A Fish Named Heather: Another casualty in the drug wars

We have had a crazy drug policy in the U.S. since 1914, and we dictate it to most of the world. The War on Drugs is masterfully covered in Johann Hari’s important new book, “Chasing the Scream.”


Easy Prey

The small players in the drug wars are easily entrapped. Witness the sad case of Heather Alfonso, a Connecticut nurse practitioner who has been indicted for getting kickbacks from Insys Therapeutics, the maker of the powerful pain medication, Subsys. Ms. Alfonso is being pilloried while thousands of physicians give worthless CME lectures on medications every day in the U.S. She was a dupe to her handler (a PhARMA product manager) in the company’s attempt to push a legal, but tightly controlled narcotic analgesic. I suspect Alfonso may well be a fine person who was corrupted by easy money, as so many others have been. Her life is now ruined, and she probably helped hundreds of chronic pain patients. As a payback for her testimony against Insys, she will likely get a reduced sentence, but what about her career? I know scores of physicians who have fed off this same gravy train for decades.

Insys Therapeutics was following the proven business plan pioneered by Purdue Pharmaceuticals and the Sackler family in their promotion (a.k.a. pushing) of Oxycontin around 15 years ago. Barry Meier’s brilliant and sobering book “Pain Killer” discusses that program in great detail.

The marketing of powerful opioids is a hugely profitable business and the cost of litigation for companies like Purdue and Insys is just the price of doing business. Sadly, it is bit players, like Ms. Alfonso, who pay the heavy price while the amoral crooks that run these rogue PhRMA firms are pulling down huge salaries with generous perks and their products continue to proliferate.

We should hear from Ms. Alfonso’s patients at the pain clinic to find out who she is. How can we judge her adequately until we learn about her as a pain professional? Physicians and others who treat pain skate on thin ice because of our country’s moral stance towards those who suffer chronic pain. It’s time to reconsider that.


The Subsys Case, NY Times
Heather Alfonso, an advanced nurse practitioner, was being paid by Insys for speaking engagements, even though many times the only other person in attendance was an Insys sales representative, or friends and colleagues who had no authority to prescribe the drug. This is really funny.

Ms. Alfonso, as an advanced practice registered nurse, is authorized to prescribe medication to patients, and was responsible for more than $1 million in Medicare claims and was the highest prescriber of Subsys in Connecticut.



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