Drug company used rap video to push for higher doses, sales

[mahatmakanejeeves]

Source: Associated Press

Drug company used rap video to push for higher doses, sales
By ALANNA DURKIN RICHER
18 minutes ago

BOSTON (AP) — Employees at a drug company accused of bribing doctors rapped and danced around a person dressed as a bottle of the highly addictive fentanyl spray in a video meant to motivate sales reps into getting patients on higher doses.

The video was shown to jurors this week in the closely watched trial (1) in Boston of wealthy Insys Therapeutics Inc. Founder John Kapoor and four other onetime executives, including a former exotic dancer who prosecutors say was hired as a regional sales manager even though she had no pharmaceutical experience. ... They’re charged with scheming to pay doctors bribes and kickbacks in exchange for prescriptions of the drug meant for cancer patients with severe pain. Kapoor and the former other executives of the Chandler, Arizona-based company have denied all wrongdoing.

The video, titled “Great by Choice,” was shown during a national sales meeting in 2015 to encourage employees to talk doctors into prescribing higher doses, prosecutors said. ... In it, suit-clad sales reps rap to the tune of a song by the artist A$AP Rocky about titration, the process of increasing the strength of a patient’s prescription until it reaches the adequate level.

“I love titration, yeah, that’s not a problem. I got new patients and I got a lot of ’em,” they say. “Build relationships that are healthy. Got more docs than Janelle’s got selfies.” ... At one point, the person dressed up as the bottle of fentanyl spray takes off his costume to reveal then-vice president of sales, Alec Burlakoff. Burlakoff pleaded guilty in November to racketeering conspiracy and is expected to testify against Kapoor.

“What we built here can’t be debated. Shout to Kapoor for what he created,” the sales reps rap. “The competition just making noise. We’re making history because we’re great by choice.” ... The video is the latest eyebrow-raising piece of evidence in the trial, which has put a spotlight on the federal government’s efforts to go after those it says are responsible for fueling the deadly drug crisis. The trial, which began last month, is expected to last several more weeks.
....

(1) https://www.apnews.com/2e1738224798482eb1043cf1c0aca3ab

Read more: https://apnews.com/2a40fb45332e48deb89ada69e71ed6a7

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Employees at a drug company accused of bribing doctors rapped and danced around a giant bottle of a highly addictive fentanyl spray in a 2015 video meant to motivate sales reps into getting patients on higher doses.

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[moriah]

1. What ad executive thought this was a good idea, let alone the best one among others?

I will say that "titration" is actually an important topic in opiate prescribing, especially when switching between opiates -- if you don't start at a lower dose on the new opiate compared to the "average" conversion, you risk the patient not being "average" and the new drug dosage being too much/having too many side effects. At the same time, your patient may not be "average" in the other direction, indicating that it is appropriate to slowly raise doses until appropriate relief is established when switching meds. With a med like Fentanyl, active in the microgram dose, it's even more important to remember to do it right, and explain to patients that they may feel more pain at first but it's better to let them get used to the med at a slightly lower dose first.

The liver processes opiates differently, and the ones with less addiction risk are usually precursors -- the liver processes them into the actual effective medication. As everyone has different livers, it makes a difference. So especially when switching from or to a med that is more liver-affected in the range of dose, it's *extremely* important to start low and titrate up vs start too high.

[tymorial]

2. Very true and providers must also consider contraindictions between medications

Prescribers must consider active medications taken by patients because certain medications may inhibit metabolism. This is especially the case with medications as dangerous as Fentanyl. CYP3A4 is the primary enzyme by which Fentanyl is broken down to its metabolites norfentanyl and despropionylfentanyl. Antifunglas and Antibiotics inhibit as does Grapefruit (in truth you would need large amounts of grapefruit juice to see a noticeable impact but it is an inhibitor). This doesn't even consider inducers which increase metabolism and reduce overall blood levels which could lead to unmanaged pain or other conditions treated by medications which are substrates.

[dalton99a]

3. Kick