Pain Hustlers (2023) Ending Explained – Did Liza Drake go to jail?

Pain Hustlers Plot Summary

Netflix’s new big-pharma entertainer stars Emily Blunt and Chris Evans in central roles. The film’s culmination is a powerful reminder of how ruthless and unforgiving the path of greed can be. Director David Yates and writer Wells Tower use opioids as a metaphor to fuel their narrative about a working-class lady with no formal education making big waves selling addiction to the vulnerable. Perha[ps that characterization is too harsh but it essentially represents what Pain Hustlers is really about.

In this piece, we delve deeper into the plot of the film, explaining the major incidents that defined it and also the ending which was all about setting things right. Fair warning; spoilers ahead! 

Pain Hustlers is the story of Zanna Therapeutics, a failing pharma company with a wonder drug, Lonafen. It promises revolutionary change in the treatment of cancer patients. The firm’s proprietor, Dr Jack Neel, offers it as holy water that can dispel patients’ pain within minutes. And, without any lasting side effects. However, Zanna doesn’t have enough money to market it and is preparing to file for bankruptcy. In walks Liza Drake, a part-time stripper, and full-time mother with very few choices or education in life. 

Liza’s promise is immense and Pete Brenner, the effective CEO of the company, spots her talent for smooth talking. He also senses that Liza’s resilience and never-die attitude are exactly what they need to springboard Lonafen into national prominence. Lo and behold, Liza’s determination and grit works wonders. Doctors gradually start prescribing the drugs to their patients, even if it takes some amount of rule-bending on Pete’s part. Sales are great and so are the commissions, enabling Zanna to launch the most successful pharma IPO in years.

However, this unprecedented success brings upon Neel’s erratic behaviour that sees him grow circumspect and guarded. He is also encouraged to go down a path of self-destruction that unravels the dark side of the drug on patients. 

Is Pain Hustlers based on a true story?

Well, partly yes. But not exclusively. Pain Hustlers is inspired by the real-life pharma firm Insys’ drastic downfall. The firm introduced a new drug called Subsys for the treatment of pain in advanced-stage cancer patients. But eventually, the firm went off track and started encouraging doctors to prescribe large doses of the drug to patients for off-label uses. The film takes a swipe at the general opioid crisis that has bolted the US and Canadian regions since the 1990s when they became abundant. 

How did Dr Neel end up destroying the future of his company?

Dr Jack Neel became overly ambitious after tasting unprecedented success with Lonafen. He started going out of bounds of the law with more confidence and defiance. In a pivotal move, he ordered Liza and the other sales reps, through Brenner, to bribe doctors to prescribe the drug “off-label.” This essentially means that even though the drug is meant to be prescribed to cancer patients, doctors would now be encouraged to give it for even simpler things like joint aches or headaches. 

“Pain is pain” became their new motto. Liza knew exactly what they were getting into but could do little about it. Her stocks in the company vested only in November, which was a few months away. She was trapped but had to follow the dictum. She tried to warn Dr Lydell, her first capture and the poster boy of Lonafen in the region, about the consequences. But the German was only interested in making more money off the backs of his poor, unsuspecting patients. 

We had earlier seen another pharma firm, Proxima, go bankrupt for using this exact same tactic. The Feds were all over their business and most of its high-ranking officials who, after knowingly participating in the scheme, went to jail.

Why did Liza want to trade her stock to Dr Neel?

Liza knew the company would not survive the date her stock options were vested in. Since Phoebe had epilepsy and the doctors made it clear she had to get surgery, Liza made this desperate move. She did not have that much money liquid to afford the surgery since her insurance would not be covering the procedure. That coincided with the testing situation the firm found itself in and Liza went to Neel to ask that he buy some of her stock options.

Although Neel absurdly rejected her pleas, Liza eventually arranged the money. It remains unclear what she did exactly. However, Phoebe did undergo a more invasive procedure that was not covered by insurance. Neel cited his bizarre experience of feeling more motivated when his own wife fell ill – and later died – and asked Liza to go through the same.  

Ending Explained:

How did Jackie’s affair with Neel prove to be his downfall? 

Liza was feeling very guilty for the death of Sidney, the neighbour from the motel. She had earlier seen him at Lydell’s clinic and then saw his name against “Deceased” in company records. The deaths due to Lonafen were rocketing. The drug’s misuse and abuse by doctors and patients exposed its dark side. Liza decided to go to the Justice Department to blow the whistle on the firm’s malpractices. She is warned at the first meeting that they would need hard evidence against Neel to prove his involvement in the schemes.

However, Neel’s choice to stay away from daily operations in any documentation proved to be insurmountable. His name and signature were not on anything to prove his knowledge. He used to run everything by Brenner, who would then shred the paper evidence and pass on the instructions to the other employees. Jackie reveals that Neel replied to her emails once when she wanted more money and a promotion. In the emails, she explicitly referenced payout amounts and used the word “bribe money,” so, while Jack didn’t ultimately acquiesce to any of Jackie’s requests, the emails proved his legal defence claiming he had no knowledge of or involvement of Zanna’s business decisions was a lie.

What did Elliot Hartigan say about Lonafen?

Brenner referred to the Hartigan study at Massachusetts General to explain the drug’s credibility. The movie ends with a brief clip of Elliot, its inventor, explaining the possible side effects. The study only related to clinically controlled doses to opiate-resistant stage 4 terminal cancer patients. That setting is pivotal in negating the risks on paper.

Since stage 4 patients have almost zero life expectancy and chance of recovery, the risk of adverse effects from overdosing is virtually eliminated. Before they could witness such effects in patients, they’d be long dead. Also, the off-label use meant it was present in vast quantities in the patients’ bodies, which might have led to many of them overdosing. 

Using Opioid as a metaphor for Power

The opioid crisis is used as a powerful narrative tool by Yates and Towers to represent a similar addiction to greed. Just like the patients could not control themselves and ended up begging for more of Lonafen, Neel, Brenner, and the others, who purported to have the best interests of suffering patients at heart, could not resist the opportunity to exploit them. Dr Lydell’s veiled threat to Liza, just before he is arrested, is a manifestation of that greed. The addiction to power and money is as detrimental to human life and civil society as any other. 

Liza’s final fantasy during the ending of Pain Hustlers is an appropriate gesture to show how she moved past her power frenzy. The little humanity that was left in her forced Liza to do the right thing and whistle blow on the entire operation so that no more lives were hurt.


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