
I'm close to home,
so my wife can come visit me.
I get to visit my kids every weekend.
This saved my life.
It gives me an opportunity for a second act.
I screwed up the first one.
I can't ever take it back,
but I get an act two
where maybe I can build upon the past
and use my past experiences
to make a better life
for my wife and my kids
and possibly other people
that would go down
the same stupid road I went down.
So yeah, I mean...
act two.
[bright tone]