Pain and Gain

John Kapoor made his billions by letting his drug companies push legal and ethical limits—which was fine when he was peddling blood-pressure pills, but not once he started selling one of the strongest narcotics in the world.

- Matthew Herper and Michela Tindera

On Mar. 25, 2016 Sarah Fuller, 32, was supposed to drop her mother’s car at the shop. Her mom called at 8 a.m. to make sure her daughter was up. She got Sarah’s fiancé. He found Sarah in her room, motionless,with her face on the floor. She was dead. The medical examiner implicated two drugs Sarah had been prescribed: Xanax, for anxiety, and Subsys, the fastest-acting form of fentanyl, among the most potent narcotics known to medicine. The combination was dangerous, but Sarah’s family blames Subsys and its maker, Insys Therapeutics, for her death and plans to sue. “They obviously had no regard for human life,” says Debbie Fuller, Sarah’s mother. “In order for them to make the bottom line bigger, people have to die for it.”

Subsys is the brainchild of John Kapoor, 73, one of the most successful pharmaceutical entrepreneurs in America and the founder, chairman and chief executive of Insys. Kapoor is worth $2.1 billion, and his Insys shares represent $650 million of his net worth. The company’s stock is up 296% since its 2013 IPO.

His idea for what became Subsys was to pair fentanyl, a narcotic 80 times more potent than morphine, with spray technology that would allow patients to get a dose under their tongues. The point was to ease cancer-related pain, which often breaks through high doses of existing opioids. It’s a subject Kapoor knows well: Editha, his wife of three decades, died of metastatic breast cancer in 2005.

“I was a caregiver for her,” Kapoor says. “I took care of her. I saw what she had to go through, and I can tell you, pain is such a misunderstood thing for cancer patients. Nobody understands pain. They think pain is just pain. My wife went through it.”