Scripts and the City

As New York City’s special narcotics prosecutor, Bridget Brennan has seen the city’s drug habit shift from the needle to the crack pipe to the prescription pad.

Bridget Brennan loves New York.

That’s the essential point here. No matter what other themes enter in — and there are a lot of them: law, politics, medicine, public health — hers is essentially a love story, albeit one between a woman and her adopted hometown.

“The people in the city are phenomenal,” says Brennan ’77, JD’83. “Of course, not everybody — but [New York] doesn’t have a scary heart. It’s got a big heart, with a hugely diverse population. If you approach it with the right attitude, it’s just a wonderful place.”

But the love at the center of Brennan’s story is a codependent kind of love. New York has a drug problem — and it’s had one for decades, since long before she first came to the city in 1983. It’s become Brennan’s job to help the city break that habit, using the various tools that the law offers. She’s the city’s special narcotics prosecutor, a role she’s held since 1998. As with many labors of love, her work is complicated, it’s frustrating, and it often seems quixotic.

The problem that vexes Brennan these days is the script — prescriptions for opioids, in particular, those sold illegally. New York, like the rest of America, has a growing taste for narcotic drugs such as oxycodone (sold as Percoset or OxyContin) and hydrocodone (the main ingredient in Vicodin). In 2007, she notes, New York had about half a million prescriptions for oxycodone variants. By 2010, that number had doubled to 1 million, and in addition, the city had a further million prescriptions for hydrocodone.

“That’s not pills,” she says. “That’s prescriptions: a million prescriptions for a city of 8.5 million people, and many of those people are children.”

If the prescriptions are all justified, it would indicate nearly a quarter of the city’s population suffers from chronic, severe pain. That doesn’t seem likely.

“Clearly,” she says, “there’s a huge surplus [of opioid drugs] out there.”

Since 2011, her office has increased its concentration on the special problems of prescription drug abuse. She’s indicted five doctors whom she believes were running “pill mills” (thinly disguised drug-dealing operations), as well as a dentist and a podiatrist, and pharmacists, office managers, and others.

Still, this is not how Brennan would like to spend her time.

“Truthfully, from where I sit, it would be preferable if the regulatory agencies and the [medical] profession managed this problem,” she says. “It shouldn’t be me. I’m a prosecutor. … As law enforcement, we come in with very crude tools. But we have a big responsibility for public safety. When everybody else fails, that tends to be when law enforcement steps in, with its heavy-handed approach.”

New York’s prosecutorial system is decentralized, with each of the city’s five boroughs having its own elected district attorney (DA). In 1971, the state’s legislature decided that the growing narcotics problem required a unified, citywide approach and so directed the creation of the Office of the Special Narcotics Prosecutor. Functioning as a sort of sixth DA, the office is appointed by and responsible to the five borough DAs, but maintains its own budget ($16 million in 2010) and an independent staff.

The first attorney to lead the office was Frank Rogers, appointed in 1972. In that same year, Brennan enrolled at UW–Madison. A Milwaukee native, she had no intention then of moving to New York or becoming a narcotics expert, or even an attorney. Her goal was to write, like her father, Gale Brennan, author of such children’s books as Gloomy Gus the Hippopotamus and Emil the Eagle. She studied journalism and took on freelance work as a stringer for the Milwaukee Sentinel and the Waukesha Freeman. After graduation, she became a television reporter at WEAU in Eau Claire. Her decision to attend law school had more to do with improving her career as a TV reporter than with fighting crime.

“I was covering a lot of court cases in Eau Claire, and I realized I had no idea what I was talking about,” she says. “I think at one point I said [a defendant was] ‘released on his own reconnaissance,’ rather than recognizance. I really didn’t understand the system well enough to report on it. … And I thought I could control my own destiny if I developed a specialization in law. I could make it into a larger market in a city where I wanted to be.”

At the UW’s Law School, Brennan studied under Frank Tuerkheimer, a former U.S. attorney, and she came to see the power and influence that a prosecutor wields. Whereas judges and defense attorneys have important roles, it’s the prosecutor who controls which people are indicted and how they are charged. “You exercise a tremendous amount of discretion,” she says. “You’re much more of an activist, and that appealed to me.”

Tuerkheimer, a friend of Manhattan district attorney Robert Morgenthau, nominated Brennan for a job as an assistant DA. Her first view of New York was not favorable.

“There was carnage — car carnage — to the left and the right: abandoned, burnt-out cars and tires,” she says. “It all just looked dilapidated, miserable, and frightening.”

She impressed Morgenthau, who offered her a job. She accepted — then “cried all the way home,” she says. But in time, she found that New York was more than concrete and wrecked cars. Strangers and friends showed her where to find trees and where to exercise. And the law offered widely varied challenges.

As a prosecutor in America’s largest city, Brennan has seen successive waves of drug epidemics wash over New York: heroin, crack, and now scripts. “Each new substance gives me a headache,” she says. “And the next problem will come at us from an entirely unexpected source, just as they all have.”

Still, the job also offers Brennan a chance to improve the city she’s adopted.

“When I look at New York City,” she says, “the New York City I see now, compared to the one I came to in 1983, is in a much better place, much better for all of its citizens. And some of that was reining in the drug problems that we suffered through. And I have great confidence in the city and the people who are working on this issue that we’ll rein this one in, too.”

Talking Smack

To understand Brennan’s concern about the rising illegal trade in prescription narcotics, it helps to understand the history of heroin, one of the first opioid drugs.

A brief vocabulary lesson: though the terms are often used interchangeably, opiate and opioid mean something slightly different. Opiates are the natural alkaloids of the opium poppy. They include morphine, codeine, and thebaine. Opioids are synthetic narcotics that act like opiates — in particular, like morphine. Opioids include heroin (derived from morphine), oxycodone (from thebaine), and hydrocodone (from codeine).

Heroin wasn’t invented to be a highly addictive, highly dangerous illicit substance. Rather, its creator’s goals were quite the opposite. When C.R. Alder Wright, a chemist working in a lab at St. Mary’s Hospital Medical School in London, first synthesized the drug, which he called diacetylmorphine, he was looking to create a less addictive alternative to morphine, the dangerous properties of which were already becoming well known. Wright gave up on diacetylmorphine when the drug wasn’t working as hoped. But the German chemical firm Bayer — best-known now as makers of aspirin — rediscovered diacetylmorphine and gave the drug the trademark name Heroin (implying its “heroic” properties) and marketed it as a cough suppressant, pain reliever, and cure for morphine addiction.

Soon, however, it became clear that the improvements made heroin not less potent than morphine, but more so, and consequently more addictive. The federal government estimated in 1914 that there were 200,000 opioid addicts in the United States, better than one in 500 Americans. That year, Congress passed the Harrison Narcotics Tax Act, the first federal anti-drug law, to control the sale and distribution of heroin and other opium- and cocaine-based drugs.

Heroin was also the impetus for the U.S. “War on Drugs” — declared by President Richard Nixon in 1971 — and for the creation of New York City’s Office of the Special Narcotics Prosecutor. In that year, the city was believed to be the entry port for 90 percent of America’s heroin. It was the only urban area in the world in which heroin overdose was the leading cause of death for people between the ages of fifteen and thirty-five.

Four decades later, pharmaceutical firms are still working to find ways to relieve pain without getting patients hooked. Oxycodone, for instance, was developed in Germany in 1916, after Bayer ceased production of heroin, and hydrocodone was invented in 1920. Still, both can lead to dependence. According to some equinalgesic charts, which compare the strength of different pain relievers, hydrocodone is about 60 percent as potent as oral morphine, and oxycodone equally or even twice as potent.

Through much of the twentieth century, use of these drugs was rare. “Until the 1990s, doctors were loath to prescribe [opiates],” Brennan says, “until they were convinced by the pharmaceutical companies that they could be prescribed for chronic pain.”

Prescriptions for both oxycodone and hydrocodone increased significantly through the 1990s and 2000s, according to the National Institute on Drug Abuse (NIDA), from about 76 million prescriptions nationwide in 1991, to about 210 million in 2010. At the same time, the rate of deaths due to accidental drug overdose spiked, from around 2 per 100,000 Americans each year, to more than 9 per 100,000. The White House’s Office of National Drug Control Policy notes that prescription drugs account for nearly a third of all illicit drugs consumed in the United States. Remove marijuana from the equation, and illegal drugs obtained through scripts total more than all other illegal drugs combined.

This rise in opioid use over the last decade caught Brennan’s attention.

“We had regular meetings with the treatment providers to discuss emerging trends,” says Brennan. “And during these discussions, they uniformly talked about prescription drugs, particularly among young people and middle-class people.”

Further, prescription drugs began showing up in large volumes in police seizures of other illegal narcotics.

“There are these call-up delivery services,” Brennan explains. “You can call up and order a bag of marijuana, and I’ll get a gram of coke, and da-da-da. Well, we’d seize prescription narcotic drugs from those delivery services. We were seeing it in all sorts of unlikely places.”

Though the drugs are getting out into the same trafficking circles, these prescription drugs present different public health challenges than other illegal substances. For instance, Brennan believes that addictions to prescription drugs are particularly difficult to overcome, as the drugs are available at pharmacies, and they carry the stamp of approval from doctors.

“Our approach in this country has been a pill for this, a pill for that,” she says. “As long as we have that approach, we’re going to keep having these kinds of problems. I mean, the proposed solution to the opioid problem is yet another pill, suboxone.”

But not all addicts want treatment to wean themselves off of narcotics. The rise in prescription drug abuse appears to be leading to a resurgence of heroin use.

“That’s the other drug we’ve seen a spiking demand in,” Brennan says. “We’ve seen a big increase in heroin seizures in our city. People become addicted to the opioid prescription drugs, and when it becomes too expensive to continue using the pills, they turn to heroin.”

Crack Downer

When Brennan started as an assistant district attorney, the heroin epidemic was near its end, and the city’s rising drug problem was with crack, which brought with it a wave of violence. In 1983, her first year at the Manhattan DA’s office, there were 1,622 homicides in New York, or 22.8 per every 100,000 residents. By 1990, that number had risen to 2,245, or 30.7 per 100,000. Crack addiction took much of the blame.

“For a relatively low investment,” Brennan says, “[street gangs] could buy cocaine and cook it up into crack vials that they sold for $3 or $5 on the street. But in order to make money, they had to sell thousands and thousands of vials. There was a lot of traffic, and a lot of violence between competing street organizations, and it was just horrendous.”

As an assistant DA, Brennan’s initial cases were small-time misdemeanors, but she quickly graduated to prosecuting homicides and sex crimes. She had to deal with what she calls the “back end” of the crack epidemic — the murders and robberies and other crimes committed by those under the influence of the drug.

“As a homicide assistant, you would go out when the police made an arrest to take a statement from the defendant,” she says. “We would wear beepers, and there were nights when I got three beeps a night.”

The cases were so numerous that the police had little time to follow up their investigations, and victims and witnesses had to be cajoled into testifying. Prosecution became nearly impossible in the flood of crime and violence. “You couldn’t get witnesses in [to testify],” she says. “Even if your witnesses were cops, you couldn’t get them in. Everybody just had a finger in the dike.”

But it wasn’t a murder case that had the deepest effect on her; it was a lost child.

“Probably the saddest case I had involved a four-year-old girl who had been found wandering in a housing project by housing police,” Brennan says. “She was turned over to foster care, and when the foster mother was giving her a bath, she noticed bleeding from the vaginal area. A lot of bleeding.”

The girl’s mother had left her with a man while she went to smoke crack. The man, also high on drugs, had sexually abused her. To prosecute that man, Brennan had to present a case to a grand jury within five days, but the mother never showed up to give a formal statement, and neither did any other witness.

“I went to the hospital trying to get the hospital records for the girl,” Brennan says. “Remember, this is before DNA evidence. [The girl] couldn’t testify; she was too young. And I went in to see her at the hospital, and there was nobody there. I mean there was no mother. There was no foster mother. No nothing. And it just brought home to me the destructive nature of that particular drug. One of the strongest human bonds is that maternal instinct, and how that mother could walk away from her child, I’ll never know.”

In the late 1980s and early 1990s, Brennan felt “utterly defeated,” as the effort to clean up the effects of New York’s narcotics problem seemed impossible. But instead of giving in to despair, she decided to move from the back end of narcotics cases to the front, aiming to stop the damage by attacking the problem closer to its source.

“What you always want to do,” she says, “is turn off the spigot at the highest level, turn off the flow. To the extent that there’s a surplus of addictive drugs out there, there are going to be more addicts.”

Brennan switched from the Manhattan DA’s office to the Office of the Special Narcotics Prosecutor in 1993, rising to the office’s second-in-command in ’95 and to the top job in ’98. In fifteen years, she’s expanded the office’s efforts to investigate money laundering and gangs, and she helped create a drug diversion program for non-violent defendants.

As the crack wave subsided through the 1990s, the challenges to her office changed, but the ultimate goals are much the same: to protect people from the consequences of addiction.

“It’s tough to get people to take the pill epidemic seriously,” she says. “All the consequences that were so clear with crack are not as clear with the opioid drugs. Crack users were impoverished, and so the spiral downward was quick. In the prescription-drug arena, the people using have a better social safety net, so the consequences are less apparent and seem less urgent. But the sad stories are just as sad.”

Pill Mills

According to Brennan, the prescription drug problem differs from previous drug epidemics in several ways. The addicts tend to be members of the middle class, for instance, and those selling the drugs often aren’t street dealers but physicians.

Brennan doesn’t want to limit doctors from giving legitimate pain relief to patients in need, but she’s found that it’s not hard to spot offenders. As the attorneys in her office have looked into the rise in prescription drug sales, they’ve found that the drugs are often being sold by doctors whose offices were little more than what she calls “pill mills” — drug-selling operations disguised as clinics.

“There was one case we looked at because there were community complaints about lines of addicts outside the door of the clinic,” she says. “And we looked at that doctor’s practice, how much he’s prescribing, and [we] also went to the medical examiner’s offices and obtained the names of people who had overdosed, and compared them against this doctor’s patient list. We saw that sixteen of his patients had overdosed and died during the two-year period we were looking at. We talked to medical experts who told us that even one patient overdosing and dying is a lot. So sixteen is way over the top. So we knew he was a public health risk.”

A closer investigation found that the office maintained a price list for prescriptions: $125 in cash for an opioid prescription for an ordinary patient; $250 for patients whom the office regarded as “complex” — that is, who had multiple opioid prescriptions in a month or whose prescriptions were above a certain number of milligrams.

“Clearly he was just selling prescriptions,” Brennan says. And that’s the kind of physician she and her office are targeting. “We’re not going at [doctors in] the gray area, where you might quibble about what criteria they might use or how much they’re prescribing, but the blatant selling of prescriptions.”

The role of doctors, and the implied authority they bring, has made fighting prescription drug crime difficult. Those who become addicted often don’t realize what they’re getting themselves into.

“We find many accidental addicts to opioid prescription drugs,” Brennan says. “With crack, it has a big stamp of society’s disapproval and society’s fear. It’s illegal. What could be more clear than that? Crack and heroin have that written all over them. The opioid prescription drugs, not so much.”

John Allen is senior editor of On Wisconsin.

Published in the Fall 2013 issue