In the two years since she joined Montefiore Einstein, physician-scientist Deepika Slawek, MD, MPH, has enriched the hospital community with her insights into patient care and research collaborations. Since 2017, the rising star has completed a General Internal Medicine fellowship, graduated from Einstein’s Clinical Research Training Program (CRTP), received a Mentored Clinical/Translational Research Career Development Award (KL2); and a $50K pilot grant from the Einstein-Rockefeller-CUNY Center for AIDS Research. She was also awarded a competitive NIH loan repayment award and was recently promoted to Assistant Professor of Medicine (General Internal Medicine). Deepika and her husband also adopted Juniper, a street dog from Puerto Rico.

We spoke with Deepika about her passion to improve outcomes for people living with HIV, many of whom are affected by chronic pain, what drives her ambition, and what she does when she’s not working in the Bronx.

Q: You attended Texas A&M Health Sciences Center College of Medicine, then trained as an Internal Medicine resident at Stony Brook and Infectious Disease fellow at NYU. How did you end up at Montefiore Einstein?

DS: I was very lucky to meet Dr. Chinazo Cunningham when I was an ID fellow (at NYU) at a four-day immersion training that aims to give sub-specialty fellows skills to integrate addiction medicine into clinical research. She was a core faculty and I discovered that she had very similar research interests as me. She invited me to work on a research project with her when I was still finishing my Infectious Diseases fellowship and I found that I really enjoyed it. I already knew that I was interested in the intersection of addiction medicine and HIV care, but I realized a whole new side of how I could learn about it and contribute to the field in clinical research. I approached Chinazo and asked her what I should do after ID fellowship to keep my engagement in clinical research alive; my plan at the time was to jump in feet first into clinical ID. But Chinazo recommended that I get training in the skills needed to do research well; I applied to the GIM fellowship and the Einstein Clinical Research Training Program and now my research interests have grown to include the study of medical cannabis and its use in people living with HIV with Dr. Cunningham.

Q: Now that you’re an attending in the Division of General Internal Medicine, your clinical work is primarily focused on patients with HIV-related issues. How did you become interested in HIV?

DS: Growing up, HIV was so ubiquitous in our popular culture and I was constantly aware of it; I wanted to do something to help communities affected by HIV. As an undergraduate at University of Texas at Austin, I volunteered with a non-profit that served people living with HIV, many of whom relied on organizations for services and connection to care. After that I did my master’s in Public Health in Washington, DC, where I became acutely aware of how intricately connected the HIV epidemic was with the opioid epidemic. I worked for a needle exchange and was immersed in the concept of harm reduction as I counseled community members on safe needle disposal and the importance of not reusing needles. That experience opened my eyes to a field of medicine and public health that I found to be incredibly rewarding and shaped who I am now as a physician.

Q: You recently received a KL2 award and a pilot grant from the Einstein-Rockefeller-CUNY Center for AIDS Research (CFAR) to study how medical cannabis affects chronic pain and inflammation in people living with HIV. Can you tell us about the study?

DS: A large proportion of people living with HIV have chronic pain, so much so that it has become clear that this population is disproportionately affected by chronic pain. Though we don’t know exactly why this is, there is evidence that people living with HIV have more inflammation which could be related to or cause their pain. Their pain may also be mediated from other factors, such as trauma, anxiety, and everyday stigma. It’s been hypothesized that all those factors converge into a very unique experience of pain. Until recently, opioids were the primary treatment for chronic pain in this population. Now that we know that chronic use of opioids can lead to other negative consequences, like opioid use disorder and many of the co-morbidities that come with it, there has been a scramble to figure out what works best to help manage chronic pain among people living with HIV. Medical cannabis is a new option that has emerged for managing pain, among other symptoms in the state of New York. With this, there has been a lot of interest and curiosity from our patients about whether this is an option for them. My study is aiming to specifically determine how medical cannabis affects pain in people living with HIV, and how it does so. So, we’re looking at markers of inflammation in addition to how their pain responds when they’re using medical cannabis.

How is this study novel?

There’s really not a lot known about medical cannabis for a lot of reasons. Recreational cannabis has been studied in observational settings, and there have been some small studies in more controlled settings that have looked at how cannabis affects pain, but my study is really trying to drill down to the ‘how’ and determine if medical cannabis reduces pain by way of reducing inflammation in people living with HIV. I have a great opportunity to leverage an existing study being led by my mentor, Dr. Chinazo Cunningham, that is looking at people who experience pain for many reasons to see if cannabis will reduce their need for opioids. I’ll recruit people living with HIV who have chronic pain, are not on opioids, and are newly certified to receive medical cannabis. Then we’ll monitor them and evaluate how medical cannabis affects their pain and alters biomarkers of inflammation. The research may reveal how well medical cannabis works to manage pain in people living with HIV and how it does so. I’ll also be collaborating with co-mentors Drs. Julia Arnsten and Chenshu Zhang here at Einstein-Montefiore, and with Dr. Jessica Merlin at University of Pittsburgh.

Your research will be more in the field than at the bench. What are the challenges?

Recruiting patients will be a challenge. We are watching people who have been evaluated by a practitioner registered with the New York State Department of Health's Medical Marijuana Program and certified to receive medical marijuana. (This includes people with a life-threatening illness, including HIV, accompanied by an associated condition, such as chronic pain.) We’ll be out in the field recruiting patients at dispensaries and clinics. One issue for many people is that medical cannabis is not covered under insurance, and paying for medical cannabis can be very cost-prohibitive. This creates a big economic disparity. Our patients have to have access to a certain amount of money in order to even consider going to a dispensary and getting medical cannabis, and that just isn’t a reality for many of our patients. Because it’s not legalized federally, there are restrictions on how we do research on medical cannabis. We are limited to performing observational research, where we basically watch our patients closely. In order to perform more rigorous clinical research on medical cannabis, like randomized controlled trials, we have to work within very restricted parameters. We need a Schedule I license, and then the only product that can be dispensed to participants is what is provided to us by the National Institute on Drug Abuse, which might not look a lot like what our patients are receiving here in the state of New York. It really makes you think about the implications behind our federal policies and how those policies can restrict the science and our ability to help our patients.

You spend 25% of your time seeing patients at CFCC. Describe the focus of your clinical work?

DS: I’m a primary care physician, and I also treat patients for chronic infectious conditions. I really love taking care of patients who have HIV, hepatitis C, and hepatitis B. In my experience, you develop a connection with those patients that is especially strong. Many of my patients have experienced a lot of stigma, including in and almost especially in health care settings. I get the opportunity to try to change that narrative for them and express to them that my goal is to help them live their lives as the healthiest, happiest, and most functional version of themselves as we can achieve. I’ve had similar experiences with prescribing buprenorphine for opioid use disorder in the primary care setting and in certifying patients for medical cannabis. In primary care, managing HIV, hepatitis C, chronic pain, and opioid use disorder all fits together really well.

Q. You learned to play the sitar when you were two years old. Tell us about the story behind that!

My parents are both professional musicians. They met in India when they were at the same university learning North Indian classical music. My dad is a concert sitarist and an ethnomusicologist at the University of Texas at Austin, where I went to college, and my mom is a North Indian classical vocalist. Sitar was an important part of my life growing up. My dad trained with Ravi Shankar from the mid-70s until he passed away in 2012. My sister and I both started learning sitar when we were about 2 years old, and I continued on through college. I tried continuing after that, but it became really difficult to keep up with it during training, and given the space requirements of a big instrument like that. I do miss it, though, and hope I’ll be able to pick it up again in the future.

What do you do when you’re not working?

My husband I and just adopted a rescue dog about a year and a half ago, so we spend a lot of time with her. Juniper is a street dog from Puerto Rico, about 35 pounds (scrolls through phone for photos) with short legs, maybe has a little German shepherd (scrolls through more dog photos), and some terrier or chihuahua in her. Sometimes we hike to a dog park in Astoria and we try to make it up to the Catskills once or twice a year. She’s really a snuggle bug and incredibly affectionate. I also enjoy knitting, so she likes to sit with us on the couch when I’m doing that. I also enjoy collecting records, and exploring our rapidly changing neighborhood in Queens with my husband.

What are you reading now?

I like to listen to podcasts and rent audio books from the library while I knit on the train. I’m a political junkie so spend a lot of time listening to NPR and other podcasts. Some of my favorite books from the past few months have been Educated by Tara Westover, and I recently started listening to the Harry Potter books, which I somehow never read before.