Pain Hustlers: A Comprehensive Explanation

Summary

Pain Hustlers explores the cost of greed and the role of the pharmaceutical industry in the fentanyl crisis in the United States.

The opioid crisis serves as the backdrop for Pain Hustlers, although the characters and companies depicted in the film are entirely fictional. However, some influence was taken from real-life companies such as Insys Therapeutics. The dramatic increase in addiction and fatalities within the movie can be attributed to Zanna's unethical sales tactics, which included bribing doctors and advocating for the unauthorized usage of the drug Lonafen.

Warning: Spoilers ahead for Pain Hustlers. The conclusion of Pain Hustlers uncovers the consequences of avarice and the involvement of the pharmaceutical industry in the tragic fentanyl crisis in the United States. Helmed by David Yates, Pain Hustlers is a Netflix original film showcasing the talents of Emily Blunt and Chris Evans. It is based on the gripping novel "The Hard Sell: Crime and Punishment at an Opioid Startup" written by journalist Evan Hughes and skillfully adapted into a screenplay by Wells Tower.

Is Pain Hustlers a True Story?

In Pain Hustlers, Liza Drake (portrayed by Emily Blunt) is a struggling mother who faces financial difficulties in caring for her daughter who suffers from epilepsy. Her fortunes change when she is offered a job by David Brenner (played by Chris Evans), a representative of Zanna Pharmaceuticals. The job involves selling Lonafen, a fentanyl product. Liza and David venture into ethically questionable territory as they engage in activities that defy the law to promote Lonafen. However, the success of Zanna Pharmaceuticals relies heavily on these illicit practices, all of which are fueled by the company's primary investor, Dr. Jack Neel (played by Andy Garcia). As the Fentanyl crisis worsens, Liza's guilt compels her to expose the company's wrongdoing and serve as a whistleblower, ultimately leading to the downfall of the entire organization.

The opening of Pain Hustlers includes the statement "what you are about to see is inspired by actual events," but it should be noted that not all the characters and events depicted in Pain Hustlers are based on real people or situations. While the portrayal of the opioid crisis and the actions of pharmaceutical companies promoting fentanyl products generally reflect reality, the characters in Pain Hustlers are entirely fictional, including Zanna and most of its competitors (although real companies like Pfizer are mentioned). Fentanyl is a genuine drug, and there exists a real pain-relief medication called Lonafen; however, it should be clarified that the fictionalized version of Lonafen in Pain Hustlers bears no resemblance to the real drug.

The content of Evan Hughes' book, "The Hard Sell: Crime and Punishment at an Opioid Startup," revolves around Insys Therapeutics, a real-life company. Insys developed the sublingual fentanyl liquid called Subsys, similar to Pain Hustlers' Lonafen. John Kapoor, the founder of Insys, shares a background resembling that of Dr. Jack Neel in Pain Hustlers. Furthermore, Insys adopted a similar business model to Zanna's strategy in Pain Hustlers, wherein they incentivized doctors to prescribe Subsys by offering bribes.

Pain Hustlers draws many other elements directly from Insys, such as hosting parties at strip clubs and bestowing expensive gifts like steak upon doctors. Additionally, the eccentric rap performance by the character David Brenner, portrayed by Chris Evans, during a sales meeting is inspired by a real-life video showcased in Pain Hustlers. The video features sales representatives dressed in costumes rapping about dose titration and the profitability resulting from increased doses. In a similar vein to Zanna's downfall in Pain Hustlers, Insys Therapeutics faced a similar fate when Maria Guzman, one of their sales representatives, acted as a whistleblower. However, it is worth noting that the story of Liza Drake in Pain Hustlers differs significantly from Guzman's narrative.

How Did Liza Pay For Phoebe's Surgery?

Liza was on the verge of giving up on selling Lonafen after facing rejection from every doctor on her list. Her primary motivation was to find a more stable environment for her daughter, Phoebe, who had recently experienced a seizure. During a consultation with a doctor, it was explained that Phoebe may require a surgical procedure to address her seizures. The first option involved a somewhat invasive approach where a section of her skull would be opened up to remove the "ateriovenous malformation" (AVM) using a technique similar to a "melon baller." The second option, on the other hand, was less risky and invasive, requiring entry through the nose without any skull incisions or brain movement. Unfortunately, the second option was not covered by Medicaid.

However, Liza's fortunes took a turn for the better as she managed to succeed in persuading doctors like Dr. Nathan Lydell to prescribe Lonafen. With her newfound success, she found herself earning enough money to afford a more lavish lifestyle, including an expensive house, fashionable attire, luxury cars, and an exclusive school for Phoebe. Despite this newfound prosperity, Liza faced a dilemma when it became apparent that Phoebe still needed the surgery. Financially, she found herself without sufficient funds to cover the procedure. Insurance continued to deny coverage, her savings fell short, company stocks could only be accessed after a year of tenure, and loan applications were rejected due to the volatile nature of the pharmaceutical industry.

Liza eventually approaches Dr. Neel, seeking financial assistance for Phoebe's surgery. However, instead of offering help, he suggests that Phoebe's condition could be seen as a hidden blessing, encouraging Liza to use it as a motivation to boost her sales. Although never explicitly mentioned in their conversation, the visible incision on Phoebe's head during her recovery serves as confirmation that she ultimately underwent the riskier and more invasive surgery. Surprisingly, Phoebe appears to recover well, indicating that Liza's involvement in Zanna's corruption had no impact on her daughter's surgery in the end.

Why Did Lonafen Patients Start Dying?

During the initial part of the film, David Brenner mentions the "Hartigan study out of Mass General," which claims that Lonafen carries a risk of addiction or overdose of less than 1 percent. However, it is important to note that the Hartigan study is purely fictional. Near the end of the movie, Elliot Hartigan, the fictional author of the study, clarifies that it only pertained to controlled doses administered to opiate-resistant stage 4 terminal cancer patients. In this particular context, the possibility of experiencing adverse effects from overdosing is virtually eliminated. Additionally, it should be mentioned that many of these patients passed away from cancer before any long-term side effects could manifest.

Zanna initially adopted a sales strategy similar to that of the Hartigan study. However, the escalation in addiction, overdose cases, and fatalities only occurred when the company started offering bribes to doctors in order to prescribe Lonafen "off-label" to patients without cancer, as well as providing incentives to increase the dosage. It remains unclear whether there is an actual study equivalent to this scenario. Nevertheless, Zanna's exploitation of the Hartigan study in Pain Hustlers mirrors the real-life manipulation of scientific studies to manipulate or distort the findings.

Why Jackie's Emails Were the Key For Liza Taking Down Jack and Zanna

After initially approaching the Florida District Attorney to expose Zanna's corrupt business practices, Liza claims that implicating Dr. Jack Neel in the bribery scheme would be extremely difficult. This is because he does not use email or a smartphone, and he strictly prohibits any electronic devices near him. The only potential evidence of his awareness of the bribery scheme lies in the notes he shares with David Brenner. However, when Liza attempts to steal David's copy of the notes, she is caught in the act.

Despite Jack's extreme caution and efforts to avoid leaving any evidence, his brief romance with Liza's mother, Jackie Drake (portrayed by Catherine O'Hara), inadvertently exposed his awareness and active participation in Zanna's corrupt practices of bribing doctors. Trying to exploit their relationship, Jackie sent Jack emails with the intention of achieving better deals and higher commission payments for herself. The emails explicitly mentioned specific amounts of payout and even used the phrase "bribe money." Although Jack ultimately rejected all of Jackie's requests and even advised Liza to terminate her employment, the content of those emails debunked his legal defense, which claimed that he had no knowledge or involvement in Zanna's questionable business decisions.

Pain Hustlers Full Ending and True Message Explained

Liza raised the alarm regarding Zanna's corrupt activities and exposed the entire bribery scheme to the Florida District Attorney. She also furnished the necessary evidence to convict several executives, with former CEO Eric Paley (Amit Shah) receiving a jail sentence of 16 months, CEO David Brenner receiving 36 months, Dr. Jack Neel receiving 66 months, and Liza Drake receiving 15 months. While the district attorney recommended no imprisonment for Liza, acknowledging her crucial role in the case and visible remorse, the judge still ordered her incarceration due to the significant pain and suffering caused by her involvement in Zanna's promotion of a fentanyl product, leading to addictions and deaths.

The finale of Pain Hustlers depicts Liza and Jackie united in selling Jackie's skincare line alongside numerous former Zanna representatives recruited by Liza and David. Liza sometimes finds herself daydreaming about the wealth, accomplishments, and authority she once possessed during her tenure at Zanna. However, she admits that the sheer exhilaration of her current circumstances both pleases and frightens her. In many aspects, Liza's conclusion mirrors that of a recovering drug addict, albeit without the reliance on substances like fentanyl or other opiates. Instead, Liza grapples with the withdrawal symptoms triggered by her relinquishment of power and greed from her past life.