October 19

by John Richardson Writer

BANGOR — Mariah arrived this summer, on schedule and weighing in at 7 pounds, 2 ounces.

To her much-relieved mother, she looked and behaved like a normal newborn: very cute and very sleepy.

Whenever the baby was awake, she cried. what little she ate, she spit up. her entire body was stiff, as if all of her muscles were cramping.

Her mother knew what Mariah was feeling. she had experienced the pain of opiate withdrawal once herself.

"I feel bad that she’s in this situation," said her mother, a thin, soft-spoken 20-year-old from the Rockland area.

Mariah’s mother, like others who were interviewed for this story, agreed to talk about her addiction and her daughter’s withdrawal, but she did not want her name published.

As addiction to prescription painkillers spreads in Maine, it touches even some of the most innocent and fragile.

More than 570 babies were born last year to mothers who used prescription painkillers or other drugs while pregnant, according to hospital reports to the state. The number more than tripled in six years, and it doesn’t include the mothers who didn’t tell their doctors about their drug habits.

Most of the drug-exposed newborns experience opiate withdrawal and require weeks of hospital treatment, often with small daily doses of morphine or methadone, a drug to treat adult opiate addicts. It costs about $25,000, on average, to treat each baby in withdrawal.

The most fortunate babies have mothers who got into addiction programs during pregnancy and took controlled doses of a treatment drug. The long-term effects on the children are still unknown, but most of the babies go home after two to four weeks of detoxification with no immediate complications.

On the other hand, an unknown number of pregnant addicts do not get treatment. They take street drugs throughout their pregnancies, or they try to quit cold turkey in the belief it will help their babies. In both cases, doctors say, the women are much more likely to miscarry or give birth prematurely to babies with higher rates of birth defects.

"when someone is using street narcotics, it’s a seesaw of high, low, high, low. for a baby, that’s very dangerous," said Dr. Brenda Medlin, a pediatrician who cares for drug-affected babies at Maine Medical Center in Portland.

Quitting altogether during pregnancy threatens the unborn baby because the mother’s body rebels, causing the uterus to twitch and contract, said Dr. Mark Brown, neonatalogist at Eastern Maine Medical Center in Bangor. "We don’t want (expecting) mothers in withdrawal."

Treatment during pregnancy with controlled doses of methadone or suboxone dramatically improves the babies’ chances of avoiding complications, doctors say. It doesn’t mean the babies will be spared all the effects of their exposure to the drugs.

The newborns are watched closely. About 55 percent of the opiate-exposed babies begin showing symptoms a day or two after birth, as their bodies cry out for another dose.

"It’s very difficult to see a baby go through withdrawal," Brown said. "They’re not cuddly; they’re not lovable. They can’t engage their surroundings. They can’t even eat."

Doctors and nurses assess the severity of each baby’s symptoms, including fever, diarrhea and vomiting. a baby in withdrawal will often have all of his or her muscles contracted.

"They are very stiff. if you try to lift them up, instead of their head hanging back a little, they are like a board." Medlin said.

Once they’re certain that a baby is experiencing withdrawal, not gas or some other discomfort, doctors begin administering medication. They use medicine droppers to put small doses in the babies’ mouths and typically taper the doses off over about two weeks.

Several days into her methadone treatments, 1-week-old Mariah slept peacefully in her mother’s arms. The private hospital nursery room was quiet, and dark except for the light coming through a large window overlooking the Penobscot River.

Mariah’s mother sat in a rocker, a towel draped over her shoulder. she had the tired look of a sleep-deprived new mother, but the shadows under her eyes were especially dark. she didn’t smile.

"It doesn’t feel real good, seeing her like that," she said quietly.

Mariah’s mother started taking Percodan and OxyContin pills when she was 18. she had a 2-year-old daughter at the time and lived with the girl’s father, a lobsterman who bought the pills and crushed them into powder so they could snort them and get high together.

After just two weeks of using the drug every day or two, she was addicted, she said. "One day I just woke up and I was throwing up and felt sick. then I used (the pills), and I felt better."

That’s when she started using the pills not so much to get high, but to keep from being sick.

Three or four months later, she started addiction treatment at a methadone clinic in Rockland. for a year, she took daily, measured doses of the powerful narcotic and attended counseling in hopes of gradually reducing her dependence.

In August 2010, the clinic closed. she went back to getting pills on the street, she said.

She started taking buprenorphine, or Suboxone. The drug is used to treat addiction but has become a street drug for addicts who are desperate to get high or avoid withdrawal.

In October, Mariah’s mother realized she was pregnant and knew immediately that the unborn baby could be in trouble. The only treatment program within reach of her home couldn’t help her, she said.

"They put you closer to the top of the waiting list when you’re pregnant, but you’re not in automatically," she said.

Treatment centers across the state say they give first priority to pregnant mothers because of the risks to their babies.

Her doctor could not help because he was not licensed to prescribe buprenorphine. He effectively sent her back to the street to medicate herself, and her baby.

"He told me ‘Don’t stop taking it,’" she said. "Some days I would go without and I felt so bad. I didn’t want it to affect her."

Finally, about four months into the pregnancy, she went to a hospital, suffering from withdrawal. her body ached, she had sweats and chills, and she was vomiting and unable to eat.

"I hadn’t had any in about a week and I was getting pretty sick, and I didn’t want the baby to … I didn’t want to miscarry," she said.

She was taken into a treatment program and put on controlled doses of buprenorphine for the rest of her pregnancy.

Three weeks after Mariah’s birth, she was still at the hospital. but the baby was eating well, cuddling in her mother’s arms and nearly ready to go home, her mother said.

Some babies have withdrawal symptoms, such as crying or irritability, for months. It’s not known what long-term physical effects may await Mariah and the other babies.

Researchers haven’t had time to answer that question. however, there is cause for concern about the effects of opiate exposure before birth, as well as the withdrawal process and drug treatments that newborns experience in their first days and weeks of life, said Marie Hayes, a professor of psychology at the University of Maine.

"The little brain is in a critical period," she said. "There is actually potential damage to the brain from the withdrawal process itself."

Hayes and a team of Maine researchers have been studying the effects in about 150 children during their first year of life. Brain wave tests have shown developmental delays in a higher percentage of babies who go through opiate withdrawal, but it is too soon to know whether the children will have long-term problems. "are those enduring (developmental) deficits?" Hayes said. "We don’t know."

It’s also difficult to sort out the effects of the opiates from the effects of alcohol exposure and other factors.

Among the risks that most concern Hayes are the sleep deprivation and fragmentation that accompany withdrawal. she fears that sleep disturbances at such a sensitive time may make the babies less arousable and more at risk of Sudden Infant Death Syndrome.

The most immediate concern about the babies’ future well-being is that their mothers could start abusing drugs again. Pregnancy brings many mothers into treatment for the first time.

"They’re really taking a step in the right direction. our role is to welcome them with open arms and to not alienate them from treatment," said Brown, at Eastern Maine Medical Center.

Simply discharging the mothers back to their communities with new babies to care for is risky for both. So the hospitals work with community agencies to set up supports so the mothers continue treatment.

"Addiction is a chronic medical disease. …," said Mark Moran, a social worker at Eastern Maine Medical Center who works with the new mothers. "You have to manage that over a long period of time."

Hospitals also notify the Maine Department of Health and Human Services whenever babies experience opiate withdrawal.

The DHHS sends a public health nurse to work with the mother and baby. as long as the mother is getting treatment and there are no other circumstances that jeopardize the child, such as domestic violence, the state does not move to take custody of a child from her mother.

More than 95 pecent of the opiate-affected babies born at Eastern Maine Medical Center go home with their parents, Moran said.

Two years after giving birth, 27-year-old Sarah of Brunswick is confident that her daughter made it through the experience unscathed.

The little girl shows no visible effects of her mother’s addiction. she walks around her mother’s apartment with a sippy cup, feeds her crackers to the dog and likes to try to climb the stairs.

Sarah, who did not want her last name published, continues to take Suboxone to control her cravings for OxyContin and other drugs.

"I think about the pills still now," she said, "but I haven’t acted on it. … I never want to do it again, because of my daughter."

At Maine Medical Center, Dr. Medlin checked on a 3-week-old boy who was nearly ready to go home to Biddeford with his mother and father.

The baby, who weighed 5 pounds, 12 ounces at birth, had to be fed through a tube during withdrawal. At three weeks, he was eating from a bottle and gaining weight.

"He’s just like a normal baby," said his mother.

The 20-year-old first-time mother, who also wanted her name withheld, said she grew up around drugs and started taking pills when she was in eighth grade. It took pregnancy to get her into treatment, she said. she wasn’t alone.

"when I went to detox, every girl there but two were pregnant. There were maybe eight women there," she said.

Now, even though she will return to the same community where pills are easy to get, she is determined to stay clean and protect her son, she said.

"He did change my life," she said. "I wouldn’t think of messing up now."

She broke up with the boyfriend, who had gone to jail for selling pills, she said. she also cut off contact with all of her old friends. she, Mariah and her older daughter were moving in with her parents in Rockland.

"It’s starting to look a lot better," she said. "I wouldn’t ever do that again."

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ROBERT PRICE: Summer of LSD inspired doctor’s 40-year mission The Bakersfield Californian | Saturday, Oct 22 2011 09:30 PM

last Updated Saturday, Oct 22 2011 09:40 PM

At the bookstore: Dr. David E. Smith will read from his out-of-print biography and sign copies of his book “Unchain your Brain: 10 Steps to Breaking the Addictions that Steal your Life” at 6:30 p.m. Tuesday at Russo’s Books, 9000 Ming Ave.

On the radio: Smith will be on “Californian Radio” with host Robert Price from 9 to 10 a.m. Tuesday on KERN-AM 1180.

to legalize or not to legalize? The question of marijuana's safety, its impacts on society and its potential as a government revenue source has probably never been so hotly debated in the mainstream of public opinion. We've been waging war on the drug trade for decades, and what has it gotten us? Prisons full of drug users and street-corner dealers, an ever-increasing enforcement bill that cuts deeply into other services, and a murderous drug cartel to the south that threatens to turn Mexico into a full-blown narco state. Today, even "respectable" people feel the burden of those hard truths.

Dr. David E. Smith certainly does. And, as a person uniquely and intimately qualified to talk about the social, medical and spiritual ramifications of illicit drugs' widespread use, his is a worthwhile voice.

Smith is a physician. He's a toxicologist. He's a philanthropist. He's a nonprofit executive. He's a stoner — well, a reformed stoner who can tell portions of his life story against a backdrop of firsthand dope-smoking and LSD-dropping experiences.

And, wouldn't you know it — Dave Smith is one of ours, a Bakersfield native with a deadly (but retired) 20-foot jump shot and fond memories of a certain '47 Chevy from his days at East High School.

Smith graduated from Bakersfield College in 1958, got his undergraduate degree from UC Berkeley in 1960 and then obtained his M.D., along with an M.S. in pharmacology, from UC San Francisco in 1964. he interned at San Francisco General Hospital for almost three years and for much of that time was chief of the alcohol and drug screening unit. And, simultaneously, he himself was a raging alcoholic. In fact, for a time, Smith enjoyed a full range of intoxicants and hallucinogens. how could he have achieved so much as a young man while indulging in such behavior? Timing.

"Fortunately, interest in that lifestyle hit me after I already had my skills (as a doctor)," Smith said.

but on Jan. 1, 1966, he resolved to stop drinking, and by the time the Summer of Love descended on San Francisco in 1967, Smith had also extricated himself from the grip of that era's signature vice, LSD. he would happily stick to marijuana.

part of his motivation for (mostly) sobering up was the abundant evidence of the drug scene's distressful consequences: Smith had grown increasingly alarmed by what he saw on the streets of San Francisco. he saw teens and twentysomethings, many of them far from home, in search of the freedom and beauty portrayed in the breezy psychedelic rock music of the day, reduced to homeless addicts. If you're going to San Francisco / be sure to wear some flowers in your hair. In countless cases, what young people found instead of freedom and beauty was the devastation of exploitation, mental illness and, most frightening, overdose.

"it was the era of Ken Kesey and 'The Electric Kool-Aid Acid Test,' the Merry Pranksters," said Smith, who is now 72. "They were all taking LSD, and bad trips were a regular thing."

others were disturbed by the psychosocial carnage as well. Robert Conrich, the son of a San Francisco architect, approached Smith, then 27, about the possibility of addressing the city's growing public health crisis by opening a privately financed free medical clinic, with Smith as medical director. Smith, having heard about the successes of a free clinic that opened in Los Angeles in the wake of the 1965 Watts riots, agreed it was a worthy undertaking, and on June 7, 1967, in an office formerly occupied by a dentist, they opened the Haight Ashbury Free Clinic.

"it came to be called the Hippie Clinic," Smith said. "I practiced without an income and without malpractice insurance from 1967 to 1972, but we saved the city of San Francisco millions of dollars because these were people who would have gone into the emergency room without our intervention. We had all kinds of people, including vets coming back from Vietnam. We were detoxing 100 addicts a day."

They were also breaking new ground in the field of addiction medicine. "We were suddenly defining the treatment protocols," said Smith, who went on to write textbooks on the subject, founded the Journal of Psychoactive Drugs and served as president of the American Society of Addiction Medicine.

but in those early years, the clinic eked out an existence with volunteer workers, community good will and benefit events — mostly rock concerts.

for a time, the DEA didn't know what to make of the clinic. "They weren't sure what we were up to at first," Smith said. "I had my picture in the DEA offices in San Francisco (as a person to monitor). We had to take steps to make sure there was no dealing in the lobby. We put up a sign on a door — everybody says they remember that door — 'no dealing! that can close the clinic.'" Eventually, the government decided the clinic was a good thing, not a detriment to society, and the first federal grants started coming in 1972.

The clinic became closely identified with San Francisco's rock music scene and Smith became friends with bill Graham, the impresario who brought fame to the Fillmore Auditorium as a '60s concert venue and, with the help of Apple's Steve Wozniak, helped create Mountain View's Shoreline Amphitheatre. Graham was probably the first to hire medical personnel for his larger shows — and he preferred the staff of the Haight Ashbury Free Clinic for his Bay Area concerts.

The connection was a great benefit to the clinic, whose supporters over the years have included Janis Joplin, Creedence Clearwater Revival, George Harrison, Jefferson Airplane, the Grateful Dead, Carlos Santana, even Buck Owens. All played benefit concerts.

but Graham himself wasn't particularly interested in the more unpleasant details of the drug scene. Overdose cases were bummers, and Graham didn't want to witness bummers, especially if he sensed he might have been, by virtue of the culture he had helped nurture, tangentially responsible.

"I asked him once: 'do you want to come down and see us treating an overdose?' no, he didn't want to see a bad acid trip," Smith said.

Graham died in a helicopter crash in 1991 — 20 years ago this week, in fact — having lined up, just minutes before, the headliner act for a benefit concert to help the victims of the devastating fires in the Oakland/Berkeley hills.

There'd been a lot of alcoholism in Smith's family and he knew he was predisposed. he eventually beat it, though not without some pain. he took LSD for the last time in late 1966 or early 1967, but quitting marijuana was another matter. he found himself sneaking out of the house to smoke. then, one day, sometime in the early 1980s, Smith realized just how ridiculous his habit had become. "I had been stuck in the 1960s," Smith said, "and it was time to grow up. Quitting it was a spiritual thing, but it was also important to me from a professional and academic point of view."

his years in the clinic, and as a willing participant in the drug culture, leads him to the conclusion that nothing beats sobriety — even marijuana. "Marijuana," he said, "gets in the way of spiritual recovery."

Neither side of the legalization debate, he says, has been honest or willing to make rational concessions.

"I grew up in the 'Refer Madness' era, when there were liars on the enforcement side," he said. "now there are liars on the legalization side. When I was smoking it, I was on the wrong side, and now that I'm sober, I'm on the wrong side again."

Smith says he could endorse some form of legalization only in one scenario. "I've talked with proponents of legalizing marijuana and all they talk about is the money, the profits, the tax revenue potential," Smith said. "I tell them, 'but there will be consequences. If you agree to put all of the revenue in education and treatment, I could agree to it.' but they won't (agree) because they say that would be like admitting that there's something wrong with marijuana." And there is, Smith maintains.

Smith isn't buying the argument for medical marijuana, either — at least not the way it's prescribed and distributed today. "Medical marijuana is a farce, just a cover for people who want to score," he said. "Getting a medical marijuana card is about as hard as getting a Blockbuster (Video) membership."

We've botched the war on drugs, Smith says, but he does believe in one strategy: drug court, which gives users the chance to size up their lives. "It's when you realize you don't want to lie, cheat and steal that you finally take the steps you need to take to live again."

Smith married Millicent Buxton, who he'd met at the clinic, in 1977. At the time she was a recovering heroin addict; now, Smith said, "she is an esteemed old timer in Narcotics Anonymous." They have four children and three grandchildren.

Today, the Haight Ashbury Free Clinic is in the midst of change: last July, it merged with the much-larger Walden House, another S.F. nonprofit social service agency. Dr. Vitka Eisen, CEO of the new Haight Ashbury Free Clinics-Walden House, is a former heroin addict who owes her sobriety, in part, to Smith and the Haight Ashbury Free Clinic's detox program.

The combined organization, which has an operating budget of $60 million, has 2,000 employees plus hundreds of volunteers who deal with 40,000 unique patient visits a year and 1 million annual patient visits throughout the state. "everything," Smith said, "from skinned knees to full-blown heroin addiction."

it takes considerable passion to devote a lifetime to such a daunting cause. Smith says he managed by hewing close to a belief he's had all of his professional life: "Health is a right, not a privilege," he said. "Addiction is a disease, and addicts have a right to treatment." maybe he says those words with such conviction because, as a former user, he knows just how close he came to losing everything. "part of it had to be God's will," he said. "I could have been killed. Lots of stuff happened, bad stuff. now look at me: now I'm just an old grandfather, hanging on."

Email Editorial Page Editor Robert Price at .

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Writing about eating disorders feels like an exercise in vulnerability, not because I am ashamed to share my story, but due to the extremely emotional nature of the topic for countless women. in an era of Kate Moss, skinny jeans, and “she’s too skinny!” tabloid fodder, eating disorders run rampant like a cultural epidemic, continuing to fester alongside a never-ending preoccupation with body image. Although the majority of the media narrows the scope of the issue to models and celebrities, eating disorders are actually most prevalent amongst us everyday girls. Simultaneously, the reality of EDs extends beyond the teenage anecdotes of starving ourselves to be popular; these serious diseases have lifetime physical and psychological ramifications and are far more multifarious than extreme dieting. Weight is a sensitive subject to say the least, one I am going to handle diplomatically. The objective of sharing my story is not to be controversial, blame Hollywood, or spark debate on how to confront eating disorders, but to reflect on the complexities of a ghost that has haunted me and so many others for over a decade.

There is no getting around the fact that I was a bit of a nerd in high school. Whilst my cohorts were voted “most Likely to Succeed,” “best Personality,” or “most Athletic,” I was voted “Class Writer.” I wasn’t entirely unpopular or unattractive, but I was certainly no Sofia Vergera. a feeling of awkwardness permeates that time; I was constantly fumbling between establishing a sense of self and transforming into an impractical image of who I thought I should be (this was normally a blonde beach bombshell when I was a short Italian brunette). My awkwardness was like the discomfort I feel when I purchase a too-tight dress for a special event and spend the evening scolding myself for not buying the dress I really liked — except the discomfort extended four years. Personality-wise, I was (and still am) a perfectionist and an overachiever who is highly critical and judgemental of herself, and I have my strict parents to blame for those gems. The one and only time I brought home a C on my report card, I was punished. even when I won a myriad of academic awards and volunteered in the community and with my church, I was still told I could do better.

It is no wonder that when I was 16, I developed an obsession with my weight. I was neither heavy nor skinny, but somewhere in between. I favored school plays to sports and wasn’t as toned or as busty as those beauties on the cheerleading squad. I began to compare myself to my peers in the locker room during PE and noticed that the prettiest girls fancied by my crushes didn’t have thighs that touched like mine and flashed their hip bones with low-rise flares. Understanding now that control is the nucleus of this fixation, I tried in vain to cut calories and skip breakfast, but was thwarted by an Italian mother who constantly supplied me with carbs, sugar, and more carbs. My solution was to throw up after dinner.

Little splatters of vomit that I failed to clean off the walls near the toilet triggered my parents to force me to see a psychologist. I cannot pinpoint a specific turning point when the problem escalated to bingeing and purging, but my struggle with weight had become bigger than me. I spent my junior year of high school depressed and disillusioned by the belief that enough vomiting would convert me into that blonde beach bombshell, one that was also a triumphant size zero. I subscribed to the fantasy that a slender version of me would be the one that girls envied and boys would ask out. Amongst a class of girls (and boys who hid it well) that dabbled with diet pills, overexercised, and fainted in class due to starvation, I didn’t think I was doing anything wrong. in fact, I thought I was doing everything right.

A genuine rapport with my psychologist and spending hours on the Internet cycling through pages on bulimia snapped me back to my senses  during senior year. I developed the courage to end the cycle of shame and anxiety that accompanied bingeing and purging and recommitted myself to focusing on mental and physical health. I didn’t lose much weight in my junior year and gained more than ever when I transitioned to my newfound stance on nutrition. instead of relapsing, I joined a gym. Although my health teacher (who was fully informed of my history) warned that one addiction leads to another, regular runs on the treadmill and the occasional spinning class alleviated the stress born from the next stage in my life – college. Food became satisfying, working out felt therapeutic, and the whole world was at my fingertips.

College was my personal renaissance. I threw my fake blue contacts in the garbage, dyed my hair back to its natural chocolate brown, and surrounded myself with heaps of eclectic and fun people. I felt as though I was at last allowed to be myself. in turn, my maturity grew organically and my confidence unfolded naturally. Like the Christopher Columbus of personal revelations and development, I discovered how delicious it felt to let go of trying to be Britney Spears pre-Kevin Federline and coax the beauty hidden inside to come out and play. I was pleasantly surprised that men found me attractive, even after I finally embraced my high school nerdiness. I had heard through the gossip mill that a charming Brit described me as confident and sexy, and I quickly snapped him up as my first college boyfriend. in retrospect, I know it was naive of me to believe that all of my insecurities and serious problems with weight from high school had been washed away with the tide of my glory days.

After girls in our posse of friends tried one of those fad detox diets in preparation for a university ball (and subsequently didn’t eat for three days), my personal demons made a guest appearance. I asked my man if he thought I should partake. Candidly, he told me I wasn’t fat, but I wasn’t skinny. his comment sticks with me to this day. I’m not 100 percent sure why it was so detrimental, especially since I was aware of being a “normal-sized” girl. perhaps hearing it from someone I loved startled awake the perfectionist in me who desperately wanted to please her boyfriend with a flawless physique. a track record of satisfying my parents mirrored a new aspiration to impress my boyfriend. I was again transfixed by another body-conscious myth, one that nagged me into thinking he would love me more if I was skinny.

My eating disorder returned to a degree of unparalleled ferociousness I had never experienced before. Ironically, I destroyed my body endlessly with extreme dieting and over-exercise at a time when I felt the most peace with my identity. perhaps the commitment to becoming an unrealistic prototype of a woman fostered a false sense of self-improvement, as though my hard work would pay off in the long run. a typical day consisted of an intense two-hour workout, walking to classes whenever I could (especially if they were far away), and forcing myself to do star kicks and push-ups until my muscles burned before bedtime. My eating plan was straightforward: no breakfast, endless cups of coffee, a cup of salad for lunch, and another cup of salad and maybe some chicken or soup for dinner. no dressings, sauces, or real sugar. Extra time spent at the gym meant I could indulge in the occasional cottage cheese, wine, and a normal dinner in town with my boyfriend.nonetheless, a toddler ate more than me.

As hoped, people praised my weight loss and commented on how good I looked. Numerous eating disorder sufferers often comment on how they experienced the same paradoxical reaction; whilst they were essentially killing themselves to achieve an unrealistic ideal, their loved ones encouraged them, praised them, and essentially added fuel to the weight loss fire, unaware of the true horror that occurred behind the scenes.

The attention continued until I melted away into a waif. I was compared to such objects as a sheet of paper, a rail, a stick, and on one occasion, a lollipop. one would think that the alarm bells would have been going off, considering the obvious bingeing and purging hurdle I overcame in high school. But the gravity of the situation didn’t click until I noticed I didn’t have the energy to walk down the block anymore. one afternoon, I went shopping with a girlfriend and discovered I had dropped six pant sizes. even the tiniest jeans were baggy and I could see constellations of bones in my arms, chest, and back. I am ashamed to say that I was proud to be scary skinny. Finally, every girl would be green with envy over my figure. I wanted them to hate me for it.

Instead of recognizing a fragile skeleton, I felt empowered. It was like I had reached a new plateau of personal accomplishments on the perfection spectrum. My friends were extremely worried to the point that they checked my vitamin bottles for dieting pills and often tried to keep tabs on my meals or stage mini-interventions, while acquaintances would bluntly ask me if I had a problem. The boyfriend that had sparked my self-torture dumped me at the end of my freshman year because I was constantly irritable, moody, and tired from starving myself. instead of heeding this wake-up call, his absence allowed me to binge and purge again in the privacy of my single dorm room. I was given absolute privacy to become the master of my own downward spiral. It would be an understatement to say that I was a total mess.

When I returned home after my first year at college, my mother knew instantly that my eating disorder had taken complete hold of my life. we argued endlessly about the time I spent at the gym, how I picked bread stuffing out of her chicken specialties, and how she knew I was bingeing and purging but couldn’t prove it. I openly blamed her for melding me into a monster of perfection, and although I knew I alone was responsible for my actions, I didn’t care. I enjoyed persecuting her and watching her squirm like a witch burning at the stake. What an ugly person I had become inside. again, she forced me to go see a psychologist, who wasted no time in recommending that I immediately join a daily therapy program where I spent five days a week, eight hours a day, with other recovering young adults. Would you believe my response? I stormed out of her office, huffing and puffing, ate every piece of bread, chocolate, pasta, and ice cream in the kitchen when I returned home, and took a decent swig of ipecac to throw it all up. The addict had hit rock bottom, but I was not yet prepared to face it.

My parents reluctantly allowed me to return to college — and it actually ended up being for the best. Similar to my senior year in high school, something inside of me yearned to the turn the page and end this deplorable chapter of my life. Change became inevitable and necessary for my health and state of mind. Feelings of security and confidence had become a memory; I was a glimmer of a girl who had faded from a vibrant spirit to a pathetic shadow. already a volunteer with the student support services, I worked with counsellors to reconstruct perceptions of my image. by my senior year, after much soul searching, treatment for depression and anxiety, and even more counseling, I formed and headed the first eating disorders support group at my university. I embraced the positivity extracted from a diverse group of women and men who suffered like I did, and allowed myself to heal from what felt like a lifetime of humiliation and hatred.

I would be lying to you at 27 years old if I said the magnitude of my eating disorder hadn’t left deep scars, like craters in my psyche. Images of Heidi Klum and faultless bikini bodies linger in the back of my mind as a constant reminder that my issues with weight, control, and self-esteem are evermore. I wish I could tell you that I am comfortable at any weight, but this is not the reality of the situation. I become stressed when I fluctuate a couple of pounds, especially around the holidays. I worry that my husband — who often tells me he will love me at any weight —  might think I’ve become a fat housewife who doesn’t care about her appearance. that is the latest falsehood that plagues me, but I have learned to recognize its shallowness and discipline it. I am destined to remain a calorie counter and a runner, except nowadays, I must proactively monitor these behaviors and pursue them in moderation. I remain vigilant of emotional eating and feeling helpless in an effort to derail control problems before they arise. I eat a relatively clean diet because I honestly like vegetables; I enjoy rock climbing and hiking because it’s fun, not because it’s a way to lose weight. At the same time, I’m no stranger to ordering fried food or indulging in cake and feeling a bit guilty if I go overboard. I have accepted that this is who I am and who I always will be.

I am deeply saddened by the stories of people who die from eating disorders and I am equally terrified when my 13-year-old niece with no hips claims she is fat at 100 pounds. none of us are immune to the universal pressures of weight and beauty and I would be surprised if someone hasn’t grappled with their self-image in any form. It is a delicate balance between self-improvement and self-destruction, and teetering around the boundaries of these opposites is unique for each individual.

I don’t like to tell people how to live their lives and I don’t want to come across as a know-it-all. The only thing I will say is it is totally acceptable and encouraged to speak to friends, family, or professionals if you have any concerns, eating disorder or not, that are torturing you and blocking you from experiencing joy in your life. Don’t be afraid to write your own story.

“Skylar Gray” is a pseudonym. If you would like to contact the author of this essay, send an email to and she will forward it to the author.

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October 20 Problem: Maine doesn’t always have enough treatment options

BY JOHN RICHARDSONThe Portland Press Herald

PORTLAND — It takes Blake Carver just a few minutes to walk down the front steps of Serenity House, shaking hands with the men gathered to congratulate the house’s newest "graduate."

But it has been a long journey to get here — years of addiction to prescription pills followed by years of prison for burglarizing houses to feed the habit.

"I didn’t know where to go and I didn’t see a bright future for myself," he said. "I feel great today."

That is the good news about Maine’s painkiller abuse epidemic, experts say. Opiate addiction is treatable.

The bad news is that Maine doesn’t have enough treatment options for all of the people who want or need it.

"there are tens of thousands of Mainers who have serious opiate addictions and who have no access to care," said Mark Publicker, a physician and addiction specialist at Mercy Recovery Center in Westbrook.

Officially, about 300 people are on waiting lists at treatment programs around the state at any time, according to the Maine Office of Substance Abuse. but experts say many more Mainers go without help because it’s not available in their communities, they don’t have insurance to cover it, they’re too embarrassed or ashamed to seek help, they can’t leave jobs or children, or they simply don’t know where to turn.

"when we have people come in here, that’s the tip of the iceberg. There’s many more people out there," said Virginia Blake, clinical supervisor at Discovery House, a methadone clinic in downtown Calais.

Instead of getting treatment, many addicts continue to use whatever pills they can get on the street, dealing and stealing if necessary. or they try to quit on their own and, experts say, inevitably fall back into addiction.

"People with opiate addiction cannot stop without treatment," Publicker said. "Willpower doesn’t work with pills."

The number of people who seek treatment for painkiller addiction has been steadily rising. Nearly 4,000 were admitted for prescription opiate addiction treatment in Maine last year, second only to the number who sought alcohol abuse treatment — about 5,500.

Despite the demand for more treatment services, Maine is struggling to maintain existing programs.

The LePage administration proposed a $4.4 million cut to substance abuse treatment funding this year, potentially closing as many as 10 small residential programs. all but about $400,000 was restored to the budget before it passed, and the remaining cut was spread out to avoid eliminating any individual programs. the budget included limits on MaineCare eligibility, however, which left an unknown number of addicts without health insurance to pay for treatment.

In a visit to Serenity House in Portland in July, Gov. Paul LePage said his administration is continuing to review treatment funding. "We’re looking at every program and evaluating what are we doing," he said.

Treatment saves money

The cost of treatment varies depending on the type of program. A month of treatment at a methadone clinic can cost nearly $400, while a month of intensive counseling can cost $1,200 or more. MaineCare provides comprehensive coverage for addiction treatment, while private insurance is variable, depending on the plan.

Every dollar spent to treat an addict saves an estimated $12 in avoided health care costs and crime-related costs that would come with continued addiction, according to the Office of Substance Abuse.

Treatment can be a long process. Detox, the process of breaking the body’s acute dependence on opiates, is not considered treatment, although it can be the first step.

"You can’t just detox and be OK, because your brain chemistry has been altered," said Blake, at Discovery House. "This is a very involved disease."

Treatment includes intensive counseling to understand the addiction and develop the tools to manage it. Some unknown percentage of patients will relapse, and it’s not uncommon for addicts to go through treatment two or three times. but, the experts say, many people do get well.

"I’ve seen people who I thought were never going to get clean and sober, and they did," said Dr. George Dreher, a Portland-based psychiatrist and addiction specialist. "It can be very discouraging after you go through treatment a few times and keep relapsing. It doesn’t mean it won’t work the next time. There’s always hope. It is a treatable disease."

Addicts may also need counseling and treatment for underlying medical problems that could lead to relapse, such as depression or stress from being sexually abused as a child. And some have to deal with new trauma related to the addiction itself, such as women who trade sex for pills. "we get a lot of women who come in here pretty damaged from having to do that," said Blake.

The clinic that Blake supervises is one of eight in the state that provide methadone to about 4,500 addicts statewide.

Its 200 patients start filing into the nondescript Calais storefront at 5:30 a.m., often before heading out to work on lobster and fishing boats.

The line of patients ebbs and flows throughout the day. Whenever a bell rings, the first patient in line enters a private dosing room.

Inside, an attendant behind a thick glass partition checks identification and enters the person’s individual dose. A machine pours the precise amount of red liquid into a small plastic cup, and the patient drinks it down as the attendant watches.

"It was embarrassing when I first came here," said Tasheena Fitzsimmons, 26, of Calais. "when I realized how much it helped, I wasn’t embarrassed anymore."

Fitzsimmons has been coming to the clinic for three years and has gradually reduced her dose from 135 milligrams a day to 24, she said. she works with the counselor in hopes of getting off the medicine entirely someday. but she is under no time limit.

"It’s unique for every person," said Blake, the clinical supervisor. "the brain is healing and they are changing their lifestyles."

Methadone itself is a highly addictive synthetic opiate, and it’s commonly prescribed for pain in pill form. In controlled doses, addicts get just enough of the drug to keep from experiencing cravings and withdrawal.

"I feel completely normal," said Rick Fitch, 30, after drinking his daily dose. He has been coming to clinic every day before work for two years, he said.

Some addicts and treatment counselors view methadone therapy as trading one addiction for another. Methadone providers, on the other hand, say the clinics have reduced emergency room visits, crime and other problems.

The daily doses come with required counseling visits and periodic urine tests to make sure patients are taking only the methadone they get at the clinic. Anyone caught taking other drugs, some of which can cause deadly interactions with methadone, faces additional counseling and monitoring, and may get cut off from the treatments.

Methadone was the first opiate-replacement therapy drug in Maine, but it is no longer the most common.

Dozens of Maine physicians have been trained and certified to treat opiate addicts with a drug called buprenorphine.

The drug, usually prescribed under the trade name Suboxone, contains an addictive synthetic opiate as well as an opiate blocker that’s intended to discourage abuse. Buprenorphine carries less risk of contributing to overdoses, because it doesn’t last in the body the way methadone can.

"It is extremely valuable. It can save people’s lives," said Publicker, who has 100 patients at Mercy Recovery Center who receive prescriptions for the drug — the maximum allowed for one doctor.

But buprenorphine is no wonder drug. It controls cravings and prevents withdrawal, but addicts still need counseling and treatment.

Suboxone patients manage their own medication and don’t have to show up every day for a dose. They do face regular urine tests and other monitoring to make sure they are taking the medicine, and not other drugs.

Lack of access

Not all addicts in Maine have access to the drug.

Some of Dr. Steven Weisberger’s patients drive two hours to his office in Jonesport to get refills of their Suboxone prescriptions. He has the maximum 100 addiction patients and 25 on a waiting list.

Not only is there a shortage of addiction doctors and treatment centers in his part of the state, there are shortages of psychiatrists, substance abuse counselors and pain specialists to help care for his patients, Weisberger said. "In Washington County, you’re on your own."

Physicians who prescribe Suboxone as part of their primary care practice can get treatment to addicts who wouldn’t otherwise seek help, said Dr. Ira Stockwell, a licensed Suboxone prescriber in Westbrook.

"I think more family practice doctors should do it," Stockwell said.

James Cox, 31, a recovering addict from Jonesboro, takes 4 milligrams of Suboxone a day, in a thin strip that dissolves under his tongue.

"It’s not sober, but it’s pretty damn close for me," said Cox, who has been taking the drug for three years and is gradually reducing his dose. "Basically, it keeps me going. I can go to work. I can be with my kids. I can be a father."

Many adult addicts go through treatment without taking replacement drugs. They may detox in a jail or in a hospital, then enter outpatient or residential treatment.

Replacement drugs are not typically prescribed to teenagers. but treating kids also can be a slow process, said Don Burke, outpatient director at Day one, a South Portland-based treatment agency for teenagers and young adults in southern Maine. Nearly all of Day One’s patients — more than 400 a year — have been referred by schools, courts or parents.

"They’re not embracing treatment," Burke said. "They’re in a battle with it."

Residential treatment is the most intensive, and allows addicts to begin recovery in a supportive, sober environment. but it is not an option for many women who have children to care for, said Nikki Oliver, program manager at Crossroads’ halfway house in Portland. Budget cuts have left the agency with space for only two mothers to bring their children to a 60-day residential treatment program.

"the waiting list is really long (for the two slots), so they have to make a choice between the treatment and their children," Oliver said. even after a two- or three-month residential program, recovering addicts need outpatient counseling and community support to prevent relapse, Oliver said.

"if it was about just putting down the drink or the drug, it would be no big deal. It’s a disease that needs treatment."

Blake Carver said the three months at Serenity House, a treatment center for men, changed his life. "You understand now it’s possible to get over these things that seemed so bleak before," he said.

And, on his graduation day, he promised his housemates that he would prove it by staying clean. "You watch and you see."

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Times File PhotoAt the 2008 groundbreaking for Lawrence Campus West medical office building on Federal City Rd., John Simone of Simone Realty Inc. talks about the new building.

LAWRENCE — four months after the local zoning board denied developer John Simone’s bid to put a residential drug and alcohol detox center on Federal City Road, Simone announced plans to put an outpatient drug clinic at the same site.

Neighbors who launched a prolonged and well-organized fight against the in-house clinic would have very little to say about an outpatient clinic because it is permitted under current zoning laws, Simone said.

In a letter from the township zoning officer this week, Simone was told he would need no variance or public hearing to provide a walk-in treatment for addicts at the commercial center that borders an adult community and other neighborhoods. Simone owns the property.

“We could build it tomorrow. It’s a permitted use,” Simone said. “I’m in negotiations now with two groups who want to operate it.”

Zoning for the site allows “medical offices for the purpose of drug and alcohol treatment” as long as the patients aren’t staying overnight, James Parvesse, township zoning officer wrote in the letter to Simone.

The outpatient clinic Simone is considering would operate Monday through Saturday from 9 a.m. to 9 p.m. Staffed by 10 to 12 people, including health care professionals, the clinic would provide addiction evaluation and counseling for up to 75 walk-in patients a day, according to information Simone provided to The Times.

“this would be an alternative to the residential treatment center that everybody gave us a hard time about,” Simone said.

Sunrise Detox, the group Simone had lined up to operate the residential center that failed to get zoning approvals, is interested in running the outpatient clinic, he said. The company currently operates two other residential centers — one in North Jersey and one in Florida — and is branching into out-patient treatment, Simone said.

Another company, which Simone would not name, is also interested in running the facility, he said.

Simone sued the township and its zoning board last month, alleging that the decision to deny the use variance for the residential facility was “arbitrary, capricious, unreasonable and contrary to the public interest.”

As that appeal makes its way through civil court, Simone says he’s moving forward with alternate plans for a walk-in clinic at the site.

“I’m weighing lease negotiations and timing,” he said. “It’s about how quickly we can open an outpatient clinic there as opposed to the time it will take me to get through this appeal. this is all about getting that building rented.”

Jean Howarth, who lives next door to Simone’s property, was an outspoken critic of the residential treatment facility. Notified of Simone’s latest proposal, Howarth vowed she and her neighbors would fight it.

“You better believe it,” she said. “he originally wanted that center for doctors’ offices and he went back on his word. he can’t be trusted.”

In a series of hearings that drew hundreds of objectors for months on end, Simone tried in vain to persuade the township zoning board that his proposed Sunrise Detox residential center would serve an “inherently beneficial use” to the community, a key factor in obtaining a zoning variance.

That center would have had a capacity for 38 overnight patients. it would have included a commercial kitchen and laundry for patients who would stay five to six days on average.

Neighbors expressed fear that desperate addicts would slip past security at the facility and wander neighborhood streets in search of money for a fix or a way out of town.

They cheered when the board voted 4-2 against the proposal in June.

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