On the Front Lines

  • The patient lounge at the Milestone Foundation, where Dowd is the medical director.

  • Mike Carr has worked as an attendant at Milestone's Emergency Shelter—Maine's only shelter devoted to those with substance abuse disorder—for 40 years.

  • The entrance to Milestone Foundation on India Street, one of the few places addicts can detox and get access to treatment in Portland.

  • Dowd's stethoscope.

Dr. Mary Dowd is devoted to helping addicts get well.

“I’m not looking for challenges. I’m just following what I enjoy,” says Dr. Mary Dowd, a 65-year-old mother of four and family physician who has found a calling in the field of addiction medicine. As medical director of the detoxification program at Milestone Foundation in Portland, Dowd offers a beacon of hope to patients who have hit rock bottom. “I think it’s very rewarding to be able to help somebody completely transform their life,” she says.

Dowd did not set out to become a physician. Soon after receiving her doctorate and beginning a career in medieval studies, Dowd decided to leave the academic world. The turning point was the birth of her first child. “It kind of woke me up to our vulnerability and fragility,” says Dowd, a soft-spoken woman who wears her glasses on a chain around her neck. Dowd attended and graduated with honors from the University of Massachusetts Medical School in 1988. After medical school, she and her husband, Carroll Dunn, moved to Maine, where she continued her training at the Maine Medical Center family medicine residency program.

Dowd and her husband put down roots in Yarmouth, where she opened a medical practice. “I remember having one or two patients who had opiate addiction problems in private practice,” she says. Her eyes were opened to the significance of the addiction issue in 2005, when she began working part-time at the Cumberland County Jail in Portland. She says that the majority of patients she cared for at the jail came through the doors for drug-or alcohol-related reasons. “They were there because of something crazy they had done while they were intoxicated or high,” says Dowd. “Or something crazy they had done in order to get money to get intoxicated or high.”

Of the various drugs that have been linked to addiction, Dowd had the most concern about opiates, the category that includes some prescription pain medications, heroin, and its more powerful synthetic cousin, fentanyl. “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,” she says. “At first 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 are having.” Opiate abuse has reached crisis proportions in Maine—in 2016, overdose deaths from opiates averaged one per day.

Dowd eventually made addiction her full-time focus, taking a position with the Milestone Foundation in 2008. She also began working with the Catholic Charities substance abuse treatment program and at the Discovery House methadone clinic in South Portland. “For patients who have insurance, we can get them into treatment within about a week,” says Dowd. “For those who don’t, it is almost impossible. The medicine is very costly—$10 a dose. That plus the the doctor visits and counseling make it out of reach for someone without insurance or a wealthy, supportive family.”

Seeing a scarcity of treatment options, Dowd took on the role of advocate and began writing opinion pieces for the Portland Press Herald. “There are so few services you can offer patients with addiction in Maine,” says Dowd. “Most of the patients—especially the heroin addicts— have lost everything. They’ve lost their homes, they’ve lost their cars, and they’ve lost their families. They can’t work and they don’t have insurance or any way to pay for services.”

Dowd also began using writing to reconnect with her past, and her feelings about addiction as they related to her own family story. “My early and middle years could be seen, on one level, as a one-way trajectory away from the chaos and heartache of growing up in an alcoholic household in a town made up largely of first- and second-generation Irish immigrants who worshipped whiskey, the Pope, and President Kennedy, in no particular order,” writes Dowd in the introduction to a book of her poems, which will be published this spring.

Dowd has watched the multigenerational nature of addiction play out in her patient population as well. “Some of the patients we see at Milestone start when they’re 13 or 14 trying opiates,” says Dowd. “They come from generations of alcohol and opiate abuse. It’s what their families do; it’s what they know.”

Dowd notes that even within the lifetime of a patient, it can take time before he realizes that he is in trouble. “It’s usually about 20 years between the time an alcoholic realizes he has a problem with alcohol and he seeks treatment,” she says. “With an opiate addict, that time’s getting shorter. I’d say probably people are realizing now earlier on that they need help.”

Despite the lack of resources and complex nature of addiction, Dowd continues to be rewarded by her work. “I really enjoy the patients,” says Dowd. “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 their next meal is coming from, and having no money. They make it through these days. They have a lot of creativity.”


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