In 1998, Cunningham began practicing medicine at Montefiore Medical Center in The Bronx and began teaching medicine as a Professor at Albert EinsteinCollege of Medicine. There, she has specialized in working with patient populations struggling with homelessness, poverty, addiction, and HIV/AIDS, working to make healthcare more accessible to them. During her tenure, she has worked to develop policies and programs to meet their healthcare needs. She has also worked to educate the healthcare community on adopting opioid treatments, such as those leveraging the opioid agonist buprenorphine, and reducing the stigma around existing treatments.
Research on Addiction
In addition to treating patients with substance abuse disorders, Cunningham has engaged in research to both investigate strategies for treating and reducing the likelihood of addiction, while investigating how to promote adoption of these intervention and treatment strategies. She has a structured and evidence-based curriculum around strategies to treat addiction. She has also studied the roles of bias and discrimination in treatment of patients battling addiction. Cunningham and her colleagues have studied the policy implications of legalizing medical marijuana. In 2014, they published an analysis of opioid-related deaths from 1999 to 2010 and found that fatalities were lowered in states that had passed medical cannabis laws. The study suggested that access to medical marijuana could reduce the need for prescription painkillers. The study later came under scrutiny when a 2019 study found that states that introduced medical marijuana laws between 2010 and 2017, the number of opioid overdoses increased. Cunningham noted that the conflicting findings necessitate more research into the impacts of medical marijuana, which is currently difficult because of regulations around cannabis. Cunningham currently leads one of the only Federally-funded studies on the use of marijuana for pain management. In 2017, she was awarded a five-year, $3.8 million grant from the National Institute on Drug Abuse to investigate the effect of medical marijuana on a cohort of 250 patients in New York State with chronic pain, some of whom are HIV positive and others HIV negative. These patients are otherwise likely to receive opioids to manage their pain, so Cunningham and her colleagues are exploring the impact of medical marijuana as a substitute for pain management and reducing dependency on opioids. She has also studied the addictive potential of benzodiazepines, a class of anti-anxiety medications such as Xanax and Valium. She and her colleagues analyzed prescription data and the number of overdoses between 1996 and 2013 and found the rate of overdose fatalities due to benzodiazepines rose faster than the rate of prescriptions.
COVID-19
Since New York City became the United States' epicenter of the coronavirus disease 2019 pandemic, Cunningham has worked to treat patients with the disease. In April 2020, she and her colleagues wrote about the toll working on the frontlines has taken, both on their mental health and their ability to treat their patients, in a perspective piece for the Annals of Internal Medicine. She has also noted that the pandemic has had negative consequences for those in treatment for addiction, as recovering addicts no longer have access to support groups. In addition, she has advocated for the need for outpatient clinics to begin providing refills of buprenorphine prescriptions without requiring visits to the doctor, which could jeopardize their safety by forcing them out of their homes.
Leadership
Cunningham has applied her expertise to advocating for policies and programs that address addiction in New York City and across the United States. She has also noted the importance of integrating addiction treatment into the rest of the medical system to facilitate holistic care of patients fighting addiction. In 2015, she was appointed to Mayor Bill de Blasio's ad-hoc Task Force Heroin and Prescription Opioid Public Awareness, working to expand access to buprenorphine and naloxone to treat opioid use disorders and deaths due to overdoses, while raising awareness of these treatments and destigmatizing their use. She has also served as a reviewer of the 2016 Centers for Disease Control and Prevention guidelines for primary care physicians prescribing opioids for chronic pain management and in 2018 was appointed to a CDC board of scientific advisors to advise on approaches to address the opioid epidemic in the United States.