Letter to the editor: Response to The Spectrum's article, ‘Questionable business practices cast shadow over UB donor’s pharmaceutical legacy’

As a friend of Dr. John Kapoor’s and as someone who has spent the last 20 years in the field of substance abuse prevention (currently chairing one national organization and another state-based organization dedicated to those issues), I wanted to respond to Sarah Crowley’s April 26 article, “Questionable business practices cast shadow over UB donor’s pharmaceutical legacy.”

One of the tasks I have been involved in over the years is ensuring the media understands the facts, language, and true issues involved in substance abuse. And while I applaud Ms. Crowley for her attention to the current opioid epidemic, she is in good company with a great many professional journalists in conflating several complex issues involved in what I believe is crucially important to straighten out. This country does, indeed, face a massive opioid overdose crisis right now, but it will not be addressed if we do not understand its causes and, at the same time, if we try to affix fault or blame on issues, people, and institutions that have little to nothing to do with the crisis. Again, given the interchangeable language involved in such issues and the complex nature of the crisis, it is easy to conflate and confuse the problems we face, but it is more important we get them right so we can address them.

Thus, if I may address the errors in Ms. Crowley’s article in order:

1. While it is true, the company Dr. Kapoor helped found, Insys Therapeutics, manufacturers a prescription opioid, Subys, that prescription drug is not the source of the opioid crisis we read about or see on television. To begin with, as Professor Mark Kleiman of New York University and one of the nation’s top experts in drug policy put it recently at a forum at Arizona State University: “[Subsys] is a perfectly ordinary opioid….there are fentanyl deaths in this country….the stuff being made in China is not the Insys product, to blame the manufacturer [Insys] is pretty absurd.”

In other words, when we speak of the opioid crisis and overdose deaths in this country, it is important to realize, most of those deaths come from illegal drugs—e.g., heroin and illegally manufactured and smuggled opioids that bear the name “fentanyl.” The fentanyl overdose deaths we read about overwhelmingly do not come from legally prescribed and manufactured products, like Subsys.

Indeed, from a pure numbers perspective, the actual contribution of Subsys to the opioids being used by patients is so low as to practically require a microscope to find its prevalence on a pie chart—Subsys has .01 percent market share of the legal opioid prescription market. And to obtain a prescription for Subsys is not an easy thing: As mandated by an FDA dictated program, physicians who prescribe Subsys must go through several steps of particularized training and follow up certifications to provide this drug to those requiring the product. It’s simply not like prescribing any other drug, including far more well-known opioids like Vicodin or OxyContin.

2. While it is true, as Ms. Crowley writes, that several, former Insys representatives have been “charged” by the Department of Justice with unethical sales practices, four things are important to note (all of which can be gleaned from the public disclosures of Insys): i) those activities in question occurred several years ago and involve former employees of the company, ii) Insys has been working and cooperating with the Department of Justice in an attempt to ultimately resolve these matters, iii) Insys does not sell its product directly to patients so the alleged unethical sales were to physicians, not the public (again, see above, where physicians must go through rigorous protocols to prescribe the Insys product), and iv) while the allegations against these former employees are serious, they are, for now, allegations and each individual deserves their day in court. I know it is difficult sometimes but it would be far better if the media and public in general wouldn’t jump to conclusions about the other people associated with Insys, including Dr. Kapoor, based on the alleged unfortunate actions of others.

3. Finally, while I have never taken Subsys and hope never to need to, it is an important and legitimate drug on the market for those suffering terrible and often end-of-life pain, due to cancer. For those who suffer such breakthrough pain and could not find any relief from any other practice or product, Subsys is seen as a godsend. Helping the suffering, I would think, would be something the University of Buffalo would very much want to honor, and to the degree Dr. Kapoor and his family have deemed it important to help the University of Buffalo teach and train more students, he should be thanked—not disparaged.

Thank you for allowing me to respond to your article—I do so, again, not only as a friend of Dr. Kapoor’s who has seen his charitable work, but, moreover, as someone who hopes more journalists can report on the opioid crisis accurately as the issue requires it. I can help explain any of this further, I am happy to do so.


Seth Leibsohn

Phoenix, Arizona