Insys Therapeutics founder John Kapoor convicted in US opioid case

John Kapoor

The founder of Insys Therapeutics John Kapoor has become the first pharmaceutical boss to be convicted in a case linked to the US opioid crisis.

A Boston jury found Kapoor and four colleagues conspired to bribe doctors to prescribe addictive painkillers, often to patients who didn’t need them.

The former billionaire was found guilty of racketeering conspiracy for his role in a scheme which also misled insurers.

Tens of thousands of deaths have been caused by opioid overdoses in the US.

Indian-born Kapoor founded drugmaker Insys Therapeutics in 1990 and built it into a multi-billion dollar company.

The jury found Kapoor had also misled medical insurance companies about patients’ need for the painkillers in order to boost sales of the firm’s fentanyl spray, Subsys.

The court heard that Kapoor – who was arrested in 2017 on the same day President Donald Trump declared the opioid crisis a “national emergency” – ran a scheme that paid bribes to doctors to speak at fake marketing events to promote Subsys.

During the 10-week trial, jurors were also shown a rap video made by Insys for its employees on ways to boost sales of Subsys.

Kapoor and his co-defendants – Michael Gurry, Richard Simon, Sunrise Lee and Joseph Rowan – face up to 20 years in prison.

A statement from Kapoor’s lawyer said he was “disappointed” with the verdict. The men had denied the charges and have indicated that they plan to appeal.

Forbes listed Kapoor’s net worth as $1.8bn (£1.4bn) in 2018, before dropping off the publication’s billionaire rankings this year.

His conviction marks a victory for US government efforts to target companies seen to have accelerated the opioid crisis.

The US Centres for Disease Control and Prevention has said that opioids – a class of drug which includes everything from heroin to legal painkillers – were involved in almost 48,000 deaths in 2017.

The epidemic started with legally prescribed painkillers, including Percocet and OxyContin. It intensified as these were diverted to the black market.

There has also been a sharp rise in the use of illegal opioids including heroin, while many street drugs are laced with powerful opioids such as Fentanyl, increasing the risk of an overdose.

US-Americans ‘more likely’ to die of opioid overdose than car crash

Opioid overdose has become the fifth most probable reason for preventable death, according to a new report.

A discarded syringe is seen under a bridge on Lester Avenue in Johnson City, New York [File: Andrew Kelly/Reuters]

A discarded syringe is seen under a bridge on Lester Avenue in Johnson City, New York [File: Andrew Kelly/Reuters]

In the United States, the probability of dying from opioids has for the first time surpassed the likelihood of being killed in a car crash, according to a new report by the National Safety Council.

Published on Monday and based on National Center for Health Statistics’ 2017 data, the report found that opioids overdose was the fifth most probable cause of preventable death, with a one-in-96 odds. The odds of dying in a vehicular crash were one-in-103.

More probable causes than opioids overdoses were heart disease, cancer, chronic lower respiratory disease and suicide.

Opioids contributed to the overwhelming majority – 69 percent – of fatal drug overdoses in 2016, totalling 37,814 deaths, according to the NSC.

These opioids include the use of illegal narcotics, such as heroin, and prescription pain killers, such as oxycodone and hydrocodone.

“The nation’s opioid crisis is fueling the Council’s grim probabilities, and that crisis is worsening with an influx of illicit fentanyl,” the council said in a statement on Monday, referring to a synthetic opioid often used to treat severe pain.

Just a day before the report was released, one person died and at least 12 people were hospitalised in northern California in what police described as a “mass overdose” stemming from fentanyl use.

OPINION

Addiction in the US: A corporate morality crisis

Larry Beinhart
by Larry Beinhart

In 2017, overdose deaths soared, surpassing 70,000, according to the Center for Disease Control’s (CDC) National Center for Health Statistics.

And between 2013 and 2017, fatal drug overdose rates grew in 35 of the 50 US states as well as the District of Columbia. In many of those states, synthetic opioids were behind a growing number of deaths, per CDC statistics.

In December, a separate report concluded that fentanyl had become more common than heroin in drug overdose deaths in the country.

Bipartisan legislation, criticism

US President Donald Trump signed an opioid law in late October. The bipartisan law expanded medical treatment for opioid users and made it more difficult to mail illicit drugs.

“Together we are going to end the scourge of drug addiction in America,” Trump said during an event at the time.

“We are going to end it or we are going to at least make an extremely big dent in this terrible, terrible problem.”

The legislation expands access to substance abuse treatment in Medicaid, the government health insurance programme for the poor and disabled.

It also cracks down on mailed shipments of illicit drugs such as fentanyl, and provides a host of new federal grants to address the crisis.

In October 2017, Trump declared opioid addiction a 90-day emergency, a limited declaration that critics said fell short of implementing the measures needed to combat the crisis.

Critics also point to Trump’s previous attempts to slash hundreds of billions of dollars from Medicaid, which provides treatment to around one-third of people seeking help with substance abuse.

In July 2018, Senator Elizabeth Warren, a vocal opponent of Trump, accused the Trump administration of undermining programmes that are pivotal to tackle the opioid crisis.

In a nine-page letter to the president, Warren said his administration “failed to take the actions needed to meaningfully address this crisis … (and has) continued to substitute empty words and broken promises for real action and bold ideas”.

Controversial tool emerges in opioid fight: fentanyl test strips

Test strip helps prevent fentanyl overdoses
Test strip helps prevent fentanyl overdosesTest strip helps prevent fentanyl overdoses 01:50

(CNN)A controversial tool has emerged in the fight against opioid overdose deaths. It’s a strip that allows people who use street drugs such as cocaine and heroin to test whether their drugs are laced with fentanyl.

If the drugs test positive, they might choose not to use them or choose to use less of them.
According to a new report by the US Centers for Disease Control and Prevention, fentanyl is now the deadliest drug in America and was linked to nearly 29% of all overdose deaths in 2016. The synthetic opioid is about 80 to 100 times stronger than morphine and produces a powerful high. It’s cheap and sometimes mixed into street drugs without the buyer even knowing. Given its potency, it can be deadly.
Fentanyl is the deadliest drug in America, CDC confirms

Fentanyl test strip technology was originally developed by a Canadian biotech company BTNX to test urine samples for the presence of the drug, but the strips work basically the same way when they’re dipped in the residue of cooked heroin or when a little water is added to empty baggies of cocaine.
It works like a pregnancy test in reverse. One line on the strip suggests that the drugs are positive for fentanyl. Two lines is interpreted as a negative result.
In a study, researchers at Johns Hopkins and Brown University determined that the test strips worked to detect even low concentrations of fentanyl in street drugs.
“Our findings bring to the table evidence that can inform a public health approach to the fentanyl crisis. Smart strategies that reduce harm can save lives,” Susan Sherman, a co-author on the study, said in a news release.
According to the study, several programs in the United States that distribute clean syringes to people who use drugs have started to distribute fentanyl test strips, as well.
This is fentanyl: A visual guide
In Los Angeles County, emergency departments, first responders and other heath care workers have been advised to discuss the potential risks and benefits of the strips with patients who use street drugs.
The test strips aren’t 100% effective at eliminating the risk of overdose, since they don’t identify all forms of fentanyl and can produce false negatives. They also don’t let users know how much fentanyl the drugs contain.
Still, the researchers see an opportunity to halt the increase in fentanyl-related overdose deaths.
“We are at a pivotal moment in the overdose epidemic, and we need to embrace the full range of interventions that can save lives,” Sherman said.
In a video, the Urban Survivor’s Union, an organization that advocates on behalf of drug users, offers instructions on how to use the strips and what to do if the results are positive.
“Let’s say you had some drugs you were going to inject. … If it tests positive, you have options,” the video explains. “One, you can shoot half back into another sterile syringe, which may not only be life-saving but also cost-effective. Or two, you may even choose not to do it.”
The concept of drug checking has jarred some.
The Trump administration’s assistant secretary of Health and Human Services for mental Health and substance use, Dr. Elinore McCance-Katz, has expressed ardent opposition to the use of the fentanyl test strips.
In a blog post, Katz laid out several reasons. Among them is a concern that even if people who use drugs know that their drugs are laced with fentanyl, they will still use the drugs, despite the apparent danger. They might also use the strips to seek out drugs that contain fentanyl to achieve a stronger high.
“We can’t afford to create a false sense of security. … Let’s not rationalize putting tools in place to help them continue their lifestyle more ‘safely,’ ” McCance-Katz said.