Impacted by Addiction #283

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. Maybe 2008, I can't remember, maybe 2005. And 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:

And she's like, oh yeah, he filled his prescription this week. I saw him. So what a gift from the universe that that information was revealed to me. So that off a series of events where I discovered just how terrible it was and 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.

Dr. 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.

Dr. 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 the 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 a Discovery House in South Portland. And 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.

Dr. Lisa Belisle:

You are an 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 that these were interests that she had. You and I both have spent time working in the Cumberland county jail. True. And you have also, I believe you were at before, when it was Pineland, when it was 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. And then when Pineland closed, I ran a clinic for them for many years.

Dr. Lisa Belisle:

And on top of that, now you're doing the work that you're doing with Catholic Charities and also Discovery House. So you're a woman who looks for a challenge.

Dr. Mary Dowd:

Well, I like to do a lot of different things, and really I kind of go to what I like. I'm not looking for challenges. I'm more just kind of following what I enjoy.

Dr. Lisa Belisle:

So tell me, what is it about the work that you are doing now that you enjoy? This is difficult work.

Dr. Mary Dowd:

Well, I think what makes it so difficult is that there are so few services you can offer patients with addiction in Maine. Most of the patients, especially the heroin addicts, have lost everything. You know, 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. So we see them over and over again, and that's what makes it so difficult. Yeah.

Dr. Lisa Belisle:

So 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. But they make it. They make it through these days. They have a lot of creativity.

Dr. Lisa Belisle:

You worked as a family doctor for quite a while in Yarmouth, the suburb where you and I both live. And I wonder if you ever had any intersections with the patients that you're dealing with now. When you were in private practice,

Dr. Mary Dowd:

I remember having one or two patients who had 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.

Dr. Lisa Belisle:

And the reason I asked 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 through family situations, by addiction.

Dr. Mary Dowd:

Yeah, it's huge.

Dr. 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. And I realized everybody was there. Not everybody. Maybe 90% because of addiction. You know, 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.

Dr. Lisa Belisle:

And 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:

Well, we do. We don't have the money to make it happen. It's just not funded.

Dr. Lisa Belisle:

Well, talk to me about this. So 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:

Well, those are the lucky patients. Those are the ones who have insurance and can get treatment. So they Come in, they do an intake with one of the counselors there to make sure they're appropriate for services. Then they see me, I do a history and physical and decide whether they're a candidate for Suboxone or possibly Vivitrol. And then I start treating them. And those people have insurance. They often have family support and they do well. I'd say 90% of my patients who have insurance can do well either with Suboxone or Vivitrol or methadone.

Dr. Lisa Belisle:

What is usually the lead time as far as coming in for treatment? How long does it usually take before somebody hits that rock bottom place that you've described?

Dr. Mary Dowd:

If they have insurance, they can get into treatment pretty quickly. It's the people who don't have insurance that are really can't get anything. Now once in a while there's a scholarship spot in one of the programs. I think Grace street has them, Catholic Charities has them, but other than that, they can't get anything.

Dr. Lisa Belisle:

And insurance usually will cover treatment?

Dr. Mary Dowd:

Yeah, insurance will cover treatment. Main care 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 insurance, has 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, but they don't have any other recourse. I mean, they don't have family doctors who 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. You know, it's. They can't detox on the streets and describe that clinically.

Dr. Lisa Belisle:

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, and they know they can fix it. They can get something that will make it all go away.

Dr. 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.

Dr. 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. So that has some obstacles to treatment, especially if 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. And Vivitrol or Naltrexone, which is the oral form of Vivitrol, is a monthly shot or a daily pill.

Dr. Lisa Belisle:

I know that in our group of physician colleagues in the state, more and more people 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 for, I think, maybe a year.

Dr. Lisa Belisle:

So how is it that some doctors will decide to get a Suboxone prescribing credential and other doctors won't?

Dr. Mary Dowd:

I think that the doctors who see opiate addicts in their practice, maybe their 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 probably doctors feel like it's too much to do in the office because 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. I mean, 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. And 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. So it's not all that simple in terms of the practical aspects of it.

Dr. Lisa Belisle:

So 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. You had another life before this, Right.

Dr. Mary Dowd:

I was a medievalist. I was in medieval studies. Yeah.

Dr. Lisa Belisle:

So you're a medievalist. And you. I know you have children.

Dr. Mary Dowd:

Yeah.

Dr. Lisa Belisle:

And you're married to a man who is a writer, I believe, and a teacher.

Dr. Mary Dowd:

Yeah.

Dr. Lisa Belisle:

And 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:

Well, having a child prompted me to do that. And not that I enjoyed labor and delivery, but it made me. It kind of woke me up to our vulnerability and fragility. So that's why I decided to change what I was doing.

Dr. Lisa Belisle:

And 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

Dr. Mary Dowd:

was a lot of work, but my husband helped me a lot and took a long time.

Dr. Lisa Belisle:

Then 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. But you set out and you had your own shingle, right, In Yarmouth for a number of years.

Dr. Mary Dowd:

Yeah.

Dr. Lisa Belisle:

What was the decision making there?

Dr. Mary Dowd:

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

Dr. Lisa Belisle:

I had asked you a question earlier about the lead time on people who are going through treatment, and 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 you can answer or not, before they finally get to the place where they realize that there's really nothing left, there's no other option but to go into treatment?

Dr. Mary Dowd:

Well, let me just back up a little bit on that question. People who have insurance and support can get into treatment pretty quickly, but the patients I see at Milestone, years, years and years before they can get any treatment. And 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 seven to 10 years. I'd say probably people are realizing now, earlier on that they need help.

Dr. Lisa Belisle:

So this means that if you've got seven to 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.

Kate Bowley:

Yeah.

Dr. Mary Dowd:

Are younger.

Dr. Lisa Belisle:

So 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 or 14 trying opiates. They come from generations of alcohol and opiate abuse. It's what their families do. It's what they know. 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. Yeah.

Dr. Lisa Belisle:

One of the things that 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.

Dr. Lisa Belisle:

And we have since learned that there was a pharmaceutical push behind that because the idea was that we treat people with narcotics if they have pain. And I felt really conflicted about that at the time. It really worried me. But there was a lot of kind of push. There was a lot of peer pressure, almost an institutional pressure to provide narcotics for people. And now we're in the place where we've done that, and 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:

Well, I think I was already doing addictions when that happened, when Jaco made that push. And I think the state medical boards were also in on that. They were feeling that people should be using more opiates. So I was kind of dismayed by it.

Dr. Lisa Belisle:

And 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. So at that time, it was still felt, you know, opiates are for cancer, pain, extreme end of life pain, and people are doing all right. You know, there are other ways to treat pain. And it turns out that something that I don't think most doctors realized is that opiates in the long run make you more sensitive to pain. So oftentimes when people get off opiates, they may have less pain and they certainly have a better quality of life. They can do more.

Dr. Lisa Belisle:

So 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.

Dr. Lisa Belisle:

And do you think that the pharmaceutical companies are now taking responsibility?

Dr. Mary Dowd:

No.

Dr. Lisa Belisle:

Would you like them to?

Dr. Mary Dowd:

Yes, I would. I'd like them to. There to be some class action suits. Yeah. I'd like them to fund addiction treatment. Yeah.

Dr. Lisa Belisle:

Well, isn't that interesting that we have now been through tobacco money that's being offered back to the states.

Dr. Mary Dowd:

Right.

Dr. Lisa Belisle:

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. And it's destroying people's lives and their ability to work, their ability to support themselves. It's destroying their families. Yeah. Much more so than chronic cigarette use does. You know, people still work. They have a full life, you know, doesn't destroy all their relationships.

Dr. Lisa Belisle:

So what is it specifically about opiates that makes them so destructive?

Dr. Mary Dowd:

They. Well, all drugs of abuse take over the reward pathways in 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 to begin with or try to medicate the anxiety and the pain they were having to begin with, why they turned to them in the first place. But after not too long a period of time, I mean, 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. So people are not enjoying anything. They're not getting pleasure out of any aspect of their life. And it's only possible taking the drug. And then even pretty soon the drug's not doing it anymore either. 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.

Dr. 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:

Well, 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, 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.

Dr. Lisa Belisle:

There are a lot of situations where we. We call something an overdose, 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 partied to any of these?

Dr. Mary Dowd:

You know, my patients will say to me, you know, 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.

Dr. Lisa Belisle:

And then the third choice is to become a patient. And yeah, if you can, if you can actually get into a program, you

Dr. Mary Dowd:

can get into a program if you have insurance.

Dr. Lisa Belisle:

So 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 and, you know, the ancillary services like counseling. And 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 to 30,000 people who need treatment who aren't getting it. And I think there's probably about 10,000 in treatment.

Dr. Lisa Belisle:

So when I think about all the young people in my practice that have enough issues just being young people in the world and then the number of them that have drug addiction issues and I don't have a lot of people in my practice who are in this case, but it seems as if their future is just. It's almost been cut short before it even began. And 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, and make good choices and participate in society and what that must feel like for the parents who didn't realize they were going to be working with an addict.

Dr. Mary Dowd:

Yeah.

Dr. Lisa Belisle:

Does this ever cross your mind as the mother of four children?

Dr. Mary Dowd:

Oh, sure, yeah. I mean, 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 when they were in high school. So yeah, it's hard.

Dr. Lisa Belisle:

Well, this leads to a question that I am still not sure I understand the answer to myself. But recently we have passed legislation to legalize marijuana.

Dr. Mary Dowd:

Oh, you would ask me that?

Dr. Lisa Belisle:

Well, I'm actually interested in what you have to say because I, 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 that I had a conversation with a fellow physician who very firmly told me that he was going to vote yes, and had really good reasons for it. So I'm not sure any of us really know how to address this. So this is purely an opinion coming from you?

Dr. Mary Dowd:

Yeah, well, I really have two opinions about it, as probably everybody does. I think it's a much safer drug than alcohol. People who are drinking are out fighting, driving, getting into domestic violence situations. So on the one hand, marijuana is a much safer drug than alcohol and alcohol is everywhere. On the other hand, I think that for young people who start using marijuana really early, and probably if it's legal, people are going 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. So 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. You know, the difference between cognitive disability and normal intelligence is only 10 points. And the other thing is it kind of saps people's motivation to keep moving on forward with their lives, with their goals. And I think people need that to feel good about themselves.

Dr. Lisa Belisle:

Do you consider it a gateway drug?

Dr. Mary Dowd:

Yeah, to the same extent that alcohol is. Yeah. But I think, you know, other drugs are everywhere. You don't need to have a gateway to get opiates now. You don't need to have a gateway to get anything. You can buy K2 and Spice legally, you know, in head shops, and those are so much more destructive than marijuana.

Dr. Lisa Belisle:

You've become a bit of an advocate not 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 kind of a big social cause to take on this far along in your career. Why are you doing this?

Dr. Mary Dowd:

Well, you know, 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. And 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, you know, write them off, not being able to work and then they get on treatment and it's, you know, it's night and day. So it's very rewarding in that sense. If you can get people into treatment and if you can't, I mean, I really love the work I do at Milestone. I feel just connecting with people and kindness and respect for people who have known so little. Kindness and respect is helpful to them.

Dr. Lisa Belisle:

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

Dr. Mary Dowd:

Thank you, Lisa.

Dr. 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 and Self Portland Methadone Clinic. Thanks so much for coming in today.

Dr. Mary Dowd:

Thank you, Lisa. Thanks for having me.

Dr. Lisa Belisle:

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 Bally 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 following 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 the community at large. That's a pretty sad story that you're coming in to talk to us about today.

Kate Bowley:

It is.

Dr. Lisa Belisle:

It's pretty tough.

Kate Bowley:

It is. It's been a journey.

Dr. Lisa Belisle:

But 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, but you work outside the home. You 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:

Yeah. 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, you know, certainly it is an epidemic in our state and in the nation, and I think that, you know, it deserves more attention than it's currently getting, so.

Dr. Lisa Belisle:

Well, tell me about Lila's father.

Kate Bowley:

Wayne and I met. Well, 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. So our family, we became a family very quickly. And 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. And we made it happen and made it work and loved our little girl very much and 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, and it was slippery on the stairs and he fell down with a handcart in his hand and tried to kind of catch himself. And needless to say, we ended up in the hospital that afternoon and he had come to find out, torn his rotator cuff. So a series of events that transpired after that, in a gist, were that workman's comp obviously got involved in the situation because it was work related. And this happened in February of 2009. So they sent him to physical therapy and unbeknownst to. To me, also were prescribing him. The doctors, two doctors were prescribing him opiate painkillers. And there was no mri. There was no additional fact finding initially until probably, I would say, close to June or July.

Dr. Lisa Belisle:

And

Kate Bowley:

so in the meantime, he ended up having surgery. Once they'd kind of uncovered all of that, the physical. Physical therapy wasn't working. I think it probably was making things worse. And again, unbeknownst to me, he was taking all of these painkillers. So 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, and 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 that things were definitely amiss. So we sorted through that. But unbeknownst to me, it was not the alcohol. It was. It was the painkillers or the combination thereof. By November, when he went back to work, it was around 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. So as a result, he was back out of work and had to have another surgery to repair that. And 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, well, because of his tolerance to painkillers, I'm giving him a prescription for oxycodone. And I thought, hmm, okay, that's odd. But I just didn't assumed it was something in terms of the surgery or the previous surgery that he'd had.

Dr. Lisa Belisle:

And

Kate Bowley:

we went through the holidays and got through Thanksgiving, and I knew that he had had a few prescriptions again after the surgery for these painkillers. And I actually woke up in the middle of the night one night and just had this, like, strange feeling. And I went to where I knew he had. He was keeping the painkillers because we had had a conversation about how, you know, I don't prefer that you don't drive if you've been taking those, especially with our daughter. And something just didn't feel right. And I went, and needless to say, they were all gone. It was just the empty bottles. So he was certainly at the time, misusing them. And so I confronted him about it, and we had a very fierce conversation. And I told him that, you know, that was it at this point, and he needed to stop and seek some help. How naive of me. But needless to say, he told me that he had stopped. He also and 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 a. Again, another very strange feeling. I felt like he was. His speech was slurred, and he just didn't seem coherent to me. So 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, you know, what's wrong? You seem a little off today. And I explained to her, I'm like, well, you know, I've got some concerns about Wayne. He's had these surgeries, some concerns with abusing the painkillers. And she's like. And she was working as a pharmacy tech at his pharmacy, and she's like, oh, yeah, he filled his prescription this week. I saw him. So what a gift from the universe that that information was revealed to me. So that started off a series of events where I discovered just how terrible it was. And he actually had returned to work that day and. And came home and was completely high out of his mind. I could tell. I could see it. So that was his first trip to rehab. And 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, you know, I was explaining to them, like, what had happened. And now this new chain of turn of events with the addiction. And we went back and forth at length in regard to that. But 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 who 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?

Dr. Lisa Belisle:

That's right.

Kate Bowley:

And there's only a certain number of cases or patients that you can take on, correct?

Dr. Lisa Belisle:

That's right.

Kate Bowley:

Okay. So this particular doctor was local to where we lived. And 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. And 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. And, you know, you don't get married to get divorced, certainly. But it had been so challenging and so upsetting that ultimately we. We did end our marriage and 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. And I found myself in a situation with him again. As the father of my child, where we had to have an intervention. And 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. And at this point, he'd lost his job, his vehicle, his license, due to child support demands or 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. And 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. And so 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 somewhere in Waterboro. So it was fairly remote, and as I mentioned, no vehicle, no job, no money, no means to even get drugs at that point. So I thought that he was safe and was going to work on recovery and getting better. So 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. And 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

Dr. Lisa Belisle:

is

Kate Bowley:

not only did he. 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, so he certainly may have benefited from that, but they found him the next day or that evening in the vehicle.

Dr. Lisa Belisle:

So they drove him there in a car and then left him in the car for somebody else to find, rather than bringing him into the emergency room,

Kate Bowley:

rather than bringing him to the emergency room or even, you know, 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 and what those circumstances were that led to him being left there. I think if it happened today, it might be a little bit different, but at the time, it was not. And it wasn't followed up on where I didn't. 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. And to this day, I had a long conversation with Wayne's mom yesterday. We still don't know what happened that night. But 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 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. Because 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 pills a month. Xanax, Adderall, and Ativan. No, I'm sorry, not Ativan. Ambien, four of the most addictive drugs that are out there. You know, 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.

Dr. Lisa Belisle:

So I want to go back to something that you said, and not only did you say it to me in a previous conversation, but you just said it now, that this. 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. I mean, he was an upstanding member of the community. He had friends, he had loving family. And 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. And it was remarkable how much he had changed, because everybody loved Wayne. Wayne was the nicest guy. He would give you the shirt off his back. He always stood up for the underdog. He was creative, he was sensitive, he was sweet. And it was truly like speaking with a completely different human being. And, you know, I think with opiates,

Dr. Mary Dowd:

it does.

Kate Bowley:

It changes the brain, and it changed who he was. I just. I couldn't get over the anger. Just so angry. I mean, maybe part of that was due to him kind of acknowledging what he'd become, but it just seemed so organic and inherent to who he was as a person.

Dr. Lisa Belisle:

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

Kate Bowley:

Just when he spoke about people, it was with so much anger, and he was looking for fights and looking for conflict, and it just seemed to be a normal part of his life and his routine. It just was. He just. It was who he'd become, and he was exceptionally negative. And, you know, I'm sure given circumstances, I could see that. But, you know, 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 was. I wasn't home at the time when I found out. And I'm very lucky that I have an amazing family that surrounds me. And so I obviously called. I called my dad. My brother came over. My mother was with my daughter, and there's nothing 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. And, you know, she had. We had been estranged from him for quite some time. He had attended her sixth birthday party, which had been back in the fall. So that was. 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, and that's a really beautiful memory that we both get to share. But otherwise, we didn't see him frequently at all. So it's. And somebody had coached me and said, okay, so this is what's gonna happen when you tell her. She's gonna be upset. She's gonna cry, and then she's gonna be like, okay, where can I have a popsicle? Or, where's my teddy bear? Or whatever. And that is exactly what had happened. And, you know, it's. 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 who 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. But nobody chooses to lose your family, lose your custody of your daughter, lose your wife, lose your home, lose your job, your vehicle, your means to exist in life. Nobody would choose that.

Dr. 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.

Dr. Lisa Belisle:

And it maybe didn't go exactly the way you were hoping.

Kate Bowley:

Yes. My. My dad and I went and met with Governor LePage last. Actually, just about a year ago. It was last December. It was. I think. I think he heard the story and what I had to say. But, you know, in terms of the things that I read about what is moving forward in the state of Maine, I mean, I think. 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 going to be just law enforcement. It's not going to be just 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. And I'm not sure that we're there yet.

Dr. 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 I know they're 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 se, but did have both his general physician and. And the surgeon prescribing medications to him without knowing it, that each other was doing the same. So, you know, I think that there's. There's an opportunity there for sure.

Dr. 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 something who ended up with addiction problems so significant that they ended his life, but again, still her father, right?

Kate Bowley:

That's a great question. Interestingly enough, it's something 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. And, you know, as I watched her in school, like some of the bullying stuff has kind of started a little bit. Not necessarily in relationship to this, but in time, I worry that she could be exposed to that. And 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. And 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. But I do think she does know that, 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, you know, Tylenol and then what he was taking. And I just want her to be armed with all of the information that that's possible, and I think that that will unfold over time. Here 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. And I want her to have the information so she can make choices that are healthy and good for her as well.

Dr. Lisa Belisle:

Well, 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. But as I said at the beginning, you're a resilient individual. And I'm guessing that Lila probably has gotten some of that resilience.

Kate Bowley:

She's a tough little cookie.

Dr. Lisa Belisle:

Well, 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 Bally, who lives in Kennebunkport with her nine year old daughter Lila and 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.

Dr. Lisa Belisle:

All good things ahead for you.

Kate Bowley:

Thank you.

Dr. 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 Patrick. For a preview of each week's show, sign up for our E Newsletter and like our LoveMain Radio Facebook page, follow me on Twitter as DRLISA and see my running travel, food and wellness photos as bountiful1 on Instagram. We love to hear from you, so please let us know what you think of lovemain Radio. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged 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.