In tracing the roots of the opioid epidemic, Palm Beach Post investigative editor Holly Baltz researched local prescribers of oxycodone and found something curious.
One Palm Beach County doctor ranked as a Top 10 prescriber nationally of an unusual fentanyl-based drug called Subsys.
What was Subsys?
That question prompted a nine-month investigation headed by Baltz and investigative reporter John Pacenti.
With assistance from staff researcher Melanie Mena and data reporters Mike Stucka and Mahima Singh, the newspaper peeled back the layers on what federal prosecutors called an unprecedented nationwide conspiracy by Insys Therapeutics to bribe doctors — through a speaker program prosecutors labeled a sham — to prescribe a spray form of the dangerous and powerfully addictive fentanyl drug.
The Post discovered that Florida doctors wrote the most Medicare prescriptions in dollars for Subsys in 2014 and 2015.
There were other Florida connections, as well.
The Post learned that the man accused of facilitating the pay-for-prescriptions strategy — Insys’ sales chief Alec Burlakoff — hailed from Boca Raton and had faced allegations of unethical behavior at another large pharmaceutical company.
His so-called “closer” to get doctors into the fold? A former exotic dancer from Rachel’s Gentleman’s Club in West Palm Beach.
Pacenti and Mena pored through thousands of pages of court documents from numerous civil and criminal actions against Insys and its executives, painstakingly building a record of the drug company’s actions. They looked into the backgrounds and records of Florida doctors who were paid tens of thousands of dollars by Insys.
With the FBI shoring up its witness list for criminal prosecutions, key players were reluctant to talk, but some Florida doctors broke their silence. Families spoke about how they lost loved ones to Subsys. Patients spoke about how they became hopelessly addicted.
Stucka developed techniques to find never-before-reported deaths linked to Subsys in the U.S. Food and Drug Administration database of adverse drug incidents. When Insys disputed the numbers, The Post reached out to Georgetown University Professor David Gortler, an expert in pharmaceutical adverse events, to validate its approach.
Identifying Subsys cases by brand name, as the FDA does, but also by an identification number, which the FDA does not do, was valid, Gortler said. He said he tends to trust the database because many of the reports are from doctors, pharmacists and other professionals.
“If they’re saying that’s what caused the death, then you believe them,” he said.
Burlakoff did not respond to questions, but his actions were captured in mountains of court documents, drawing a persuasive picture of what went on as Insys plied unsuspecting patients with its fentanyl spray, Subsys.
PAY TO PRESCRIBE? THE FENTANYL SCANDAL
Part 2: Coming April 11