The True Story That Inspired 'Pain Hustlers,' Explained

Just when you think Hollywood had told the bulk of its stories about the opioid crisis, Netflix releases the new movie Pain Hustlers. Directed by David Yates and starring Emily Blunt and Chris Evans, the film follows the rapid rise of a fictional company called Zanna Therapeutics, which takes over the cancer pain medication market with the Fentanyl spray Lonafen. Though the company starts out as a minor figure, everything changes when Liza Drake (Blunt), a down-on-her-luck single mother, gets recruited by sales rep Pete Brenner (Evans). Liza soon makes her first sale, and seemingly months later, Zanna has grown from a nondescript, sparsely-filled office to a public corporation that throws parties reminiscent to those in Painkiller—complete with Brenner rapping in a Lonafen-shaped foam suit.

Focusing on Liza and her efforts in building her commission pay, the movie follows a scheme that has now become all too common for corrupt drug companies: start of with a "by the book" procedure until the drug takes over the approved market (cancer patients who already have some opioid tolerance) and then branch out to other, more everyday pain needs (what the film defines as "off-label"). The result is am unethical and lucrative ride that shocks both Liza and the viewer with how greedy people can be (though the film arguably could have taken more time on the scheme's victims rather than its machinations). Still, after watching this wild tale, it makes sense to wonder how much of the film was inspired by real-life events, and whether there really was a Liza Drake or a Jack Neel (Andy Garcia). Ahead, read on for what we know about the true events that inspired Pain Hustlers.

Is 'Pain Hustlers' based on a true story?

As seen in the film's closing seconds, there was a real-life Fentanyl-based drug similar to the one depicted in the film. Pain Hustlers was inspired by journalist Evan Hughes's 2018 New York Times Magazine coverage (and subsequent nonfiction book) on the Arizona-based pharmaceutical company Insys Therapeutics. Subsys, a highly addictive sublingual spray, was developed and sold by Insys for the management of breakthrough pain in cancer patients tolerant to around-the-clock opioid therapy. Hughes's reporting detailed the various techniques that Insys used to push its painkiller into the market, including employing an attractive staff of motivated sales reps and recruiting doctors to recommend the drug to other prescribers via its "speaker program." As alluded to in the film, Insys's speaker program was actually a front for bribing medical practitioners to prescribe the highly-addictive drug to patients who did not need it.

Speaking with Tudum, the film's screenwriter Wells Tower explained why he wanted to fictionalize the pharmaceutical scandal. "I found it mind-blowing that these people, who for the most part have no medical training, have so much influence over the medications we’re prescribed," he told the outlet. "I knew we had a story on our hands that could offer some really shocking insights into how American medicine works."

The real-life saga of Insys Therapeutics ended in a similar way to the film. Its founder, Dr. John Kapoor (whose film stand-in is named Jack Neel), was convicted by a federal jury of racketeering conspiracy in May 2019, along with other Insys executives, including sales manager Alec Burlakoff. Speakers Xiulu Ruan and John Patrick Couch were also charged with running a "pill mill." In the same year, Insys agreed to pay $225 million to settle the federal government's criminal and civil investigations, but the company later went bankrupt. In January 2020, Kapoor was sentenced to 66 months in jail, and he ultimately served two years. (He was released last June.) Per Reuters, Kapoor is the "highest-level corporate executive convicted at trial of crimes related to the opioid epidemic."

Which parts of 'Pain Hustlers' were based on real life?

As was the case with Painkiller, some of the details of Insys' real-life racket were too good to be left on the cutting room floor. Yes, Insys' former VP of Sales Alec Burlakoff really did a parody rap based on the company, alongside an employee dressed up in a suit shaped like Subsys' spray bottle. (There's a whole video.) As mentioned previously, Burlakoff was one of the convicted executives, and Brenner in the film seems to be based off him and the company's former CEO, Michael Babich.

The film's depictions of Zanna's "speaker program" were also pretty spot on. Per The Guardian, prosecutors argued that the real-life Insys "educational seminars" were no more than social gatherings at restaurants, bars, and strip clubs." The outlet also specifically noted that Insys paid nearly $260,000 to two New York doctors who wrote more than $6 million worth of Subsys prescriptions in 2014.

In another wild detail, Liza Drake's mother, played by Catherine O'Hara, also appears to be based on a real-life member of the company. A former New Jersey sales rep for Insys named Susan Beisler really sent overly friendly emails to Kapoor about the bribes given to doctors in speaker programs, and those emails were a key part of one of the lawsuits against him.

In the film's press notes, director David Yates explained that each of the film's characters are a mix of real-life details and fictionalized storytelling. "With the exception of Liza, they’re all kind of loosely based on existing characters from that pharma world. We gave Wells license to create his own unique version of people," he said. "And Liza was our invention, a single mum with a daughter struggling with health issues, a dreamer, undervalued but incredibly capable."

Is Liza Drake based on a real person?

Liza serves as the sympathetic guide through the rise of Zanna, the film's fictional stand-in for Insys. While there were likely Insys sales reps who had a similar rags-to-riches story within the company (Hughes's article even mentions that the company had hired a former dancer), the single mother is entirely an invention of the film's creative team. Yates explained in the press notes, "[Emily Blunt and I] were both drawn to a human being who’d been undervalued, underestimated, who’d missed all those opportunities, hadn’t done particularly well at school, but who was nonetheless incredibly capable, very empathetic, very in tune with other people."

Hughes also told Time that Liza’s character was emblematic of the type of people who ended up in the sales force for Insys. "It was made up of young people who were often in over their head, and they were hungry for success, and a lot of that is embodied in her. Even if the details come from hither and yon, they're real," he said.