MILBRIDGE — It is apparent as soon as one enters Dr. Cathleen London’s medical office at 40 Main St. that this physician is not one to stand on ceremony.
In the entryway a sign invites patients to leave their muddy boots behind and don complimentary slippers.
A dog or two might wander over to sniff the new visitor. The office staff are sitting comfortably beyond the waiting room, chatting.
London opened her family practice a year ago and in that time has designed an affordable, refillable EpiPen and has established her own drug treatment clinic.
“It’s not too big a deal,” London said of the EpiPen alternative, which was featured in a number of news articles, among them the New York Times.
The number of drug addicts, she said, is the worst medical crisis she has encountered in her career.
Washington County has one of the highest per-capita rates of opiate addiction in the country.
“We don’t have an easy fix,” London said. “It’s insidious. There is the rate of recidivism. There is the lying and stealing. And it affects so many parts of patients’ lives.”
A native New Yorker, London is no stranger to northern New England. As a child she attended summer camps in New Hampshire and Maine.
After boarding school in Connecticut, London enrolled at Brown University, where she graduated with dual degrees in theater arts and computer science.
She completed her pre-medical school courses at Stanford University and, at 29, entered Yale School of Medicine.
London did her residency at Oregon Health & Science University with a focus on rural medicine.
She practiced in the Boston area for 13 years and taught at Boston University while raising her two sons, now 19 and 21. Both are now students at Syracuse University.
The family then moved back to New York City for five years to be closer to relatives. London accepted an appointment as assistant professor of medicine at Weill Cornell Medical College.
One day she received a recruiter email about a position in Fort Kent. She went up for the interview and was immediately taken with rural Maine.
“I loved it,” she said. “That is when I decided I wanted to be a rural doctor in an underserved area.”
London practiced for a short time at the Harrington Family Health Center before opening her practice in Milbridge.
She is an instinctive problem solver as well as a physician and scientist.
When Mylan boosted the price of its EpiPen to $600 for a two-pack of epinephrine injections, London the scientist went into high gear.
The auto-injecting EpiPen is a lifesaving device for persons with severe allergies.
London decided to provide her own version of the product.
She purchases reusable auto-injectors manufactured by the British company Own Mumford.
London fills the syringe with epinephrine and patients can return for a refill or new dose once the epinephrine expires.
She charges her patients $50 for an initial device and $2.50 for a refill.
The Massachusetts Institute of Technology, which has a group that comes up with solutions for high cost medical items, has asked London to prepare a kit with a video that shows patients how to assemble the injector and fill the syringe.
She is certified to treat patients with medicinal marijuana and prepares her own topical salves for problems such as rashes and pre-cancerous lesions.
She makes her own tinctures — extracting the non-psychoactive CBD — for a variety of ailments such as pain and anxiety.
“I’m not in favor of smoking anything,” she said.
London also has started a program for addicts and, working with a counselor, has a group therapy room on the second level.
She uses the SMART program, which is a recovery program for persons with all types of addictions.
The program centers on building and maintaining motivation, coping with urges, managing thoughts, feelings and behaviors and living a balanced life.
“I’m not here to hand out a prescription and watch them walk out the door,” she said.
Participants must agree to be urine tested — which she sends out to a laboratory so that she can see exactly what the patient is ingesting and at what dose.
The patients also must attend a weekly counseling session.
“They have homework too,” she said.
London endorses medication-assisted treatment, primarily suboxone, for people addicted to opiates.
She said patients with entrenched addictions cannot be expected to be chemical free in two years,
“If someone has been shooting heroin for 20 years, how can you expect them to be OK after two years?” she said. “There are genuinely some people who are never going to get off” suboxone.
London now sees about 21 patients with substance abuse problems.
The attrition rate is high, she said, because she is strict and demands complete honesty from those in recovery.
She also does not differentiate between addictions — whether it is heroin or food.
“It’s all about escaping the feeling,” she said.
London is open about the fact that she was anorexic as a young woman and ballerina.
An avid runner, she has entered the London marathon in April to raise funding for Parkinson’s disease research.
“Opioids get people in a lot more trouble,” she said. “We as a society need to come together and do what it takes. They like that I don’t look down my nose at them. If someone is seeking help you need to give them a chance.”
She said meeting her requirements shows that the patient is taking responsibility for their problem.
“They have to want to get better,” she said. “The folks who are staying in are doing great. You can see when that fundamental change happens.”
London accepts Medicare, MaineCare and some private insurers. She also offers direct primary care for a $75 monthly fee.
“You come in as often as you need to,” she said.
London’s office is located in a former home right in the middle of Main Street.
Passers-by call her by name or stop her in the supermarket across the road, often spilling their current medical issue in the grocery aisle.
Yet London said she finds some people are still reticent and attributes it to the isolation of the area.
“Downeast is its own place,” London said. “I’m tough, so that’s OK. It’s not going to scare me away.”