The world of Pain Hustlers is outrageous — full of hucksters and con artists, all operating within the thin set of boundaries that they consider the law. “Is that even legal?” Emily Blunt’s Liza Drake asks Pete Brenner (Chris Evans) at one point in the film. “67 in a 65!” he snaps back. In other words: Not quite, but let’s do it anyway. 

It’s that Wild West attitude that initially attracted screenwriter Wells Tower to the project. When he was sent a New York Times article by Evan Hughes called “The Pain Hustlers,” Tower was shocked by the out-in-the-open nature of the pharmaceutical industry’s failures. Pain Hustlers depicts a surprising ecosystem where pharmaceutical reps find it astonishingly easy to rig the game, funneling bribes for doctors through “speaker programs” and getting medication (like the fictional Lonafen) prescribed without understanding the risks.

Brian Douglas/Netflix

“I found it mind-blowing that these people, who for the most part have no medical training, have so much influence over the medications we’re prescribed,” Tower told Netflix earlier this year. “I knew we had a story on our hands that could offer some really shocking insights into how American medicine works.” Tower set out to fictionalize the pharmaceutical world, without losing the stranger-than-fiction true story that attracted him in the first place. 

When Harry Potter and BAFTA Award-winning director David Yates joined the project, things really came together. Yates was drawn to the same parts of the story as his screenwriter, and excited to bring the characters of Pain Hustlers to life. “I was intrigued by the pharma world, particularly the low rent end of it, the workaday reps and sales teams striving to make a living in a hugely competitive business of dealing with people’s pain,” Yates said. 

Brian Douglas/Netflix

Is Pain Hustlers based on a true story?

In Pain Hustlers, those workaday reps would be represented by a team of salespeople at the fictional Zanna Therapeutics company, fronted by Liza and Pete. “We gave Wells license to create his own unique version of people,” Yates said. “And Liza was our invention, a single mum with a daughter struggling with health issues, a dreamer, undervalued but incredibly capable.”

That dichotomy between reality and a character arc teased out of reality rang true for Hughes’ work as a journalist as well. “When you do what I do, you’re always looking for two things in an idea,” he said. “The article has to be about some issue of wider cultural resonance, in this case, pharma’s role in the opioid crisis. But the other dimension you’re looking for is a human story.”

Brian Douglas/Netflix

What is Lonafen?

The drug Zanna Therapeutics is pushing is called Lonafen, a fentanyl-based medication that delivers pain relief quickly to patients suffering from cancer. Developed by Dr. Jack Neel (Andy Garcia) in the wake of his wife’s death, the drug is soon being used not just for cancer patients, but for just about anyone who asks.

Brian Douglas/Netflix

Who is Liza Drake?

The team found their human story in the fictional character of Liza. “[Emily and I] were both drawn to a human being who’d been undervalued, underestimated, who’d missed all those opportunities, hadn’t done particularly well at school, but who was nonetheless incredibly capable, very empathetic, very in tune with other people,” Yates said. 

That empathy only goes so far, unfortunately. Liza’s journey takes her deep into the dark heart of the industry she bluffs her way into, and she’s ultimately complicit in Zanna’s victimization of addicted patients. “The arc of Liza’s journey is the classic rags-to-riches one, but because she succeeds by navigating a particularly tricky moral maze, her rise is ultimately bittersweet,” Yates said. “In the case of this story, unless the system is properly policed, and you’re playing by certain rules, you can hurt people.”

Betina La Plante/Netflix

Was there a real pharma rap?

While character arcs may be fictionalized, some details of Pain Hustlers were too wild to make up. The filmmakers pulled from the facts documented in Hughes’ article (and later, the 2022 book that expanded upon his reporting). One scene in particular, a memorable rap performed by Pete at a pharmaceutical conference, has its roots in a real video created by Insys Therapeutics. 

Evans hurled himself into the performance with typical bravado. “His clean-cut, alpha male, heroic demeanor is completely turned on its head when you cast him as a sleazebag pharma sales rep,” Yates said. “Chris is like an athlete. And I don’t just mean physically, but in terms of his commitment to the role. He is on set first thing, and he’s very present, always driven, always wanting to do the best.”

What happens at the end of Pain Hustlers?

Of course, Pete’s story doesn’t end happily. Pete and Jack are slapped with prison time for their bribery scam, with Liza testifying against them. It’s a redemptive moment for the film’s fictional protagonist, although the filmmakers leave the door open as to just how much she can really make up for. 

“She lost control, and through her greed and desire to be valued, she hurt people, but by the end of our story, she knows within herself, she needs to be held to account,” Yates said. “I always thought this movie was ultimately a kind of parable of the American dream and what happens when it goes badly wrong.” 

Pain Hustlers is streaming on Netflix now. 

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