I actually like using the revolvers over the colt for some reason <| sep |> Soft paywall , here is the complete textPART 1 Before they were arrested last year , Alabama doctors John Couch and Xiulu Ruan were prized customers of Insys Therapeutics Inc . , maker of a powerful and highly addictive type of synthetic opioid known as fentanyl . Drs . Couch and Ruan prescribed a combined $ 4 . 9 million of the painkiller , called Subsys , to Medicare patients in 2013 and 2014 , among the most of any doctors in the U . S . , federal data show . Insys , based in Chandler , Ariz . , went to unusual lengths to keep these highprescribing doctors happy . Insys Executive Chairman John N . Kapoor , the company ' s billionaire cofounder , personally traveled to Mobile , Ala . , to attend a business dinner with them , said people familiar with the matter . The doctors were also frequent speakers and consultants for Insys , which paid them $ 270 , 700 in combined fees over 21 months , according to government data . Many of those fees were bribes paid by Insys to reward the doctors for prescribing large quantities of Subsys , federal prosecutors allege in a 22 count criminal indictment filed in Mobile against the doctors this April . Overall , the pair wrote more than a quartermillion prescriptions for fentanyl , oxycodone and other controlled substances including Subsys over five years , some of which were abused by addicts or diverted to drug traffickers , the indictment alleges . The doctors deny the allegations . Insys declined to respond to specific questions for this article but said in a statement that it is committed to working with the health care community to help ensure the proper prescribing and use of our products . The company itself hasn ' t been accused of any crimes . Fentanyl , an opioid drug up to 50 times as powerful as heroin , is helping to fuel an addiction crisis in America that killed 29 , 500 people in 2014 . Most of the illegal use involves street versions of the drug , which can be quickly made from chemical ingredientsoften imported from Chinaand pressed into pills or cut into heroin . But prescription fentanyl is an increasing focus of lawenforcement authorities , including Subsys , a mouthspray form approved for treating severe pain . Just a handful of doctors , many with close ties to Insys , are responsible for outsize levels of prescribing of Subsys , according to a Wall Street Journal analysis of government databases , court documents and interviews with former company employees . Of the top 20 physicianprescribers of Subsys to Medicare patients in 2014 , more than half were also among the 20 largest recipients of consulting and other fees from Insys that year , a Journal analysis of recently released federal data shows . Federal and state prosecutors and regulators in more than 15 jurisdictions are investigating Insys ' business practices or doctors with whom Insys has ties , the company has said in financial statements . Two former Insys employees charged with participating in a kickback scheme allegedly helped feed this devastating surge of opioid addictions by tapping into another ageold addiction , greed , U . S . Attorney for the Southern District of New York Preet Bharara said in a statement announcing the charges in June . The two former employees have pleaded not guilty and declined to comment . In its statement , Insys said it is committed to complying with all laws and regulations that govern our products and business practices , and it has designed a compliance program and protocols that strive to ensure that our employees are properly trained , monitored , and disciplined consistent with industry standards and applicable laws and regulations . Florida ' s attorney general is investigating the company for potential violations of the state ' s civilracketeering laws , according to a subpoena sent to the company and reviewed by the Journal . Among the documents requested in the subpoena are communications by Dr . Kapoor and other executives regarding the company ' s use of doctors to promote Subsys at speaking events . Last month , federal prosecutors in Boston arrested the former head of Insys ' reimbursement unit , alleging she oversaw and encouraged widespread fraud in obtaining payment for Subsys from pharmacybenefit managers . Subsys is one of several fentanyl drugs that are absorbed through the mouth or nose . The delivery method allows for fentanyl ' s painrelieving and euphoric effects to take hold rapidly , but also significantly raises the risk of addiction , overdose and death , says Lewis Nelson , chairman of emergency medicine at Rutgers New Jersey Medical School . It is approved by the Food and Drug Administration for the treatment of extreme cancer pain . Because of the dangers , the FDA requires that the drugmakers enroll doctors , pharmacies and patients in a database . Doctors must pass an exam on the drugs ' risks . If you ' re going to die in a few months , you should be getting a medication that works really well and even carries danger , but if you ' re going to live another 30 years , the riskbenefit changes a lot , says Dr . Nelson . Doctors are largely free to prescribe drugs as they see fit , and the majority of Subsys sales have come from patients without cancer , according to people familiar with the matter . For some , the consequences were dire . In February , a pharmacy shipped a month ' s supply of Subsys to a man in his early 30 s who was prescribed the drug for back pain . He broke open the spraycontainers , poured the fentanyl into a cup , and suctioned it into a syringe . Within hours , he was dead . Multiple needles and units of Subsys were found around the bed the patient ' s body was found , according to an adverseevent report submitted by Insys to the FDA and obtained by the Journal with a Freedom of Information Act request . Insys is run by Dr . Kapoor , a 73 yearold pharmaceuticals executive known for applying aggressive marketing tactics and sharp price increases on older drugs . He emigrated from India to the U . S . in 1964 and received a doctorate in medicinal chemistry from the University at Buffalo in 1972 . Four decades later , the university named its school of pharmacy Kapoor Hall after the billionaire donated $ 10 million . By 1987 , Dr . Kapoor had gained control of LyphoMed Inc . , after investing just $ 50 , 000 of his own money to acquire the company . The company attracted protests after acquiring a decadesold drug being used to treat AIDS and quadrupling its price to $ 100 per dose , which activists called pricegouging . Dr . Kapoor made more than $ 100 million when he sold the company in 1990 to a predecessor of Astellas Pharma Inc . Dr . Kapoor cofounded Insys in 2002 with the aim of developing new ways to administer older drugs . It wasn ' t until 2012 that Insys won approval for its first new product , Subsys . Booming sales of the drug helped make Insys the bestperforming initial public offering in 2013 . In the summer of 2015 , Subsys represented one of every two prescriptions for rapidacting fentanyl prescribed in the U . S . , according to prescription data from Quintiles IMS Holdings Inc . Insys ' revenue of $ 330 . 8 million through the end of the year had more than tripled since 2013 . Profits had climbed 45 % to $ 58 . 5 million . The drug ' s success was underpinned by tactics that Dr . Kapoor used to great effect at his previous companies , charging high prices and employing a lowsalaried , highly motivated sales force . Insys paid its sales representatives base salaries of $ 40 , 000 , well below the industry average , but offered them the chance to make many multiples more in sales commissions . The costefficient and incentivebased model was similar to that used by Dr . Kapoor at his previous companies , Insys said in its IPO prospectus . Some Insys executives , including Dr . Kapoor , described their ideal sales people as Ph . D . spoor , hungry and dumb , said a person familiar with the matter . Last year , Insys had its 250 person sales force target 1 , 700 doctors who prescribed the majority of fastacting fentanyl in the U . S . , with a particular focus on the highest prescribers , the company said in its annual report . Successful sales reps were very wellcompensated , some making more than $ 500 , 000 annually , because they received a percentage of the total cost of each prescription their doctorclients wrote , according to people familiar with the matter and court records . The compensation structure was designed to push reps to have doctors prescribe the highest doses possible , prosecutors have alleged . New reps received 7 % of sales for Subsys doses between 100 and 800 micrograms , but received a 10 % commission for the highest doses of 1200 micrograms to 1600 micrograms , according to the company ' s fourthquarter 2013 compensation plan , which was obtained by the Oregon attorney general and reviewed by the Journal . The tiered commission structure was later discontinued , said a person familiar with the matter . But reps still had a financial incentive to push higher doses , because they were also more expensive , the Illinois attorney general alleged in an August civil complaint seeking to bar Insys from doing business in the state .