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Center for Substance Use Disorder and Pain Management

Overview

We aim to establish a Center for Substance Use Disorders and Pain Management that supports and advances excellence in education, research, clinical care, community engagement, public policy, and advocacy. The Center will support and advance the practice of integrated and collaborative care across five areas of substance use disorder prevention and treatment and pain management towards shared goals and outcomes:

  • Basic science research
  • Clinical bench to bedside research
  • Workforce development for interprofessional team-based care
  • Program evaluation, outcomes assessment, and advocacy for policy and legislative change based on evidence-based practice and practice-informed guidelines
  • University culture change through an Addiction Medicine Fellowship in research, clinical service, and education

Recently, we partnered with the National Academy of Medicine and more than 100 other organizations in a commitment to reversing national trends in opioid misuse and overdose.  

Meet the Research Team

Jennifer R. Bello Kottenstette, M.D., M.S.
Jennifer R. Bello Kottenstette

Jennifer R. Bello Kottenstette, M.D., M.S. Assistant Professor Family and Community Medicine


Practice Areas:

  • Family Medicine; Women’s Health; Correctional Healthcare

Research Interests:

  • Addressing the preconception health needs of incarcerated women with substance use disorders 
  • Implementation of jail-based Medication Assisted Treatment (MAT) for opioid use disorders
  •  Pregnancy intentions screening in primary care

Partnerships and Collaborations: 

  • Associate Director of the Health Criminology Research Consortium, Saint Louis University
  • Co-investigator on HEAL initiative to reduce opioid overdose
  • Implementation team for jail-based MAT at the St. Louis County Jail funded by SAMSHA
Liz Chiarello, Ph.D.

 

Liz Chiarello

Liz Chiarello, Ph.D. Assistant Professor, Sociology


Research Areas:

  • Medical Sociology; Socio-Legal Studies; Organizations; Professions; Social Movements

Research Interests:

  • Examines how the fields of healthcare and criminal justice work collaboratively and combatively to address the opioid crisis
  • Addresses how shared surveillance technology in the form of prescription drug monitoring programs affects frontline decision-making in healthcare and law enforcement
  • Analyzes how strategies for addressing the opioid crisis affect access to care for pain patients and patients with substance use disorders

Partnerships and Collaborations:

  • Academic: University of Missouri and NCADA--MO HOPE Prescription Drug Advisory Council; Washington University and University of Missouri HEAL Grant (in progress); jointly appointed in Law and Bioethics 
  • Community: St. Louis County CRUSH
David Pole, Ph.D., M.P.H.

 

David Pole

David Pole, Ph.D., M.P.H. Assistant Professor, Family & Community Medicine; Director of Center for Interprofessional Education and Research


 Practice Areas:

  •  Education

Research Interests:

  • The use of problem-based learning (PBL) framework in IPE courses for Health Care Professional Students. 
  • Community based participatory design to prepare learners for effective collaborations to improve population health.
  • Effective teamwork, professional development, collaborative practice and the impact on patient care and health outcomes.

Partnerships and Collaborations:

  • The IPE programs with nine health professions programs at the schools of medicine, nursing, social work, Doisy College of Health Sciences, and the St. Louis College of Pharmacy.
  • The IP Clinical Practicum and Community Practicum courses collaborate with 15 clinical sites and 25 community-agency partners in St Louis.
  • The Center provides professional development on collaborative change leadership development with SLUCare Clinic Managers across the entire ambulatory practice, and nurse leaders/directors at the SSM-SLU Hospital.
Fred Rottnek, M.D., M.A.H.C.M.
Fred Rottnek

Fred Rottnek, M.D., M.A.H.C.M. 
Professor and Director of Community Medicine; Physician Assistant Education


Practice Areas:

  • Addiction Medicine; Family Medicine; Interprofessional Collaborative Practice; Correctional Healthcare

Research Interests:

  • Substance Use Disorders, Pain, Health Professional Education

Partnerships and Collaborations:

  • Academic: Washington University and University of Missouri—St. Louis (Missouri State Opioid Response Team); SLU Center for Health Law Studies (Opioids, policy, access to care)
  • Healthcare: Assisted Recovery Centers of America (Clinical practice); SSM—System level (Opioid Stewardship Project); Catholic Health Association (Editorial Committee)
  • Community: Safety Net Regional Health: Saint Louis Regional Health Commission; Saint Louis Integrated Health Network; Saint Louis Behavioral Health Network; and Alive and Well Communities (Trauma)

Publications:

Daniela Salvemini, Ph.D.
 
Daniela Salvemini

Daniela Salvemini, Ph.D. Professor, Pharmacology & Physiology Director, SLU Center for Neuroscience Fellow, Saint Louis Academy of Science Co-Founder and Chief Scientific Advisor, BioIntervene Inc.


Research Interests: 

  • Chronic Pain, Substance Use Disorders, Chemotherapy-induced cognitive dysfunction (chemobrain)
  • Understand molecular and cellular pathways that drive the development of neuropathic pain states with a particular focus on traumatic and chemotherapy induced neuropathic pain.
  • Examine molecular and cellular pathways that cause opioid induced pain and tolerance that are critical in the loss of opioid efficacy over time and directly contribute to reward, addiction and abuse
  • Examine the contribution of neuroinflammation in neuropathic pain, opioid induced adverse events and chemotherapy-induced cognitive deficits
  •  Understand neuro-immune signaling at the intersection of substance use disorders and chronic pain

Partnerships and Collaborations: 

  • SLU (pain and cognitive function); University of Arizona (pain and opioids); MD Anderson (chemobrain); University of California San Diego (pain); University of Maryland (pain); Calgary University (pain and opioids); NIH/NIDDK (chemistry, novel analgesics); Virginia Commonwealth University (pain and opioids); Southern Illinois University Edwardsville (chemistry, novel analgesics); University of Florence (pain); University of Naples (pain and opioids); University of Messina (pain and opioids).
Jeffrey F. Scherrer, Ph.D.
 
Jeffrey F. Scherrer

Jeffrey F. Scherrer, Ph.D. - Director of Research Professor and Director of Family and Community Medicine Division of Research Secondary appointment: SLU Center for Health Outcomes Research (SLUCOR)


Academic Service:

  • Editor in Chief – Family Practice
  •  Serves on SLU Applied Health Research Council * Standing member ICTS JIT grant reviews

Research Interests:

  •  Prescription opioid pharmaco-epidemiology
  •  Mental health consequences of chronic prescription opioid use
  •  Role of mental illness in treatment of prescription opioid dependence 
  • Interventions to increase patient treatment seeking for opioid dependence
  •  Health consequences of mental illness
  • Large medical record databases
  • Mind-body relationships and care delivery models for comorbid physical and mental illness

Partnerships and Collaborations:

  • On-going collaborations with members of the national Health Care Systems Research Network
  • SLU Big Idea – creating a SLU-SSM patient data base
  •  Co-investigator on HEAL initiative to reduce opioid overdose
  •  Veterans Health Affairs 
  • Research Director – ARCHNet, a St. Louis family medicine practice based research network
Jaye Shyken, M.D.
 
Jaye Shyken

Jaye Shyken, M.D. Associate professor, Department of Obstetrics, Gynecology & Women’s Health Medical Director of the WISH Center


Practice Areas :

  • Maternal & Fetal Medicine
  •  Addiction Medicine

Research Interests:

  • Substance Use Disorders in Pregnancy

Partnerships and Collaborations:

  • Grant through SAMHSA with Chestnut Health Systems (Illinois) and Queen of Peace Center for the care of Pregnant and Parenting Women with Substance Use Disorder
  •  Grant through United Way and the State of Missouri Department of Health and Senior Services to cover un-insured and under-insured postpartum women with Opioid Use Disorder
  • State Opioid Response Team administered through Missouri Institute of Mental Health
  •  Ongoing referral relationships with many local chemical dependency programs
  •  Clinical co-lead for the Illinois Perinatal Quality Collaborative- Maternal and Neonatal Opioid Initiative

Saint Louis University School of Medicine Curricular Thread on Pain, Substance Use, and Addiction

With support of the Senior Associate Dean of Undergraduate Education, this curricular thread was introduced in the 2016-2017 academic yearandis being fully implemented in 2017-2018. Each session is embedded in an established course or clerkship.

Future plans include integrating Course on Addiction and Recovery Education(CARE) into MS-3 clerkships or a horizontal longitudinal course focusing on communication.

Year Course Session Objectives Instructional Method Competencies Addressed
MS-1 Clinical Interviewing
  1. Describe impact of psychoactive substances that can create dependence and addiction
  2. Differentiate among categories of chronic pain
  3. Demonstrate interviewing questions and strategies for patients with chronic pain, as well as substance use and dependence
  1. Lecture and simulated interviews
  2. Small group sessions with student interviewing of standardized patients and feedback

LCME Key Words and Hot Topics

  • Pain Management
  • Substance Abuse
  • Chronic Care
  • Communication Skills
  • Medical Ethics

USMILE1

  • Public Health
  • Ethics
  • Social Determinants of Health
MS-2 Behavioral Health and Medicine
  1. Differentiate among definitions and models of addiction
  2. Discuss concept of biologic vulnerability
  3. Explain comorbidities in Substance Use and Behavioral Health
  4. Demonstrate effective skills using Prochaska’s Transtheoretical Model (Stages of Change
  5. Differentiate among classes of substances, Intoxication and withdrawal states
  1. Lecture and simulated interviews
  2. Faculty demonstrate interviewing skills
  3. Students practice skills in triads

LCME Key Words and Hot Topics

  • Counseling for behavioral change
  • Substance abuse
  • Communication skills
  • Physician bias

USMLE Step 1

  • Effectof substances on organ systems
  • Classes of psycho-active substances
  • Neurotransmitters and receptors
  • Psychiatrytopics
MS-3 Family Medicine Clerkship
  1. Describe Substance Use Disorder andimplications for public health
  2. List tools in the interprofessional utilitybelt to treat Substance Use Disorder
  3. Explain the mechanism of action of three medications used in treatment of Opioid Use Disorder
  1. Lecture andlarge group discussion

LCME Key Words and Hot Topics

  • Substance abuse
  • Evidence-based medicine
  • Community Healt
  • Medication management/compliance
  • Chronic care

USMILE Step 2

  • Ethical and legal principles
  • Substance use disorders
MS-4 Capstone
  1. Review key elements of a pain-focused interview and assessment
  2. Discuss starting points for working with patient on non-sustainable pain treatment regimens
  3. Describe the role of the resident physician in team-based care for pain, substance abuse and addiction
  1. Lecture and large group discussion
  2. Demonstration of CDC and HRSA phone apps for clinical care

LCME Key Words and Hot Topics

  • Substance abuse
  • Evidence-based medicine
  • Community Health
  • Communication skills
  • Medication management/compliance
  • Chronic care

 

Events

Addiction, Burnout, and Saint Louis University: Caring for Ourselves and Our Community

Please join Family and Community Medicine for this second annual SLU community event on Wednesday, December 12, 2018 at the School of Medicine.

In this opioid crisis, health care professionals face increasing challenges to care for their patients and themselves. This day of training will provide practical steps forward. Providers’ Clinical Support System (PCSS) Training for physicians, physician residents, physician assistants, and nurse practitioners (Limit 50 participants).

PCSS offers a free, blended 8-hour training for physicians to obtain their buprenorphine waiver. This morning training fulfills the 4.25 hours of face-to-face training. (Participants must complete the 3.75-hour online training within 30 days after this. See below for details and resources).

Course Instructor: Fred Rottnek, M.D., M.A.H.C.M.

Register for the morning program

Afternoon program: Noon-4:00 p.m. (Starting in Pitlyk LRC A)

Audience: Faculty, fellows, residents, and students in Medicine, Nursing, and the Physician Assistant Program (Limit 100 participants).

Noon-1:00 p.m. - The Conley Lectureship: How Do We Care for our Health Care Providers in an Era of Burnout and Addiction, Joseph Skrajewski, M.A., M.F.T.I., Executive Director, Medical and Professional Education, Hazelden Betty Ford Foundation (Lunch will be provided; please bring your own beverage):

1:00-2:00 p.m. - Voices of the Community: Panel Discussion with Community Members Receiving Medication for Opioid Use Disorder, Panel Facilitator: Fred Rottnek, M.D., M.A.H.C.M.

2:15-3:15 p.m. - Breakout Sessions (Choose one).

Health Professionals at Risk: How Do We Care for Our Providers? (LRC 110-111) Panelists:

  • Emily Cybulla, M.D., Ph.D. Student, Saint Louis University School of Medicine
  • Joseph Skrajewski, M.A., M.F.T.I., Executive Director, Medical and Professional Education
  • Percy Menzies, M. Pharm., Assisted Recovery Centers of America (ARCA)

Facilitated by Kelly Everard, Ph.D., Director of Medical Student Education in Family and Community Medicine.

Research Collaboration at SLU for Prevention, Risky Substance Use, and Addiction (LRC 112-113).

Facilitated by Liz Chiarello, Ph.D., Associate Professor, Sociology and Anthropology.

3:15 p.m. Closing Networking Reception (LRC Lobby).

Register for the afternoon program

We will provide a selection of box lunches from SLU Catering. We will have some vegetarian lunches available. If you have special dietary needs, please feel free to bring your own lunch.

For additional questions, contact Fred Rottnek, M.D., M.A.H.C.M. at fred.rottnek@health.slu.edu.

Details for Half and Half Trainee Instructions:

After participants complete the live “Half” of the training, PCSS will provide participants with a link to complete the other “Half” as an online self-study. Once participants finish both halves PCSS will provide you with your certificate of completion and further instructions for registering with the DEA.

The Log of Participants will be returned to AAAP within 48 hours of the activity along with a spreadsheet that lists the first name, last name and @health.slu.edu email address of participants. Once the log has been received, AAAP/PCSS staff will verify their full attendance. An email will then be sent to the participants that will provide them with the link to the online self-study. Upon completion of the self-study and 24 question exam, PCSS will give them the link to the evaluation which will generate their Certificate of Completion and a link to the NOI form.

Please note that NPs/PAs can take the 8 hour waiver training and it will count towards their waiver application. The additional 16 hours of training is available on:

MAT Waiver

Also note, that while residents can take the waiver training, they will not be able to apply until they have a personal DEA number and an unrestricted medical license. This training allows them to be waiver-ready.

MAT Training