Transcription of Impacted by Addiction #283

Speaker 1: You ae listening to Love Maine Radio, hosted by Dr. Lisa Belisle, recorded at the studios of Maine Magazine in Portland. Dr. Lisa Belisle is a writer and physician who practices family medicine and acupuncture in Brunswick, Maine. Show summaries are available at Here are some highlights from this week’s program.

Dr. Mary Dowd: Not until I started working at the jail I didn’t have any sense how much addiction was affecting our population, and I started working at the jail in maybe 2008, I can’t remember, maybe 2005. I realized everybody was there, not everybody, maybe 90%, because of addiction, because of something crazy they had done while they were intoxicated or high or something crazy they had done in order to get money to get intoxicated or high.

Kate Bowley: He’s like, oh, yeah, he filled this prescription this week. I saw him. What a gift from the universe that that information was revealed to me. That started off a series of events where I discovered just how terrible it was. He actually had returned to work that day and came home and was completely high out of his mind, I could tell, I could see it.

Lisa Belisle: This is Dr. Lisa Belisle, and you are listening to Love Maine Radio, show number 283, Impacted by Addiction. Airing for the first time on Sunday, February 19, 2017. Addiction to both recreational and prescribed substances has become an epidemic in our state. We are all impacted. Today we speak with family physician Dr. Mary Dowd, medical director of the detoxification program at Milestone in Portland, about her experience treating addiction. We also speak with Kate Bowley, whose former husband died of an overdose after a work-related injury began his three year struggle with this problem. We know that this is a difficult topic and one that must be approached with care, so we appreciate your joining us.

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Lisa Belisle: It’s my great pleasure to interview today an individual I’ve really known for decades. This is Dr. Mary Dowd, who is formerly a family doctor and is now a medical director of the detoxification program at Milestone Foundation in Portland. Dr. Dowd also works for Catholic Charities in its substance use treatment program and at Discovery House in South Portland. Discovery house is a methadone clinic. It’s nice to have you in today.

Dr. Mary Dowd: Thank you Lisa. It’s nice to be here.

Lisa Belisle: You are in interesting person for me because I think it’s one of these situations where you can know someone for a really long time, and then, really, they continue to evolve as a person and you think, wow, I never knew that about them. I didn’t realize these were interests that she had. You and I both have spent time working in the Cumberland County Jail.

Dr. Mary Dowd: True.

Lisa Belisle: You have also, I believe, you were at, before when it was Pineland, when we were caring still for patients that had developmental disabilities and severe delays. I think you were the medical director over there.

Dr. Mary Dowd: I was, yes. When Pineland closed, I ran a clinic for them for many years.

Lisa Belisle: On top of that now you’re doing the work that you’re doing with Catholic Charities and also Discovery House. You’re a woman who looks for a challenge.

Dr. Mary Dowd: I like to do a lot of different things. Really, I go to what I like. I’m not looking for challenges. I’m just following what I enjoy.

Lisa Belisle: Tell me what is it about the work that you are doing now that you enjoy? This is difficult work.

Dr. Mary Dowd: I think what makes it so difficult is that there are so few services you can offer a patient with an addiction in Maine. Most of the patients, especially the heroin addicts, have lost everything. They’ve lost their homes, they’ve lost their cars, they’ve lost their families. Their families don’t want anything to do with them anymore. They can’t work so they’ve lost everything, and yet they don’t have insurance or any way to pay for services. We see that over and over again, and that’s what makes it so difficult.

Lisa Belisle: It’s clear that this is a challenge, but you told me that you go towards work that you enjoy. What does one enjoy about this type of thing?

Dr. Mary Dowd: I really enjoy the patients. I find them to be full of life. They’re survivors. They’re incredibly resilient. They survive against enormous odds. Things that you or I would not be able to fathom, like being homeless for years on end, not knowing where your next meal is coming from. No money. They make it. They make it through these days. They have a lot of creativity.

Lisa Belisle: You worked as a family doctor for quite a while in Yarmouth, a suburb where you and I both live, and I wonder if you ever had any intersections with the patients that you are dealing with now when you were in private practice?

Dr. Mary Dowd: I remember having one or two patients who had addiction problems, opiate addiction problems in private practice. I had a few alcoholics, but I’m sure I probably had many more alcoholics I didn’t know about.

Lisa Belisle: The reason I ask this question is, I remember early on in private practice myself that there were, I had the same kinds of numbers you’re describing, and now, being employed by Central Maine Medical Center but working in private practice, I have a fair number of patients who are coming through our doors who are being impacted either themselves or family situations by addiction.

Dr. Mary Dowd: Yeah. It’s huge.

Lisa Belisle: Did you have a sense that this was coming?

Dr. Mary Dowd: Not until I started working at the jail, I didn’t have any sense how much addiction was affecting our population. Then I started working at the jail in maybe 2008, I can’t remember. Maybe 2005. I realized everybody was there, not everybody, maybe 90%, because of addiction. Because of something crazy they had done while intoxicated or high, or something crazy they had done in order to get money to get intoxicated or high.

Lisa Belisle: Right now we don’t have a lot of great methods of actually helping people to get away from addiction and stay away from addiction.

Dr. Mary Dowd: We do. We don’t have the money to make it happen. It’s just not funded.

Lisa Belisle: Talk to me about this. If you have a patient that comes to see you at Catholic Charities or at the Discovery House, run me through what would be a typical scenario. How would you interview, how would you treat them?

Dr. Mary Dowd: Those are the lucky patients. Those are the ones that have insurance and can get treatment. They come and they do an intake with one of the counselors there to make sure they are appropriate for services. They see me. I do a history and physical and decide whether they are a candidate for suboxone or possibly vivitrol and then I start treating them. Those people have insurance, they often have family support. They do well. I’d say 90% of my patients who have insurance can do well either with suboxone or vivitrol or methadone.

Lisa Belisle: What is usually the lead time as far as coming in for treatment? How long does it usually take before someone hits that rock bottom place that you describe?

Dr. Mary Dowd: If they have insurance they can get into treatment pretty quickly. It’s the people that don’t have insurance that really can’t get anything. Once in a while there’s a scholarship spot in one of the programs. I think Grace Street has them, Catholic Charities has them. Other than that they can’t get anything.

Lisa Belisle: Insurance usually will cover treatment?

Dr. Mary Dowd: Yeah, insurance will cover treatment. MaineCare will cover treatment and other insurances. One thing that insurance doesn’t cover and that’s why we lost a lot of services in Maine was, private insurances decided a few years ago they wouldn’t cover detox or opiates anymore, the theory being that it’s not life threatening so people don’t need to be in the hospital for it. They don’t have any other recourse. They don’t have family doctors that can see them through it. They don’t have homes they can go to and be sick in and their mother will take care of them. They can’t detox on the streets.

Lisa Belisle: Describe that clinically. What does it look like when someone is trying to detox from opiates?

Dr. Mary Dowd: They’re very sick. It’s like the worst flu you ever had. Sweats, chills, nausea, vomiting, diarrhea, muscle aches, restlessness, they want to jump out of their skin, incredibly anxious. They know they can fix it. They can get something that will make it all go away.

Lisa Belisle: How long does it usually take to go through that?

Dr. Mary Dowd: It takes maybe five to seven days for the physical symptoms to go away, but what doesn’t go away is the craving for opiates. That can be lifelong.

Lisa Belisle: What are the differences between the different treatment options that you’ve just talked about?

Dr. Mary Dowd: Methadone, you have to go to a federally licensed clinic every day and get a dose of methadone. That has some obstacles to treatment, especially people can’t get there or they have jobs that conflict with getting there. Suboxone you can get at a doctor’s office, you can get it by prescription. It can be called in. None of those things are true for methadone treatment for opiates. Vivitrol or a naltrexone, which is the oral form of vivitrol, is a monthly shot or a daily pill.

Lisa Belisle: I know that in our group of physician colleagues in the state, more and more are getting licensed to offer suboxone in their clinics, but we still don’t have enough spots because you’re only allowed to prescribe to so many people. Is that true?

Dr. Mary Dowd: It was 30 the first year, then 100, but now it’s gone up to 275 if you’ve been in practice, I think for maybe a year.

Lisa Belisle: How is it that some doctors will decide to get a suboxone prescribing credential and other doctors won’t?

Dr. Mary Dowd: I think the doctors who see opiate addicts in their practice, maybe they’re family doctors and maybe one of the sons or daughters of a family that they’re taking care of has a problem, I think that would be an inspiration to get a license so you could take care of them. Other than that I think that doctors feel like it’s too much to do in the office. You do need a lot of structure to do a good job at it. You have to know they’re going to counseling. That’s really important. Just a pill or a shot is not going to change the way people behave. It’s very important to treat cravings, but they really need help changing behaviors as well. You need to be able to be set up to do urine dips and have a good lab that’ll interpret urine results for you. It’s not all that simple in terms of the practical aspects of it.

Lisa Belisle: I guess I’m wondering, backing up to why you’re choosing to do this, you originally came from Massachusetts, and you didn’t jump immediately into being a doctor. You had another life before this.

Dr. Mary Dowd: Right. I was a medievalist. I was in medieval studies. Yeah.

Lisa Belisle: You were a medievalist and I know you have children. You’re married to a man who is a writer, I believe.

Dr. Mary Dowd: Yeah. A teacher.

Lisa Belisle: That’s a pretty, it seems like it would be a little bit of a less messy life to be able to work in literature, but you decided to make this strong right turn into medicine. What prompted you to do that?

Dr. Mary Dowd: Having a child prompted me to do that. Not that I enjoyed labor and delivery, but it made me, it woke me up to our vulnerability and fragility, so that’s why I decided to change what I was doing.

Lisa Belisle: What was that like to try to go through an entirely new training process and take on an entirely new challenge and also be having a child around while you’re doing it?

Dr. Mary Dowd: It was a lot of work, but my husband helped me a lot, and it took a long time.

Lisa Belisle: Once you got out, you decided to set up private practice at a time when a lot of doctors were being absorbed into bigger systems. You set out and you had your own shingle in Yarmouth for a number of years.

Dr. Mary Dowd: Yeah.

Lisa Belisle: What was the decision making there?

Dr. Mary Dowd: I always liked, I think because had four kids, I always liked just being able to do what I needed to do both at home and at work. It was better for me to be my own boss.

Lisa Belisle: I had asked you a question earlier about the lead time on people who are going through treatment. You said that people can get into treatment pretty quickly. What I wonder about is what’s the lead time in a life? How long does it usually take someone, and maybe this is a question I can answer or not, before they finally get to the place that they realize that there’s nothing left. There’s no other option but to go into treatment?

Dr. Mary Dowd: Let me just back up a little bit on that question. People who have insurance and support can get into treatment pretty quickly. The patients that I see at Milestone, it’s years, years, and years before they can get any treatment. As far as lead time overall on addicts getting into treatment, it’s usually about 20 years between the time an alcoholic realizes he has a problem with alcohol and he seeks treatment. With an opiate addict, that time’s getting shorter. I think it was thought to be maybe 7-10 years. I’d say people are realizing now probably earlier on that they need help.

Lisa Belisle: This means that if you’ve got 7-10 years and you’re treating people of all ages, but they tend to be on the younger side.

Dr. Mary Dowd: The opiate addicts, yeah, are younger.

Lisa Belisle: This means they’re starting really young.

Dr. Mary Dowd: Yeah. They’re starting 18, 19, 20, earlier. Some of the patients we see at Milestone start when they’re 13, 14 trying opiates. They come from generations of alcohol and opiate abuse. It’s what their families do, it’s what they know. In other instances, people get it for twisted knee, for tooth extractions, for pelvic pain, they get opiates and then they like the way they make them feel and they keep using them.

Lisa Belisle: One of the things I noticed 20 years ago when I was going through training was that they had made pain one of the vital signs.

Dr. Mary Dowd: Oh yeah.

Lisa Belisle: We have since learned that there was a pharmaceutical push behind that because the idea was, we treat people with narcotics if they have pain. I felt really conflicted about that at the time. It really worried me, but there was a lot of push, a lot of peer pressure almost, an institutional pressure to provide narcotics for people. Now we’re in the place where we’ve done that. Doctors are now being blamed for a lot of the opiate abuse. What is your, how did you feel about this when we first were being told pain was a vital sign, and we needed to give more medication?

Dr. Mary Dowd: I think we were already doing addictions when that happened, when JCAHO made that push. I think the state medical boards were also in on that. They were feeling that people should be using more opiates. I was dismayed by it.

Lisa Belisle: How did you deal with it in your own practice?

Dr. Mary Dowd: I think at that time I was just doing addiction anyway. I think in my own practice when I was doing private practice I had very few patients who were on chronic opiates. I had maybe two or three. At that time, it was still felt opiates are for cancer pain, extreme end of life pain, and people were doing all right. There are other ways to treat pain. It turns out that something that I don’t think most doctors realized is opiates in the long run make you more sensitive to pain. Often times when people get off opiates, they may have less pain and they certainly have a better quality of life. They can do more.

Lisa Belisle: Do you think that doctors and other health care providers have some responsibility for this what we’re now calling a crisis?

Dr. Mary Dowd: I would pin a lot of the problem on the big pharmaceutical companies who made the push to make this seem like a really great idea.

Lisa Belisle: Do you think that the pharmaceutical companies are now taking responsibility?

Dr. Mary Dowd: No.

Lisa Belisle: Would you like them to?

Dr. Mary Dowd: Yes, I would. I’d like there to be some class action suites. I’d like them to fund addiction treatment.

Lisa Belisle: Isn’t that interesting that we’ve now been through tobacco money being offered back to the states because we came to realize that this was a very damaging product that, marketed successfully, was going to lead to things like illness and death, and now here’s another product that we have yet to understand how to use fully, and we haven’t gotten to the place where anybody’s helping to pay to clean up the mess.

Dr. Mary Dowd: Right. It’s destroying people’s lives and their ability to work, their ability to support themselves, it’s destroying their families. Much more than chronic cigarette use does. People still work, they have a full life. Doesn’t destroy all their relationships.

Lisa Belisle: What is it specifically about opiates that makes them so destructive?

Dr. Mary Dowd: All drugs of abuse take over the reward pathways of your brain, but opiates seem to do it best. They seem to really get a grip on you, and I think they’re so rewarding and then after a little while they’re not rewarding at all, people keep using to try and feel the pleasure they felt it begin with or try to medicate the anxiety and the pain they were having to begin with while they turned to them in the first place.

After a not too long period of time, some people get addicted within a month or two, they’re taking them because they feel bad, because they’re withdrawing all the time and they’re taking them because their own hormones that the drugs increase have really been depleted, those people are not enjoying anything. They’re not getting pleasure out of any aspect of their life. It’s only possible taking the drug, and then even pretty soon even the drug’s not doing it either, and they’re just taking to not be in withdrawal, so they can function. They’re taking it to feel normal so they can get out of bed and go and do something.

Lisa Belisle: How do people get to the place where they feel such despair that they decide that they want to take the ultimate path and not live anymore?

Dr. Mary Dowd: When something that seems extraneous like a drink or a drug takes control of your life and you feel like you have no control over it, you can’t stop craving alcohol, you can’t stop craving cocaine or opiates, you feel, even though you try over and over again, like a total failure, like you have no hope. That’s how you get to that place.

Lisa Belisle: There are a lot of situations where we call something an overdoes, but maybe we think of it more as an accidental overdose. That maybe there’s a question. Maybe it’s not so accidental after all? Have you witnessed any of these or been party to any of these?

Dr. Mary Dowd: My patients will say to me, you have a choice every day to seek your drug and take it, and you’re hoping you’ll overdose or if you don’t overdose you feel like the walking dead.

Lisa Belisle: Then the third choice is to become a patient and if you can, if you can actually get into a program.

Dr. Mary Dowd: If you can get into a program.

Lisa Belisle: If you have insurance. It sounds like access right now isn’t limited so much by the number of providers that we have, at least not in this part of the state. It’s more limited by the ability to pay for the services themselves.

Dr. Mary Dowd: Yes. It’s very limited by the ability to pay for the services. The ancillary services like counseling. People need sober houses. Most sober houses don’t allow patients to be on suboxone. I think the number throughout the state is there’s 25,000-35,000 of people who need treatment aren’t getting it. I think there’s about 10,000 in treatment.

Lisa Belisle: When I think about all the young people in my practice that have enough issues just being young people in the world.

Dr. Mary Dowd: Right.

Lisa Belisle: The number of them that have drug addiction issues. I don’t have a lot of people in my practice who are in this case, but it seems as if their future has almost been cut short before it even began. I think about my own children. I think about what it would be like to raise a child and get them to a place where you finally thought they were going to go out into the world and make good choices and participate in society and what that must feel like for the parents who didn’t realize they were going in order to be working with an addict.

Dr. Mary Dowd: Yeah.

Lisa Belisle: Does this ever cross your mind as a mother of four children?

Dr. Mary Dowd: Oh sure. Yeah. It’s heartbreaking to have a child who’s an addict and you can’t really communicate with them. Some of my kids had trouble with alcohol and marijuana in high school. It’s hard.

Lisa Belisle: This leads to a question that I am still not sure I understand the answer to myself. Recently we have passed legislation to legalize marijuana.

Dr. Mary Dowd: You would ask me that.

Lisa Belisle: I’m actually interested in what you have to say because I know how I voted and I know the argument that I had with my 23 year old son about it and I’m not going to make a commitment one way or the other as to which direction I went in, but I also know I had a conversation with a fellow physician who very firmly told me that the was going to vote yes and had really good reasons for it. I’m not sure any of us really knows how to address this. This is purely an opinion coming from you.

Dr. Mary Dowd: Yeah. I really have two opinions about it as probably everybody does. I think it’s a much safer drug than alcohol. People who are out drinking are out fighting, driving, getting into domestic violence situations. On the one hand, marijuana is a much safer drug than alcohol, and alcohol’s everywhere.

On the other hand, I think that for young people who start using marijuana really early and if it’s legal, people are going in order to start using it earlier and earlier, it changes the way their brain works. Their brains aren’t mature. Teenage brains aren’t mature until they’re 25 or 27. If you’re using marijuana pretty regularly when you’re 13, 14, 15, it’s going to change things for your brain. It’s not going to be a good thing. People have more difficulties with focusing for chronic use, IQ drops about eight points, and that’s big for IQ. The difference between cognitive disability and normal intelligence is only 10 points. The other thing is it saps people’s motivation to keep moving on forward with their lives, with their goals. I think people need that to feel good about themselves.

Lisa Belisle: Do you consider it a gateway drug?

Dr. Mary Dowd: Yeah, to the same extent that alcohol is. Yeah. I think other drugs are everywhere. You don’t need to have a gateway to get opiates now. You don’t need a gateway to get anything. You can buy K2 and spice legally in head shops. Those are so much more destructive than marijuana.

Lisa Belisle: You’ve become a bit of an advocate for treatment. You’ve taken on the responsibility of writing op-eds for the local paper. You’ve spoken about this whenever anybody will listen, and yet you describe yourself as an elderly physician. You describe yourself that way. I’m not describing you that way. This is a big social cause to take on this far along in your career. Why are you doing this?

Dr. Mary Dowd: I really love the work. I love working with addicts. I love my patients. I think it’s very rewarding to be able to help somebody completely transform their lives. It is a complete transformation. Somebody going from living on the streets and having no connection with family, having their kids taken away, having their parents write them off, not being able to work, and then they get on treatment and it’s night and day. It’s very rewarding in that sense, if you can get people into treatment and if you can’t. I really love the work I do at Milestone. I just feel connecting with people and kindness and respect for people who have known so little kindness and respect is helpful to them.

Lisa Belisle: I appreciate your taking time out of your very busy schedule to come in and have a conversation with me today. I think it can be very difficult to be in health care, and it’s nice to talk to somebody who’s probably in one of the more difficult fields of health care who feels rewarded by it. I encourage you to keep doing what you’re doing because we need people like you.

Dr. Mary Dowd: Thank you, Lisa.

Lisa Belisle: I’ve been speaking with Dr. Mary Dowd, who is a family doctor and medical director of the detoxification program at the Milestone Foundation in Portland. Also, working for the Catholic Charities substance use treatment program and at Discovery House in South Portland methadone clinic. Thanks so much for coming in today.

Dr. Mary Dowd: Thanks so much, Lisa, thanks for having me.

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Lisa Belisle: My next guest is an individual that I’ve known for a few years as a very successful single mother and member of the Kennebunkport community. This is Kate Bowley who lives in Kennebunkport with her nine-year-old daughter Lila. In 2014 they lost Lila’s father to a three year struggle with opiates after he became addicted after a work related injury. Kate is passionate about advocating for opiate reform in the state of Maine and the impact the epidemic has on families and on the community at large. This is a pretty sad story that you’re coming in to talk to us about today.

Kate Bowley: It is.

Lisa Belisle: It’s pretty tough.

Kate Bowley: It is. It’s been a journey.

Lisa Belisle: On the flip side, you’re an incredibly resilient individual. You’ve had to raise your daughter by yourself for a little while, you’re a single working mom, I guess all moms are working. You work outside the home, support the two of you, you’re survivors. I think that’s part of the reason why you were willing to come in here today.

Kate Bowley: I think it’s important to talk about Wayne and his legacy in terms of what happened and what the progression was with his story, because I think it is unique and as we’ve discussed, it certainly it is an epidemic in our state and in the nation, and I think that it deserves more attention than it’s currently getting.

Lisa Belisle: Tell me about Lila’s father.

Kate Bowley: Wayne and I met, we had known each other for quite some time, but we fell in love in 2007, and chicken before the egg, I suppose, I was pregnant quite immediately. Our family, we became a family very quickly. Lila was born in 2007 and we raised her together, and Wayne worked locally in the community as a meat cutter for 15 years for the same company, and I was traveling for work. We made it happen and made it work. Loved our little girl very much.

Decided after a couple of years that we might as well make it official and get married; however, prior to that, about six months before our wedding, Wayne was doing a delivery for work. It was slippery on the stairs and he fell down with a hand cart in his hand and tried to catch himself, and needless to say we ended up in the hospital that afternoon, and he had come to find out he had torn his rotator cuff.

The series of events that transpired after that, in a gist, where that workman’s comp obviously got involved in the situation because it was work-related. This happened in February of 2009. They sent him to physical therapy, and unbeknownst to me also were prescribing him, two doctors were prescribing him opiate pain killers. There was no MRI, there was no additional fact finding initially until probably, I would say, close to June or July, and in the meantime he ended up having surgery, once they’d uncovered all of that, the physical therapy wasn’t working. I think it was probably making things worse. Again, unbeknownst to me he was taking all of these pain killers.

Once he had the surgery, he still had a lot of pain and was struggling, was not able to go back to work until almost November of that same year. We got married in the meantime in August of 2009, as I mentioned. It was around that time that I started to figure out that something was off. I had asked Wayne on numerous occasions to maybe curb the drinking a little bit because I noticed when he did drink things were definitely amiss. We sorted through that, but unbeknownst to me it was not the alcohol, it was the pain killers and the combination thereof. By November when he went back to work it was Thanksgiving, and while he had some restrictions, on what he could do as far as lifting and weight and things like that, at the end of the day it’s Thanksgiving, it’s a butcher shop, and he ended up actually rupturing his biceps.

As a result he was back out of work and had to have another surgery to repair that. I found it fascinating at the time because when he came out of the surgery, the doctor said something to me that I thought was peculiar. He said because of his tolerance to pain killers, I’m giving him a prescription for oxycodone. I thought okay, that’s odd, but I just assumed it was something in terms of the surgery or the previous surgery that he’d had.

We went through the holidays and got through Thanksgiving. I knew that he’d had a few prescriptions again after the surgery for these pain killers. I actually woke up in the middle of the night one night and just had this strange feeling. I went to where I knew he was keeping the pain killers because we had had a conversation about how I would prefer that you don’t drive if you’ve been taking those, especially with our daughter. Something just didn’t feel right and I went and needless to say they were all gone. It was just the empty bottles. He was certainly at the time misusing them.

I confronted him about it, and we had a very fierce conversation, and I told him that that was it. At this point, he needed to stop and seek some help. How naïve of me. Needless to say he told me that he had stopped. He also didn’t drink at all and started attending meetings. Christmas comes and goes, and it’s now January of 2010 and I go on a trip for work out to Los Angeles and called to check on him and Lila and had again another very strange feeling. I felt like his speech was slurred. He just didn’t seem coherent to me. Upon my return from my trip, I happened to be working out of my home one day and the woman who was cleaning my house came over and she said, hey, what’s wrong? You seem a little off today, and I explained to her, I’ve got some concerns about Wayne, he’s had these surgeries, some concerns with abusing the pain killers. She was working as a pharmacy tech at his pharmacy.

She’s like, oh, yeah, he filled his prescription this week. I saw him. What a gift from the universe that that information was revealed to me. That started off a series of events where I discovered just how terrible it was. He actually had returned to work that day and came home and was completely high out of his mind. I could tell, I could see it. That was his first trip to rehab. He went up to Mercy for a number of days and ended up in an outpatient therapy program for a number of months.

In the meantime, still negotiating with workman’s comp. They are very aggressive in monitoring progress, and I was explaining to them what had happened and now this new turn of events with the addiction, and we went back and forth at length in regard to that. The next year and a half or so was very challenging. He was sober, but in the midst of this we had been introduced to a doctor that could treat him with suboxone. My understanding, and perhaps, Lisa, you can speak to this better than I can, but not all doctors can prescribe suboxone, correct?

Lisa Belisle: That’s right.

Kate Bowley: There’s only a certain number of cases or patients that you can take on, that’s correct?

Lisa Belisle: That’s right.

Kate Bowley: Okay. This particular doctor was local to where we lived. Wayne started seeing him for treatment. Maintained his sobriety for probably a good year, I would say, but unfortunately with the addiction comes a number of other symptoms. There was lying, there was money missing. There were things happening that unfortunately ultimately led to the disintegration of the marriage, and he was making some choices, I think, because of his state of mind that were not healthy for Lila and were essentially putting her in harm’s way. You don’t get married to get divorced, certainly, but it had been so challenging and so upsetting that ultimately we did end our marriage in divorce.

At that time, I do believe that he was still sober; however, because of the nature of the work injury, he came into some money due to a settlement and spent the next summer, basically, blowing it on drugs and pills. I found myself in a situation with him again, as the father of my child, where we had to have an intervention. He went back to Mercy for a second time with the assistance of some of his good close guy friends. Cleaned up again for a period of time and then ultimately I watched from afar as he lost everything due to his addiction.

He, as you mentioned, he passed away in 2014, and in 2013, it was late fall, he called me on Halloween, I was trick-or-treating with Lila, and he said, “I need to go back to rehab. I need to go back. I’m a mess.” A this point he’d lost his job, his vehicle, his license due to child support demands, lack of meeting them, and when he came over to my home the next morning, he’d been dropped off by one of his fellow drug friends and didn’t even have the clothes on his back at that time. He was wearing somebody else’s clothes, somebody else’s shoes.

We sat at length and spoke about his addiction and spoke about what it was like for him, how his entire day at that point revolved around finding drugs, using drugs, keeping drugs to get through the next day, what the process was, no different than a work schedule or the way you would schedule a child’s day or anything like that. He went back to Mercy again for the third time, and when he got out, he also didn’t have a place to live, and he went to live with a family member in Waterboro. It was fairly remote. As I mentioned, no vehicle, no job, no money, no means to even get drugs at that point.

I thought that he was safe and was going to work on recovery in getting better. When I got a phone call on a Saturday afternoon the following June, it was very shocking to learn that he had actually passed away from a heroin overdose. Unbeknownst to me, at some point along the way he’d started using heroin as well intravenously. The tragedy of all of this, beyond just the circumstances itself and watching this amazing man who was a wonderful father and a great husband disintegrate like this is, not only did he die of an overdose, but the folks that he was with brought him to the hospital to SMHC and left him in a vehicle to die.

Narcan wasn’t on the radar at that point, the way it is now. He certainly may have benefited from that, but they found him the next day or that evening in the vehicle.

Lisa Belisle: They drove him there in a car and then left him in a car for somebody else to find, rather than bring him in the emergency room.

Kate Bowley: Rather than bringing him to the emergency room or kicking him out the door on the front steps of the hospital or making a phone call or anything else. I certainly think in terms of law enforcement things have changed since that time, but the other challenge here is that there wasn’t, it wasn’t followed up on in terms of who was responsible. What those circumstances were that led to him being left there. I think if it’d happened today it would have been a little different, but at the time it was not, and it wasn’t followed up on where… I don’t have a lot of recourse legally because he wasn’t my husband at the time. We had gotten divorced, so it wasn’t something I could follow up on and push for. To this day, I had a long conversation with Wayne’s mom yesterday, we still don’t know what happened that night.

What I do know is this. I think things could have been different if all of the prescriptions for the pills were not written and filled and paid for by the workman’s comp, and also if the doctors that were involved in his care weren’t so free to write him multiple prescriptions. When he returned to rehab the third time, and we sat and spoke at length about what he was suffering from, he shared with me that the same doctor that we had been directed to for him to be able to take Suboxone was now writing him prescriptions for Oxycodone, upwards of 300 pulls a month, Xanax, Adderall, and Ativan. I’m sorry, not Ativan. Ambien. Four of the most addictive drugs that are out there.

I don’t understand that. I don’t understand why a doctor would do that. Hippocratic Oath states do no harm, and there’s nothing but harm in that.

Lisa Belisle: I want to go back to something that you said. Not only did you say it to me in a previous conversation, but you just said it now, that this person that he became was not the person that you first knew. That he was a husband and a father and a son and a hard worker. He was an upstanding member of the community. He had friends, he had a loving family. It really was this addiction that changed his mind and his body so significantly that he was almost unrecognizable.

Kate Bowley: That’s correct. The person that I was communicating with when he returned to detox and rehab the third time, the person sitting in front of me was this angry, bitter, hateful, just angry person. It was remarkable how much he had changed. Everybody loved Wayne. Wayne was the nicest guy, he’d give you the shirt off his back, he always stood up for the underdog. He was creative, he was sensitive, he was sweet. It was truly like speaking with a completely different human being. I think with opiates, it does, it changes the brain and it changed who he was. I just couldn’t get over the anger. Just so angry. Maybe part of that was due to him acknowledging what he’d become, but it just seemed so organic and inherent to who he was as a person.

Lisa Belisle: Was he angry at someone or something or at circumstances? How would you describe the anger that he was showing you?

Kate Bowley: When he spoke about people it was with so much anger. He was looking for fights and looking for conflict. It just seemed to be a normal part of his life and his routine. It was who he’d become, and he was exceptionally negative and I’m sure given the circumstances, I can see that, but it’s challenging for me because when he passed away, and I found myself in a position where I had to break that news to my daughter, fortunately she wasn’t home at the time when I found out. I’ve very lucky that I have an amazing family that surrounds me.

I obviously called my dad, my brother came over, my mother was with my daughter. There’s nothing that I’m ever going to have to do as a parent that will be as challenging as that day when I had to tell Lila what had happened. We had been estranged from him for quite some time. He had attended her sixth birthday party which had been back I the fall. I’m grateful that she has that really happy memory with him, and he showed up and he cleaned up and he was sober and he was helpful. That’s a really beautiful memory that we both get to share. Otherwise we didn’t see him frequently at all.

Somebody had coached me and said, this is what’s going to happen when you tell her. She’s going to be upset, she’s going to cry and then she’s going to be like, can I have a popsicle or where’s my teddy bear, and that is exactly what had happened. I was so angry at him for it and really looked at it for so long as a choice, I think, until I started doing more research and speaking to folks that struggled with addiction and gaining a better understanding that it’s a disease no different than diabetes or cancer or what have you. Did he make some choices in the process that might have contributed? Yes, absolutely. Nobody chooses to lose your family, lose your custody or your daughter, lose your wife, lose your home, lose your job, lose your vehicle, your means to exist in life. Nobody would choose that.

Lisa Belisle: It’s been important for you, as difficult as it is to tell the story, it’s been important for you to have these types of conversations because otherwise, there’s not really a way to see that this can change, until people really are aware of what’s going on and who this impacts. One of these conversations was with the governor.

Kate Bowley: Yes.

Lisa Belisle: It maybe didn’t go exactly the way you were hoping.

Kate Bowley: Yes. My dad and I went and met with Governor LePage actually just about a year ago. It was last December. I think he heard the story and what I had to say, but in terms of the things that I read about what is moving forward in the state of Maine, I’m not sure that it was entirely heard. I think it is an evolution, and I hope that we’ll get there, but there are so many moving parts to this epidemic that need to be addressed and it’s not just law enforcement, it’s not going to be just the pharmaceutical companies, it’s not going to just be Narcan, it’s not just going to be good Samaritan laws or physicians or anything else. It’s got to be all. I’m not sure that we’re there yet.

Lisa Belisle: How do you feel about the laws that were most recently enacted about physician prescribing?

Kate Bowley: I’m on board with it. I think it would have made a big difference for Wayne. I’ve talked to folks, though, who do struggle with chronic pain, and they are frustrated with it because they don’t feel like their needs are being met. I think for my family and for our situation it would have made a big difference. I think a database also would have made a big difference because Wayne was not doctor shopping per say, but did have both his general physician and the surgeon prescribing medications to him without knowing that each other was doing the same. I think that there’s an opportunity there for sure.

Lisa Belisle: How are you going to frame this for Lila as she gets older, because obviously this is her father that she loved, and it’s also someone who ended up with addiction problems so significant that they ended his life. Again, still her father.

Kate Bowley: Right. That’s a great question. Interestingly enough it’s something that I’ve been speaking with my friends and loved ones about a lot lately because she’ll be 10 this year, and obviously I worry about her and any sort of genetic predisposition, if that does in fact exist. I also worry about the stigma, if you will, around this, because at the end of the day there is a stigma around it. I think that that’s shifting socially and culturally, but it still exists. As I watched her in school, some of the bullying stuff has started a little bit, not necessarily in relationship to this, but in time I worry that she could be exposed to that. Lila’s an exceptionally bright young lady. She is an old soul, and she has lived more than she should have had to at her young age.

What I’ve decided is as time unfolds, I’m just going to be completely honest with her and candid and transparent and forthcoming. Is it appropriate right now to tell her that her father died of a heroin overdose? No. Not yet. I do think she does know and she has known for quite some time that daddy got involved with drugs. Found myself in a position where I had to explain the difference between Tylenol and then what he was taking.

I just want her to be armed with all of the information that’s possible. I think that that will unfold over time here as she gets a little bit older, but I have started to share more with her because I certainly don’t want her to find herself in a position where she is embarrassed or hurt or anything else like that. I want her to have the information so she can make choices that are healthy and good for her as well.

Lisa Belisle: I applaud you. It takes a lot to be willing to come on the radio and talk to people that you’ve never met before about what’s obviously a very painful story for you. As I said in the beginning, you’re a resilient individual, and I’m guessing that Lila has probably gotten some of that resilience?

Kate Bowley: She’s a tough little cookie.

Lisa Belisle: I wish you all the best, Kate. I’m sure I’ll be seeing you out and about in the Kennebunkport area. I’ve been speaking with Kate Bowley who lives with her nine-year-old daughter, Lila. In 2014 they lost Lila’s father to a three-year struggle with opiates after he became addicted following a work related injury.

Kate Bowley: Thank you.

Lisa Belisle: All good things ahead for you.

Kate Bowley: Thank you.

Lisa Belisle: You have been listening to Love Maine Radio, show number 283, Impacted by Addiction. Our guests have included Dr. Mary Dowd and Kate Bowley. For more information on our guests and extended interviews, visit Love Maine Radio is downloadable for free on iTunes. For a preview of each week’s show, sing up for our E-newsletter and like our Love Maine Radio Facebook page. Follow me on Twitter as Dr. Lisa, and see my running, travel, food, and wellness photos as bountiful1 on Instagram. We’d love to hear from you, so please let us know what you think of Love Maine Radio. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. It is our privilege that they enable us to bring Love Maine Radio to you each week. This is Dr. Lisa Belisle. I hope that you have enjoyed our Impacted by Addiction show. Thank you for allowing me to be a part of your day. May you have a bountiful life.

Speaker 5: Love Maine Radio is made possible with the support of Berlin City Honda, the rooms by Harding Lee Smith, Maine Magazine, Portland Art Gallery, and Art Collector Maine. Audio production and original music have been provided by Spencer Albee. Our editorial producer is Paul Koenig. Our assistant producer is Shelbi Wassick. Our community development manager is Casey Lovejoy. Our executive producers are Kevin Thomas, Rebecca Falzano, and Lisa Belisle. For more information on our host’s production team, Maine Magazine, or any of the guests featured here today, please visit us at