The Outrageous True Story Behind Pain Hustlers on Netflix

On the heels of Painkiller and the modernized The Fall of the House of Usher adaptation, Netflix continues its recent slate of pharmaceutical-inspired dramas with another title: Pain Hustlers. Starting Chris Evans and Emily Blunt, the dark comedy, which premiered at Toronto International Film Festival last month, follows a small company promoting fentanyl addiction in unsuspecting patients. The film will undoubtedly leave viewers with a lot of questions—and rightfully so, because it’s based on a true story.

Here’s a Pain Hustlers‘ explainer to help separate fact from fiction.

What is Pain Hustlers based on?

The seed of the film began with a 2018 investigative article by Evan Hughes for the New York Times Magazine about Insys, a company founded by billionaire John Kapoor. Kapoor promoted the opioid product Subsys, a very strong pain medication originally used to treat “breakthrough” cancer pain. It was actually based on a generic drug, but Insys attached a spray delivery system to it that allowed them to promote it as a premium product. (In the movie, the opioid drug being sold is called Lonafin and the company is called Zanna.)

Kapoor found success through what was called a “speaker program.” The reality is that he was getting doctors to prescribe unneeded and highly addictive medication to vulnerable patients. In 2020, Kapoor was sentenced to prison for bribing medical practitioners and a “racketeering conspiracy,” and ordered to serve 66 months.

“This was this kind of scrappy startup and they had this wild rags to riches tale,” Hughes said of the original story. “I would use the word ‘outrageous’ to describe both the story and the film—and you could say outrageous in two senses of the word. There’s outrageous in terms of wild, larger than life, chaotic, funny, but then there’s the moral outrage of the story—all of that was taking place and all of that was being achieved against the backdrop of patients that were being hurt.”

Hughes went on to turn the article into a book titled The Hard Sell: Crime and Punishment at an Opioid Start-Up. The dramatic tale of corruption in the pharma industry attracted the attention of director David Yates, who developed it into a fictional narrative with some parts presented in the structure of a documentary, which definitely blurs the lines between true and false even further.

How is the movie Pain Hustlers different from the book and article?

Well, the humor, for one. The Insys story is ultimately very tragic, because of all the real people involved who developed addictions under the care of doctors they trusted. Yates wanted to make the tone of the movie very different, with a goal to entertain as well as educate.

“We always felt we wanted it to be as subversive and as naughty and as different as we could compared to those,” Yates explained to Time. “Primarily we wanted to bring an audience into the issues and the opioid crisis overall.”

He also said, “We wanted it to be crazy and anarchic and fun…By the end of the story, we wanted it to have a real heft emotionally.”

And the world of Pain Hustlers was made smaller, to allow for more streamlined character development. The film is set in Florida, where there were most likely sales reps for Insys, but Insys salespeople were all over the U.S. so it was actually a much bigger operation.

Is Liza Drake from Pain Hustlers a real person?

In the movie, Yates focuses on the main character, Liza Drake (Emily Blunt). Liza is more of a composite character who represents multiple POVs from the article. She’s a single mother who is desperate to take care of herself and her daughter and ends up part of a sleazy corporation that is clearly manipulating people for sales. While she does great at first, things start spinning out of control.

Yates told Time that Liza’s characters was emblematic of the type of people who ended up in the sales force for Insys.

“It was made up of young people who were often in over their head and they were hungry for success and a lot of that is embodied in her,” he explained.

Who is John Kapoor in Pain Hustlers?

The eccentric, germaphobic Jack Neel (Andy Garcia) is probably a version of Kapoor, but as the name change indicates, he’s also a fictionalized character.

And Chris Evans’ Pete Brenner is most similar to one of the protagonists in Hughes’ article, Alec Burlakoff. In the movie, Pete meets Liza at a strip club where she’s about to lose her job; in Hughes’ article there is mention that Insys hired a “former exotic dancer.”

Was there a single mom with a daughter in the Insys story?

The actual events in Pain Hustlers are similar to the article, but the fictional characters create opportunities for dramatization. In one major plot point of the movie, Liza’s fictional daughter has epilepsy and a brain tumor. This give some context to her decision making and what quiets her conscience as she comes to understand exactly how badly she’s scamming people. And it connects her selling the drug to actual drug use in a personal medical situation.

Liza’s existence also created a new character played by comedian Catherine O’Hara, her mother Jackie, who eventually becomes a sales rep, too.

“I’ve always been fascinated by salespeople and what they do and the moral side of the pharma industry when they’re hustling to make money,” Yates told Entertainment Weekly. “Elements of the story are obviously consistent to what Evan Hughes documented in his book, but we created Liza Drake, we created the relationship she has with her daughter, Phoebe, just as a way of allowing the audience to connect with a single character and carry us through the story.”

Yates has made clear that “this isn’t the Insys story in detail at all.” He explained, “It’s inspired by that—the fringes of that industry and how they exploit one very marginal sector of the healthcare industry and make a fortune out of it.”