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Susan M. Stine, Ph.D., M.D.

Associate Professor
Room #306
Phone: 313-993-9879

Email: sstine@med.wayne.edu

 

 

 

Research Interests
My research interests include human laboratory challenge protocols exploring basic addiction mechanisms and the acute effects of potential pharmacotherapy agents, as well as clinical pharmacotherapy trials in opioid and cocaine dependence. The human laboratory studies allow me to pursue my earlier interests as a pre-clinical neuroscientist in fundamental brain function. I am especially interested in the role of the hypothalamo-pituitary-adrenal (HPA) axis in opioid dependence. I also have an interest in the treatment of opiate dependent pregnant women and am currently the PI of a NIDA-funded grant to study buprenorphine versus methadone treatment of opiate dependent pregnant women and the effect of these treatments on neonatal abstinence symptoms.

 

Clinical and Teaching Interests

  • American Board of Psychiatry and Neurology - certified psychiatrist with added qualifications in addictions

  • Director of Wayne State University (ACGME Approved) Addiction Psychiatry Residency Program
     The Addiction Psychiatry Residency Program received ACGME accreditation in May 1999. The program provides advanced fellowship training for 5 th year psychiatry residents in the evaluation and treatment of substance abuse patients, as well as research in and teaching about substance abuse. During the training year, addiction psychiatry residents participate in a supervised clinical experience with substance abusing individuals having a full range of comorbid psychopathologies and substances of abuse. This program is designed to fulfill the goals described by the ACGME.   Residents provide assessment services for the purpose of evaluating the presence and degree of comorbid psychopathology, the need for psychotropic medication to better manage substance abuse and psychiatric symptoms, and suitability of the patient for treatment with various types (e.g., individual vs. group) and intensities (e.g., outpatient vs. inpatient) of psychosocial services. Addiction psychiatry residents provide the full range of psychosocial services including individual, group, and family therapy of brief and longer duration with psychotherapy supervision in a variety of theoretical orientations. Clinical settings include an outpatient opiate treatment program, an intensive outpatient program, an inpatient detoxification treatment program, a hospital-based consultation-liaison program and experiences in a 12-step oriented rehabilitation hospital and a therapeutic community. Residents also have the opportunity to become significantly involved in one or more areas of research. At the end of the training year, the addiction psychiatry resident is well prepared to sit for the specialty board examination and function independently as an addiction psychiatrist.   In addition, a second year (PGY-6) research academic track is available for PGY-5 residents who are interested in an academic career.

  • Courses:

    • Director, Didactic Course for PG-2 Residents
    • Director, Core Seminar for PG-5 Residents
    • Lecturer in Substance Abuse Course for PG-2 Residents

 

  • School of Medicine Teaching Award (2004)

Philosophy of Teaching
All students of addiction psychiatry should understand the basic neuroscience and genetic foundations of addictive disorders, as well as psychological and socioeconomic models.   Treatment should include pharmacotherapy, behavioral and cognitive (as well as other) psychological techniques.   A balance must also be sought between an overly medicalized model (denying free will and responsibility of choice) on the one hand and an overly moralized model (denying the medical nature of the disorder and dismissing the suffering patient as a moral miscreant) on the other.

 

Selected Publications

Research Articles in Peer Reviewed Journals

Stine SM, and Kosten TR: The Use of Drug Combinations in Treatment of Opioid Withdrawal.   Journal of Clinical Psychopharmacology 12:203-209, 1992.

Stine SM, Freeman MS, Burns B, Charney DS, and Kosten TR: The Effect of Methadone Dose on Cocaine Abuse in a Methadone Program.   American Journal on Addictions, 1(4), 294-303, 1992.

Stine SM, Satel S, and Kosten TR: Cocaine Precipitation of Patient-identified Opiate Withdrawal. The American Journal on Addictions, 2(3), 255-258, Summer 1993.

Stine SM, and Kosten TR:   Reduction of Opiate Withdrawal-like Symptoms by Cocaine Abuse during Methadone and Buprenorphine Maintenance. American Journal of Drug and Alcohol Abuse, 20(4), 445-458, 1994.

Stine SM, Krystal JH, Kosten TR, and Charney DS: Mazindol Treatment of Cocaine Abusers.   Drug and Alcohol Dependence, 39, 245-252, 1995.

Stine SM, Petrakis IL, Krystal JH, Jatlow PH, Heninger G, Kosten TR, and Charney DS:   Effect of AMPT on Response to Cocaine Challenge. Biological Psychiatry, 42(3), 181-190, 1997 .

Stine SM, and Kosten TR:   Importance of Clinically Optimal Methadone Dose in the Treatment of Opiate Dependence. [Online] Medscape, http://www.medscape.com/. Medscape Mental Health 2(11), 1997.

Ling W, Wesson DR, Renner JA Jr, Malkerneker U, Wang RH, Brown LS Jr, Casadonte P, McNicholas L, Charuvastra C, Batki S, Tusel DJ, Santos E, Stine SM, Kintaudi P, Collins JF, Sather MR, Fye C, and Segal D: Buprenorphine Maintenance Treatment of Opiate Dependence: A Multicenter, Randomized Clinical Trial.   Addiction, 93(4), 475-486, 1998.

Avants SK, Margolin A, Kosten TR, Sindelar JL, Rounsaville BJ, Schottenfeld RS, Stine SM, Cooney NL, Rosenheck RA, and Li SH: Day Treatment vs Enhanced Standard Methadone Services: A Comparison of Clinical Efficacy and Cost. American Journal of Psychiatry, 156, 27-33, 1999.

Stine SM, Grillon CG, Morgan CA, Kosten TR, Charney DS, and Krystal JH: Methadone patients exhibit increased startle and cortisol response after intravenous yohimbine. Psychopharmacology, 154(3), 274-281, 2001.

Stine SM, Southwick SM, Petrakis IL, Kosten TR, Charney DS, and Krystal JH: Yohimbine induced withdrawal and anxiety symptoms in opioid dependent patients. Biological Psychiatry, 51(8), 642, 2002.

Kosten T, Oliveto A, Feingold A, Sevarino K, McCance-Katz E, Stine SM, Gonzalez G, and Gonsai K: Desipramine and Contingency Management for Buprenorphine Maintained Cocaine Abusers.   Drug and Alcohol Dependence, 70, 315-325, 2003.

Fudala PJ, Bridge TP, Herbert S, Williford WO, Chiang CN, Leiderman D, Collins J, Raisch D, Ajir K, Casadonte P, Goldsmith J, Ling W, Malkerneker U, McNicholas L, Renner J, Stine S, and Tusel D, for the Buprenorphine/Naloxone Collaborative Study Group:   Office-based treatment of opiate dependence: efficacy and safety of buprenorphine/naloxone sublingual tablets. New England Journal of Medicine, 349, 949-958, 2003.

Greenwald MK, Schuh KJ, Stine SM: Transferring heroin-dependent outpatients stabilized on moderate-dose methadone to the buprenorphine sublingual tablet: a preliminary study.   American Journal on Addictions, 12(4), 365-374, 2003.

Amass L, Ling W, Freese TE, Reiber C, Annon JJ, Cohen AJ, McCarty D, Reid MS, Brown LS, Clark C, Ziedonis DM, Krejci J, Stine S, Winhusen T, Brigham G, Babcock D, Muir J, Buchan B, and Horton T: Bringing Buprenorphine-Naloxone Detoxification to Community Treatment Providers: The NIDA Clinical Trials Network Field Experience. American Journal on Addictions, 13, S42-S66, 2004.

Ling W, Amass L, Shoptaw S, Annon J, Hillhouse M, Babcock D, Brigham G, Harrer J, Reid M, Muir J, Buchan B, Orr D, Woody G, Krejci J, Ziedonis D. Buprenorphine Study Protocol Group. A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction, 100(8), 1090-100, 2005.

 

Books

Stine SM, and Kosten TR, editors:   New Treatment For Opiate Dependence   Guilford Press, New York, 1997.

Selected Recent Book Chapters

Stine SM, Greenwald MK, and Kosten TR: Ultra Rapid Opiate Detoxification: Pharmacologic Therapies for Opioid Addiction, pp. 668-669. In: Principles of Addiction Medicine – 3rd Edition.   Edited by A. Graham and T. Schultz. American Society of Addiction Medicine, Maryland, 2003.

O’Connor PG, Kosten TR, and Stine SM: Management of Opioid Intoxication and Withdrawal, pp. 651-663. In: Principles of Addiction Medicine – 3rd Edition.   Edited by A. Graham and T. Schultz. American Society of Addiction Medicine, Maryland, 2003.

Stine SM, Greenwald MK, and Kosten TR: Pharmacologic Interventions for Opioid Addiction, pp. 735-741. In: Principles of Addiction Medicine – 3rd Edition.   Edited by A. Graham and T. Schultz. American Society of Addiction Medicine, Maryland, 2003.


Research Projects

Currently Funded Projects

Susan M. Stine (P.I.) “Maternal Opioid Treatment: Human Experimental Research”. Agency: NIH/NIDA. Period: 12/01/04 – 11/31/09.

Purpose: This multi-site, double-blind, randomized controlled clinical trial (RCT) is comparing methadone and buprenorphine for the treatment of opioid-dependent pregnant women and neonatal abstinence signs in their neonates.

Susan M. Stine (P.I.) “ Study of Safety and Efficacy of Lofexidine for Relief of Symptoms in Subjects Undergoing Inpatient Opiate Detoxification”. Agency: US WorldMeds LLC. Period: 2006 – 2007.

Purpose: This study is investigating the efficacy of lofexidine hydrochloride, an alpha-2-adrenergic agonist, in reducing withdrawal symptoms in subjects undergoing opioid detoxification.

Susan M. Stine (P.I.) No Cost Extension “Great Lakes Clinical Trials Network”. Agency: NIH/NIDA.   Period: No cost extension 2005-2007.

Purpose: The major goals of this project are to determine whether treatment interventions with demonstrated efficacy in rigorously controlled clinical trials are both useful and effective in Community Treatment Programs (CTPs), and to improve the quality of care available in CTPs by facilitating the adoption of research-based treatment interventions.

 

Other Current HIC-approved (R&D funded)

Susan M. Stine (P.I.) “Low-Dose Naloxone Challenge for Quantitative Opioid Dependence Measurement”.   Period: Indefinite, ongoing.

Purpose: Develop a method to quantitatively measure physiological dependence in opioid dependent individuals. Low-dose naloxone is used to minimize discomfort and to obtain results proportional to maintenance dose. Such a method would then subsequently be used to test various outcome hypotheses, e.g., that physiological dependence can predict differential response to agonist versus partial agonist pharmacotherapy.

Susan M. Stine (P.I.) “HPA Axis Abnormalities in Methadone Maintenance”.   Period: Indefinite, ongoing.

Purpose: Measure HPA axis function using metyrapone challenge in methadone maintained individuals and healthy control volunteers. The specific hypothesis was that inhibition of cortisol synthesis would elicit abnormal (lower) HPA axis response (evidenced by serum ACTH levels) in methadone patients compared to normal controls.

Selected Previously Funded Projects

Susan M. Stine (P.I.) “HPA Axis Alteration in Opioid Dependence: Methadone Maintenance versus Abstinence”. Agency:  Mental Illness Research Association.   Period : 2003-2005.

Purpose: The major goal of this project was to obtain information about HPA axis function in abstinent vs agonist-maintained opiate addicts.

Susan M. Stine (Co-P.I.) “Great Lakes Clinical Trials Network”. Agency: NIH/NIDA.  Period: 2000-2005.

Purpose: The major goals of this project are to determine whether treatment interventions with demonstrated efficacy in rigorously controlled clinical trials are both useful and effective in Community Treatment Programs (CTPs), and to improve the quality of care available in CTPs by facilitating the adoption of research-based treatment interventions.

Susan M. Stine (P.I.) “Effect of Naltrexone on the Abuse Liability of Hydrocodone in Methadone-Maintained Subjects HXA 2003”.   Agency: Purdue Pharma. Period: 2002-2004.

Purpose: The primary objective of this study was to determine the subjective drug effects of two doses of naltrexone that are intended to reduce the abuse potential of the hydrocodone combination product. It was thought that if the addition of naltrexone can elicit feelings of “bad effects” and withdrawal symptoms when this product is abused, it would likely have a lower abuse potential.

Susan M. Stine (P.I.) “Double-Blind, Placebo-Controlled Trial of Selegiline Transdermal System for the Treatment of Cocaine Dependence”. Agency: NIDA/VA.   Period: 1998-2001.

Purpose: The major goal of this project was to assess the efficacy and safety of the selegiline transdermal system in reducing cocaine use in subjects with cocaine dependence.   It was hypothesized that selegiline treatment, compared to placebo, would be associated with fewer days of cocaine use as assessed by self-report confirmed with urine assays for benzoylecgonine.

Susan M. Stine (P.I.) “A Multicenter Trial of Buprenorphine in Treatment of Opiate Dependence”.
Agency: NIDA funded VA cooperative study #999A.  Period: completed October 1995.

Purpose: The purpose of this study was to determine the safety and effectiveness of buprenorphine maintenance in decreasing illicit opiate use as measured by urine toxicology, retention rates, opiate craving and global rating scores in patients who met DSM-III-R criteria for opiate dependence.

Susan M. Stine (P.I.) “A Multicenter Efficacy/Safety Trial of Buprenorphine/Naloxone for the Treatment of Opiate Dependence”. Agency: NIDA funded VA Cooperative Study #1008 A . Period: 1997-2001

Purpose: The primary objective of this study was to demonstrate the effectiveness of buprenorphine in office-based treatment.

 

Service Highlights:

University Departmental Committees

  • Wayne State University Department of Psychiatry and Behavioral Neurosciences (1999 - present) Residency Training Committee
  • Wayne State University Department of Psychiatry and Behavioral Neurosciences (1999 - present) Executive Education Committee
  • PBMP Credentialing Committee

 

National Service

  • American Academy of Addiction Psychiatry Committees

    • Military Veterans (1996 - 1998)Research (1997 - present)
    • Awards Committee (1999 annual meeting)
    • Vice Section Head – Education Section (1999 - present)
    • Chair PG5 Committee (1999 - 2005)
    • Co-chair Program Committee (2002 – 2005)
    • Chair Program Committee (2006 - present)

College on Problems of Drug Dependence

    • Membership Committee (2003-2005)
    • Credentials Committee (2006 – present)
    • Human Research Committee (2006 – present)

 

National Buprenorphine Expert

    • Expert in the buprenorphine experts website (www.buplink.com).
    • Team Leader of the Midwest Region for AAAP-CSAT sponsored Buprenorphine training courses for physicians.
    • Director and lecturer at Miscellaneous AAAP-CSAT sponsored ASAM-CSAT Buprenorphine courses.
    • Serves as   a   Physician Clinical Support System (PCSS) Buprenorphine Mentor: PCSS is a national program funded by CSAT and administered by ASAM, in order to provide clinical advice and mentoring to physicians with Buprenorphine waivers http://www.pcssmentor.org/.

 

  • Great Lakes Addiction Technology Transfer Center (GLATTC)
    Scientific Review subcommittee (2003-2005)
  • Selected as national mentor for the SAMHSA-funded Physician Clinical Support System (PCSS), a nationwide mentoring network designed to assist practicing physicians, in accordance with the Drug Addiction Treatment Act of 2000, in incorporating into their practices the treatment of prescription opioid and heroin dependent patients using buprenorphine (2005 - present).

 

Other Service

  • Study sections and site visits
    ACGME Recertification

 

 

Useful Web Links :

American Academy of Addiction Psychiatry

American Psychiatric Association

College on Problems of Drug Dependence

National Institute on Drug Abuse

WAYNE STATE UNIVERSITY

SCHOOL OF MEDICINE

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