The founder of Insys Therapeutics was sentenced to 5½ years in federal prison Thursday for conspiring to bribe doctors to prescribe an addictive opioid painkiller, shortly after five patients who used the fentanyl spray made wrenching statements about how it ravaged their lives.
US District Court Judge Allison Burroughs gave John N. Kapoor, 76, easily the longest prison sentence of seven defendants convicted in the racketeering case. She did so despite pleas from his lawyer and from Kapoor to show mercy because of his age and accomplishments.
Earlier in the day, a former Insys executive who dressed as a giant fentanyl spray bottle in a rap video that championed the firm’s drug was sentenced to 26 months in prison for participating in the conspiracy. A prosecutor had urged a lighter sentence for Alec Burlakoff because the former vice president of sales had pleaded guilty and testified at trial for the government.
The criminal trial was believed to be the first of pharmaceutical executives who marketed an opioid painkiller since the nation’s deadly epidemic began.
But the sentencing of Kapoor, a one-time billionaire who founded the Chandler, Ariz-based company, was the most closely watched one in the racketeering case. Prosecutors had described him as the mastermind of a nationwide conspiracy to pay off doctors at pill mills to prescribe Subsys. The powerful under-the-tongue painkiller was approved in 2012 to treat cancer pain, but prosecutors presented evidence showing that recipients often never had cancer.
They included Jeff Buchalter, a 35-year-old Army veteran. He served three tours of duty in Iraq and was injured by several improvised explosive devices. Buchalter, of Hatfield, Pa., told Burroughs Thursday that a doctor prescribed him 400 milligrams of Subsys in 2012 for back pain and soon raised that to a staggering 2,400 milligrams every four hours — the equivalent, Buchalter said, of a gram of heroin a day.
He became addicted and lost a dream job as a federal law enforcement instructor for the Department of Homeland Security. He got divorced and jeopardized his relationship with his two children. He got clean in 2016, he said, but staying that way remains a daily battle.
“I’m acutely aware that one wrong step can send me back into that void,” he said. Addressing Kapoor, he said, “Why did my life seem so small and insignificant that you traded it for a few dollars?”
Another patient, Mark Gruenspecht, said he was prescribed Subsys during the same period for pain and it “robbed me of my life.” He said he seldom leaves his home.
“This gentleman is a criminal,” Gruenspecht, who sat in a wheelchair, said of Kapoor. “He killed people. He hurt people. He ruined people’s lives.”
Addressing the judge, Kapoor said he was heartbroken by the patients’ stories. But he said he had genuinely wanted to help patients with pain, particularly after watching his wife, Editha, die of metastatic breast cancer in 2005.
“I felt guilty that there was nothing I could do to help her,” he said. “I thought that Subsys could take away the fear of pain,” he added.
His lawyer, Beth Wilkinson, said Kapoor, who was raised in India and lives in Phoenix, was an immigrant success story. He began working in the drug industry in the United States in the early 1970s, she said, and played a key role in developing a medicine to treat a deadly pneumonia that affects people with AIDS. She also said he has been devoted to his extended family.
Prosecutors recommended a prison sentence of 15 years, but Wilkinson implored Burroughs to show mercy.
“At 76 years old, he stands before you with very little life left,” the lawyer said.
Burroughs said she had considered Kapoor’s age and accomplishments, but couldn’t overlook the harm he had caused.
Earlier in the day, Burroughs sentenced Burlakoff, the former vice president of sales, to slightly more than two years in prison.
Assistant US Attorney Fred Wyshak sought only 20 months for Burlakoff, saying that without his cooperation, it would have been hard, if not impossible, for prosecutors to convict the five former executives at trial.
Burlakoff’s lawyer, George Vien, went further. He urged the judge to spare his client prison and put him on probation. Like Wyshak, Vien said Burlakoff’s testimony against Insys executives led to the convictions and that a light sentence would encourage other drug industry executives to help authorities pursue corruption.
“There are many people in the pharma industry looking right now at what happens to Mr. Burlakoff,” said Vien.
Burroughs said she did credit Burlakoff, 45, of Palm Beach, Fla., for pleading guilty and cooperating. That decision, she said, almost certainly induced a second government witness, former Insys chief executive Michael Babich, to do the same before trial. Babich received a 30-month sentence Wednesday, also more than prosecutors sought.
But, Burroughs said, she viewed Burlakoff, Babich, and Kapoor as the biggest culprits in the bribery scheme. “I can’t help but look at relative culpability,” she said.
Burroughs, who likened Burlakoff to Dr. Jekyll and Mr. Hyde for the good and bad he has done in his life, said that by cooperating with prosecutors, “he may have done a great societal good.” But, she said, “That was preceded by a great societal evil.”
For his part, Burlakoff blamed his actions on an unquenchable thirst to be a big shot.
“I always desperately wanted to be a big success,” he said, adding, “I finally came to my senses.”
Burlakoff’s hard-driving efforts to get Insys’ sales staff to increases sales of Subsys, and higher doses of it, included his participation in a jaw-dropping 2015 rap video that was shown to jurors at trial.
In the bass-thumping video, two young Insys salesmen wearing sunglasses and hoodies danced next to a giant Subsys nebulizer in a playground. The video ended when the rapper in the Subsys bottle removed the costume, flexed his arms, and hooted. It turned out to be Burlakoff.
Prosecutors said at trial that the defendants ran Insys like mobsters, displaying “brazen audacity.” They pressured sales staff to persuade doctors to prescribe higher and costlier doses of Subsys, which was approved for treating cancer pain, and got physicians to abandon their duty to “first, do no harm.”
As part of the conspiracy, prosecutors said, eight doctors and medical practitioners got more than $1.1 million disguised as “speaking fees.” Insys also set up a reimbursement center where employees allegedly lied to health insurers about the symptoms of patients to get them to cover Subsys for people without cancer.
At least a dozen doctors and other health care providers across the country were convicted of federal charges in connection with the scheme, according to prosecutors.
Jonathan Saltzman can be reached at email@example.com