Early in his career, comedian Kumail Nanjiani did a bit about a new drug called cheese, which, if you break down the ingredients, turns out to be Tylenol PM mixed with heroin. So really, its heroin, he joked. Heroins doing the heavy lifting.
That line was going through my mind as I watched Pain Hustlers, a garish and, yes, mostly painful Big Pharma satire from director David Yates, who (The Legend of Tarzan aside) spent the last 15 years making increasingly convoluted Harry Potter movies. Pain Hustlers is the starry, mostly-true story of a company called Insys, a key player in Americas ongoing opioid crisis. In 2012, Insys launched a fast-acting spray called Subsys whose active ingredient was fentanyl. Guess what happened. People got hooked. People died. Insys got rich.
Liberally adapted by Wells Tower from Evan Hughes reporting on Insys, Pain Hustlers takes an off-putting mock-documentary approach to this tragedy, focusing on a handful of sleazebag salespeople who bent the rules to incentivize doctors to prescribe Lonafin (the films fictional Subsys substitute) first for treating cancer pain, and later for conditions as mild as migraines. They used one of the industrys more ethically dubious tactics, inviting doctors to participate in sketchy speaker programs once a legitimate peer-to-peer marketing strategy, but effectively just a scam to siphon generous honorariums directly into the pockets of prescription-writing MDs (which, in Subsys case, included dentists and podiatrists).
In the films opening minutes, we meet Liza Drake (Emily Blunt), her mom Jackie (Catherine OHara) and an especially gross drug rep named Pete Brenner (Chris Evans), all pretending to be interviewed by an artsy documentary crew (resulting in an obnoxious black-and-white format). A proper documentary treatment of the subject would be preferable, whereas Yates merely wants to establish the films irreverent tone, channeling Michael Bay as he shows Liza driving her convertible across Floridas Seven Mile Bridge. Lizas character seems to be based on a line from Hughes New York Times Magazine story, in which its revealed that Evans and Jay Duplass characters hired a former exotic dancer named Sunrise Lee as a sales manager, and she helped court [a shady doctor] as an Insys speaker.
Pete and Liza meet at the strip club, where she dazzles him with her powers of deduction (in a scene with zero charm and less chemistry, it takes her less than a minute to figure out his hustle). Emily Blunt is and can easily play a bright young woman, but the characters white-trashy side the seductive-dressing, pink-Caddy-driving dimension that makes Liza interesting feels like more of a stretch. It feels suspiciously like Blunt and/or Yates wanted to prove that Liza could be running this company, if only her upbringing had allowed her to get an Ivy League education, but that approach undermines the joke that the dudes running the company were using escorts as sales reps. (To make that point, the film inexplicably has the unscrupulous son of a doctor do all the seducing.)
Liza is all business, and her instincts help Insys hook their first big fish. In order to keep her new job, her task is to get a single doctor to prescribe Lonafin before the company goes under. (The movie briskly mentions that every Lonafin prescription they book is worth $40,000 a month.) In the last hour of her last day, Liza snags a whale named Dr. Lydell (Brian dArcy James), who runs a high-volume pill mill from his strip-mall clinic. Lydell is every bit as cartoonish as the films other characters, all of whom turn their easy-come wealth into conspicuous upgrades. In his case, Lydell gets hair implants and a flashy new sports car. Liza ditches the Mary Kay mobile, clears her debts, buys a two-story beachfront apartment and agrees to pay double tuition to send her daughter Phoebe (Chloe Coleman) to private school.
Phoebe has an abnormal growth in her brain, which will likely require operating. Its a strange subplot in a movie about pain medication that gets your brain racing ahead of the story: Will Phoebe require a Lonafin prescription that will get her hooked, until her teeth fall out and she dies of an overdose? No, that fate is reserved for another of Lizas acquaintances (something has to give her a conscience). What Phoebes condition does is effectively force the audience to sympathize with Liza, while also presenting her with a huge medical bill weeks before her stock vests. While everyone around her most notably the increasingly kooky billionaire (Andy Garcia) who bankrolled the company is angling to expand the use of Lonafin by any means necessary.
If the characters could justify their chicanery before by saying that they were offering pain relief to cancer patients, well, thats no longer the case when they start to go off-label meaning, prescribing the drug for treatments not yet approved by the FDA. As everything starts to collapse, Yates brings the film back around to that ridiculous mock-doc framing device. This is all bullshit, an understandably upset opioid widow says, turning the tables back on the imaginary filmmaker. You got your story. So what are you gonna do?
Does Yates really think his shrill satire has gotten audiences so riled up that Pain Hustlers will compel them to change the world? Nearly 200 Americans die of opioid overdoses every day. And fentanyl is 50 times stronger than heroin, so whether you say cheese or Subsys or something else, were talking a highly addictive, potentially lethal substance made to ease the pain, but marketed to do a world of harm.