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Mr. J. is a 38-year-old Caucasian male with chronic schizoaffective disorder, alcohol use disorder in sustained remission, tobacco use disorder and tardive dyskinesia. His psychotic disorder has been stable on clozapine. He has smoked cigarettes, 1-2 packs per day, for the past 20 years. Mr. J. also has mild orofacial tardive dyskinesia. At a recent outpatient visit, Mr. J. requested a trial of varenicline for smoking cessation. He underwent a 4-week trial of varenicline, which was overall well-tolerated, and his tobacco used decreased from 1.5 to 1 pack per day. During that time, his tardive dyskinesia remained unchanged, with an Abnormal Involuntary Movement Scale score of 6 at both baseline before and 4 weeks after starting varenicline.

The mechanism(s) underlying tardive dyskinesia (TD) are unclear. Beyond the dopamine D2-receptor supersensivity/upregulation hypothesis, one theory posits decreased cholinergic activity within striatal motor circuits, raising the possibility of treatments that normalize cholinergic signaling and restore the balance of 

 The cholinergic system—which is inordinately complex—is divided into 2 main branches: 

muscarinic and nicotinic cholinergic receptors

 Muscarinic cholinergic receptors have 5 sub-families (M1 to M5), all of which are G-protein coupled receptors. Benztropine and other M1 receptor antagonists worsen TD. By contrast, there are 17 vertebrate sub-units with 5 different families (alpha, beta, delta, gamma, and epsilon) of nicotinic cholinergic receptors, all of which are all ion channels, and have different physiologic functions than muscarinic cholinergic receptors.

Clinical evidence supporting a potential role of cholinergic deficiency includes the observation that 

 In an animal model of TD, administration of varenicline, a partial α-4-β-2 and full α-7 nicotinic acetylycholine receptor (nAChR) agonist, attenuates haloperidol-induced vacuous chewing movements.

 However, effects of varenicline on TD in humans is unclear.

Caroff and colleagues conduced an open-label, pilot study investing 

 Three outpatients with schizophrenia, no change in antipsychotic medication for 2 months, TD, and active smoking based on cigarette consumption and exhaled carbon monoxide (CO). After a 2-week baseline period, participants were titrated to 1 mg varenicline twice daily over 1 week, and were maintained on this dose for 4 weeks. The primary outcome was mean change in the Abnormal Involuntary Movement Scale (AIMS) total score from baseline to week 4. Other outcome measure were 7-day prevalence of daily mean cigarette use, CO, and akathisia.

Study authors recruited 3 males, mean age 59 years, who were all receiving long-acting injectable antipsychotic medication (paliperidone). The mean AIMS score at baseline was 9.7 (range 6-12). Participants showed a significant decrease in mean daily cigarette consumption (-6.3 cigarettes/day) and CO (-6.0 ppm) from baseline to week 4. There were no clinically significant changes from in TD (mean change in AIMS total score of +1) or akathisia.

The authors concluded that treatment with varenicline was associated with reduced smoking, but not TD, in a small, open-label pilot study. The authors noted it is uncertain whether results would have been different if patients were taking antipsychotics associated with marked changes in blood levels after smoking cessation (due to smoking-induced enzyme induction). Preclinical investigations of the complex dynamics underlying striatal regulation of movement may transform understanding of TD and identify novel potential cholinergic therapeutic targets, given that varenicline targets only a small slice of the cholinergic pie.

Trials of agents for smoking cessation in patients taking antipsychotic medications should include measures of drug-induced movement disorders.

is professor in the Department of Psychiatry and Health Behavior, Augusta University, Augusta, Georgia. He is on the Editorial Board and serves as the schizophrenia section chief for 

The author reports that he receives research support from Augusta University, the National Institute of Mental Health, the Brain and Behavior Research Foundation, and the Stanley Medical Research Institute.

1. Conti MM, Chambers N, Bishop C. A new outlook on cholinergic interneurons in Parkinson's disease and L-DOPA-induced dyskinesia. 

2. Quik M, Boyd JT, Bordia T, Perez X. Potential therapeutic application for nicotinic receptor drugs in movement disorders. 

3. Caroff SN, Campbell EC, Carroll B. Pharmacological treatment of tardive dyskinesia: recent developments. 

4. Caroff SN, Gutman AR, Northrop J, et al. Effect of varenicline on tardive dyskinesia: a pilot study. 

Varenicline and Tardive Dyskinesia in Schizophrenia

North America is currently experiencing an opioid overdose crisis driven mainly by fentanyl and fentanyl analogs, such as carfentanyl.

fatalities involving opioids in the United States

 The COVID-19 pandemic has only heightened the 

 of opioids on individuals who use the drugs, their families, and communities across 

 Novel solutions are needed for this complex problem.

Much is already being done. In an effort to mitigate the overdose crisis, both Canada and the United States have implemented multiple public health and treatment strategies. Extant strategies include providing opioid agonist therapies (OAT), naloxone for reversing fatal opioid overdoses, and access to harm reduction services. In addition, injectable/implantable buprenorphine is available in both countries. However, the opioid receptor antagonist naltrexone, while available in the oral formulation in both Canada and the United States, is not available in the depot formulation in Canada. Currently, OAT with methadone or buprenorphine/naloxone are the first-line interventions for individuals with moderate to severe 

 Although buprenorphine/naloxone is preferable over methadone in terms of its superior safety profile, there are many limitations to these treatments. Moreover, in Canada, there are barriers to accessing OAT, including reduced access to OAT prescribers in rural areas, and the shortage of pharmacies offering on-site OAT.

OAT clinics often lack psychosocial supports, and there are often high out-of-pocket expenses that prove problematic for individuals with OUD who have limited financial means.

 Similar economic, geographic, attitudinal, and organizational barriers exist in the United States.

 Additionally, in the United States, health insurance barriers, where public insurance providers favour methadone while private insurance favours buprenorphine/

, have caused rampant racial and economic disparities in OAT access across the United States.

Since the start of the opioid crisis, Canada has taken several novel harm reduction approaches to combat the opioid crisis. Harm reduction refers to a wide array of public health policies intended to reduce the adverse consequences of human behaviours, including—but not limited to—substance use. In the context of the opioid crisis, harm reduction interventions have included rapid access addiction medicine services, providing take-home naloxone kits, supervised consumption facilities (SCFs), and education around overdose risk mitigation.

Historically, the success of harm reduction services for OUD has been difficult to quantify; most studies have small sample sizes and poorly defined outcome measures. These studies have limited generalizability to most individuals with OUD, who respond to first-line treatments. However, there is mounting evidence that demonstrates proof of efficacy and effectiveness for a range of harm reduction services. Recent studies have shown that they can reduce opioid overdose mortality, infection-related complications, and crime amongst individuals with treatment-refractory OUD (TR-OUD).

In recent years the Canadian health care providers have implemented 3 critical harm reduction measures that have curtailed opioid-related fatalities: (1) heroin-assisted therapy, (2) hydromorphone-assisted therapy, and (3) supervised consumption facilities (SCFs). A summary of each of these novel treatments is provided in 

Following the Canadian example, we advocate for the provision of 

 in the United States that could save countless lives by increasing access to evidence-based treatment options for OUD.

Heroin-assisted treatment (HAT), or heroin maintenance, is an evidence-based intervention for managing the symptoms of treatment-refractory OUD (TR-OUD). While there are varying definitions of TR-OUD, most studies refer to the failure to respond meaningfully to 1 or more first-line treatments for OUD (eg, methadone or buprenorphine/suboxone). HAT is available in Canada (eg, Vancouver and Montreal) and in some European countries (eg, Germany, Switzerland, and the United Kingdom) and has shown efficacy in select groups experiencing TR-OUD. To receive HAT, individuals with TR-OUD must visit designated 

, where they will receive injectable medical-grade heroin (diacetylmorphine) up to 3 times daily under strict nursing and medical supervision.

 In essence, most HAT clinics operate under a supervised consumption model.

Results from randomized controlled trials have shown promising findings for individuals with TR-OUD. In one trial, HAT reduced illicit heroin use, improved treatment retention, reduced criminal activities, and improved mental and physical health compared with methadone therapy.

 While HAT is more expensive than oral methadone treatment, the social and economic benefits justify its provision for select patients with TR-OUD who have not benefited from first-line therapies. Nonetheless, studies have shown an association between HAT and a higher risk of adverse events such as seizures and opioid overdoses11 than methadone or buprenorphine/naloxone. While HAT carries a more dangerous safety profile than other forms of OAT, HAT administration typically occurs in supervised clinical settings, which lessens these risks. Thus, while HAT carries an increased absolute risk of adverse events—including opioid overdose—it is still a harm reduction measure as it lessens the risk relative to the unsupervised consumption of street-sourced heroin or fentanyl.

Given the regulatory restrictions in providing HAT, investigators in Vancouver, Canada, considered alternative strategies for treating individuals with TR-OUD. The search for alternative OAT led to hydromorphone, a synthetic opioid used to treat chronic pain. Consequently, researchers at St Paul’s Hospital in Vancouver conducted the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) trial.

In brief, the SALOME trial was an innovative study investigating the use of injectable hydromorphone (IH) as an alternative to intravenous diacetylmorphine (eg, HAT) for TR-OUD. The researchers aimed to establish the noninferiority of IH to HAT. Ultimately, the researchers found that delivering the 2 interventions under the same conditions (eg, supervised consumption facilities) led to positive outcomes in both groups. For example, participants receiving either treatment showed improved treatment retention, greater global functioning, reduced illicit opioid use, and diminished illegal activities.

 The SALOME trial was one of the first to establish the efficacy of these harm reduction measures for a population of individuals with TR-OUD. Consequently, the SALOME trial suggests that when diacetylmorphine is unavailable or other treatments are unsuccessful, IH can be a suitable alternative for treating severe TR-OUD.

In January 2019, Vancouver started the first hydromorphone tablet distribution program, based on the promising results of the SALOME trial. A qualitative study evaluated its effects, suggesting that it can decrease illicit drug use, overdose risk, engagement in illegal activities, and address social inequalities surrounding drug use.

, take-home hydromorphone has been permitted, and the effects of this expansion can be promising for the wide-scale implementation of similar programs in rural, suburban, and urban settings.

 However, further study of injectable and oral hydromorphone in TR-OUD patients in diverse settings is warranted.

Supervised consumption facilities (SCFs) are safe and clean indoor facilities where individuals can use pre-obtained drugs under the supervision of trained medical professionals to ensure safe injection or other consumption (eg, oral or smoked) methods. In parallel, SCFs can implement rapid responses in opioid overdoses, such as by providing intranasal or intramuscular naloxone.

 SCFs have emerged in Canadian cities such as Toronto, Ottawa, and Halifax as grassroots initiatives to address unmet needs for special populations with TR-OUD or other substance use disorders. These SCF initiatives can also assist in different ways by providing counselling and psychosocial supports, referrals to social services, and access to medical and psychiatric treatment where necessary.

SCFs were first developed in response to the HIV epidemic in Vancouver when Insite—North America’s first SCF—proved to be a tremendous asset in combating the 

 One of the additional benefits of SCFs is that they can provide a multifaceted opportunity to address comorbidities, such as psychiatric illness, HIV/AIDS, and other infectious diseases. As individuals with TR-OUD frequently experience co-occurring medical and psychiatric disorders, SCFs have created critical opportunities to engage with a population that is difficult to reach otherwise. Various studies have demonstrated their myriad benefits, such as decreasing overdose deaths, crime, and infectious disease transmission while remaining cost-effective.

A recent study estimated the cost and impact of establishing SCFs in New York City. It showed that an SCF can prevent 19 to 37 opioid overdose fatalities per year in New York City and between $831,700 and $2.9 million in costs would be saved by the healthcare system.

 However, this remains a controversial topic in the United States, and advocacy for drug policy changes must continue.

The overdose crisis has negatively affected all Canadian provinces and territories, with British Columbia, Ontario, and Alberta recording the highest number of opioid-related overdose deaths in 2019.

 The United States has also seen a widespread increase in the number of opioid-related deaths since the 2000s, with the Northeast, Mid-Atlantic, and Mid-Western states being most impacted.

 Currently, most of the overdose fatalities involve synthetic opioids such as fentanyl and its analogues,

 (> 90%) appear to be accidental. The high prevalence of fentanyl as an adulterant in the illegal supplies of heroin and other injectable drugs (eg, cocaine and crystal methamphetamine) are the major factors accounting for the growing number of overdose-related deaths.

The most commonly used opioid agonist therapies (OAT) in Canada and the United States are methadone and buprenorphine/naloxone. However, their availabilities vary across regions and by insurance coverage.

The rising number of opioid-related fatalities is a call to action to implement sustainable measures to prevent overdose occurrences beyond acute naloxone administration. Canada has implemented multiple harm reduction measures since the beginning of its opioid crisis, which have reduced overdose mortality. For example, the current safe supply programs focus on prescribing pharmaceutical-grade opioids, such as injectable hydromorphone and diacetylmorphine, to individuals at high risk of 

. These can be powerful aids to reducing the harm of fentanyl-related opioids from the illicit drug market, and as a result, prevent overdose events and decrease overdose mortality.

 Canadian and international SCF studies have shown effectiveness in reducing overdose fatalities and decreasing needle sharing, unsafe injection practices, and involvement in criminal activities.

 As Canada and the United States take action to combat the current opioid crisis, they can learn from the collective expertise and strategies implemented on either side of the border to search for comprehensive, collaborative, and evidence-based approaches to the opioid crisis.

is a 3rd-year medical student at Touro College of Osteopathic Medicine in New York, NY, USA.

is a Fellow in Addiction Psychiatry in the Cumming School of Medicine at the University of Calgary, Calgary, Canada.

is a Staff Psychiatrist in the Addictions Division at the Centre for Addiction and Mental Health (CAMH) and Lecturer in Psychiatry, Temerty Faculty of Medicine, University of Toronto.

is an Advanced Practice Clinical Leader at CAMH, and a PhD candidate in the Bloomberg School of Nursing at the University of Toronto.

is Professor of Anthropology and Psychiatry, and Research Chair in the Social Medicine Theme, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

is Professor of Psychiatry in the Temerty Faculty of Medicine at the University of Toronto, and Clinician-Scientist in the Addictions Division at CAMH in Toronto, Canada. He also serves as Deputy Editor of the journal Neuropsychopharmacology (NPP).

The constructive and critical comments of Dr Eric C. Strain of John Hopkins University on the manuscript are gratefully acknowledged.

1. Ivsins A, Boyd J, Beletsky L, McNeil R. Tackling the overdose crisis: The role of safe supply. 

2. Government of Canada. Opioid- and Stimulant-related Harms in Canada (Maps). Accessed March 24, 2021. 

https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/maps

3. National Institute on Drug Abuse. Overdose death rates. January 29, 2021. 

https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates

4. Government of Canada. (March 24, 2021). Opioid- and Stimulant-related Harms in Canada (Key Findings). 

https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants

5. Centers for Disease Control and Prevention. Overdose deaths accelerating during COVID-19 – expanded prevention efforts needed. December 18, 2020. 

https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html

6. Schuckit MA. Treatment of opioid-use disorders. 

7. Priest KC, Gorfinkel L, Klimas J, et al. Comparing Canadian and the United States opioid agonist therapy policies. 

8. Hansen HB, Siegel CE, Case BG, et al. Variation in buprenorphine and methadone treatment by racial, ethnic, and income characteristics of residential social areas in New York City. 

9. Young S, Fairbairn N. Expanding supervised injection facilities across Canada: lessons from the Vancouver experience. 

10. Drug Policy Alliance. Heroin assisted treatment (HAT). February 2016. 

https://drugpolicy.org/sites/default/files/DPA%20Fact%20Sheet_Heroin-Assisted%20Treatment_(Feb.%202016).pdf

11. Oviedo-Joekes E, Brissette S, Marsh DC, et al. Diacetylmorphine versus methadone to treat opioid addiction. 

12. Oviedo-Joekes E, Guh D, Brissette S, et al. Hydromorphone compared with diacetylmorphine for long-term opioid dependence: A randomized clinical trial. 

13. Timko C, Schultz NR, Cucciare MA, et al. Retention in medication-assisted treatment for opiate dependence: A systematic review. 

14. Ivsins A, Boyd J, Mayer S, et al. "It’s helped me a lot, just like to stay alive": a qualitative analysis of outcomes of a novel hydromorphone tablet distribution program in Vancouver, Canada. 

15. Behrends CN, Paone D, Nolan ML, et al. Estimated impact of supervised injection facilities on overdose fatalities and healthcare costs in New York City. 

How can understanding the opioid crisis in Canada inform strategies in the United States?

Lessons from Novel Harm Reduction Methods

Vaping—one word, but not one behavior. 

 is a method of substance inhalation that delivers anything from blueberry-flavored vitamin D to delta-9-tetrahydrocannabinol (THC) into the body. While health professionals often refer to electronic cigarettes (e-cigarettes) and vaping synonymously, e-cigarettes represent only a small fraction of the growing market for 

 products available to consumers of all ages. So, why all the fuss?

 tar and asbestos is risky, but what about zinc, lead, chromium, manganese, and copper?

 All have been identified as components in various vaping products (ie, e-liquids, vape juice), although the long-term health consequences of these ingredients are not well-defined. E-liquid ingredients that are safe to be ingested and processed in the gut may be thought to be benign (eg, vegetable glycerin [VG] and propylene glycol [PG]), but may cause 

 Beyond lung damage, aerosol inhalation may increase cardiovascular risk.

Nicotine vaping products increase the risk for the same health consequences as any other nicotine exposure: subsequent development of a nicotine addiction; priming for use of other substances; changes in attention, cognition, and impulse control; and increased risk of developing mood disorders.

 The risk is compounded by the ready availability of vape juices and e-liquids with high concentrations of nicotine, beyond what is found in traditional tobacco products.

Young children and developing fetuses may also be prone to indirect health consequences of vaping products. There are reports of vaping liquids being swallowed and absorbed through the skin and eyes, resulting in poisoning. Fetal exposure can result in multiple adverse health consequences, including sudden infant death syndrome.

Given the potential for harm, why do individuals vape nicotine and other harmful chemicals for purposes other than 

 cessation? Among youth, the most common reason for vaping is curiosity.

 Vaping may be seen an act that brings social benefit—friends use what their friends use.

 Available online and in neighborhood stores, vaping products are perceived as both fashionable and convenient.

 Vape systems can be discreet (ie no visible aerosol) or flashy (ie production of large vape clouds). With advanced features such as voice control, accent lighting, and Bluetooth compatibility, there is a vaping device to appeal to almost any subculture and customer.

The ability to customize vape systems and liquids carries additional risks. Most samples obtained from the e-cigarette liquid of individuals being treated for e-cigarette or vaping product use-associated lung injury (EVALI), contained THC. Vitamin E acetate was identified in all samples, and glycerin, propylene glycol, diacetyl, aldehydes, formaldehyde, terpenes, organic compounds, and trace metals may have contributed to the over 

2800 EVALI cases and 68 associated deaths

 In our investigation of college student vaping using data collected from the 2018 to 2019 Health Minds Study survey, we found that almost 1 in 4 students who vaped used THC,

 and a study of the 2018 National Youth Tobacco Survey found that about 1 in 4 of the middle and high school student sample had vaped marijuana.

The short answer is yes. A few US states, tribal governments, and some countries have broadened prohibitions against smoking in public places to include vaping, but most have not. The US Food and Drug Administration (FDA) 

, predominantly when marketed to children and youth, sold without age-verification or without limiting number.

 Menthol, previously considered an adult flavor, is 

While vaping products are being used by nonsmokers, vaping has utility as a smoking cessation aid for adult consumers.

 Given the undeniable harms of smoking, vaping provides an option for people who are ready to quit smoking.

 However, among youth, vaping is more often initiated as an addition to, or a gateway to smoking; in one typical study, only 7.3% of 12th graders who vaped did so for smoking cessation

 and people with dual use (smoking and vaping) are exposed to increased harms.

“Paul” was a smoker for over 30 years; despite use of numerous quit methods, Paul’s frequent attempts to stop 

 were curtailed by his anxiety and disrupted concentration. Finally, his primary care provider convinced him to give vaping a 2-week try. Cynical about anything helping, Paul was relieved when he discovered vaping worked for him. In addition, he was thrilled to find products that were within his budget. But vaping has not been 100% panacea. One day while working at his computer, Paul felt a sudden flash of pain and his pant leg burst into fire. A visit to the emergency department and a skin graft were required after his battery exploded in his pocket. Nevertheless, Paul is still vaping. He says he will never return to smoking cigarettes, although he misses it. He is scheduled to see a pulmonologist; he is certain that vaping has been better for his health than the 2 packs a day he used to smoke. However, family and friends are concerned, he reports, because he is never without his vape pen, and he realizes he hits it with no conscious knowledge of doing so, regardless of where he is.

Assessing the clinical significance of vaping.

 Talking to a patient about vaping may require some investigation (

). Frequency of use and the types of products used influence the safety and clinical significance of the behavior. If the client is distressed by their behavior, experiences functional impairment, or reports poor health outcomes including symptoms of tobacco or cannabis use disorders, you may decide to provide assistance and help your client quit, or reduce, vaping behavior.

Resources to help your client quit vaping.

 The US Department of Health and Human Services

 In-person and online classes and/or support groups, tailored text messaging services, a free QuitGuide app, and information related to nicotine replacement products are available. Patients can consult and access these resources when they want to quit smoking or vaping. While vaping cessation research is scant

 and is primarily limited to nicotine vaping, methods used to quit are likely amenable to those used in smoking cessation.

 US Preventive Services Task Force recommendations for clinicians are to ask about use, advise quitting, and provide behavioral interventions and pharmacotherapy.

 Teens and adolescents may require niched interventions, whether consuming nicotine via vaping or other methods.

 funded the development of a text-to-quit mobile application as an addition to their quit program for teens. This program is based on research of vaping patterns, quit attempts, and cessation motivation; interventions should be tailored to address social influences, outcome expectancies, and intentions to quit.

 Expecting mothers also need a tailored approach to quit vaping; counseling techniques, including relaxation activities,

 and monetary incentives improve outcomes.

 Nicotine Replacement Therapy may also be helpful.

is an associate professor and Director in psychiatric epidemiology at the University of Florida.

is a PhD student in epidemiology at the University of Florida.

1. Stratton K, Kwan LY, Eaton DL. Public health consequences of e-cigarettes: consensus study report. 

Public health consequences of e-cigarettes: consensus study report

https://www.cabdirect.org/cabdirect/abstract/20183318811

2. US Department of Health and Human Services. E-Cigarette use among youth and young adults. A report of the surgeon general

 US Department of Health and Human Services; 2016. 

https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf

3. Buchanan ND, Grimmer JA, Tanwar V, et al. Cardiovascular risk of electronic cigarettes: a review of preclinical and clinical studies. 

4. Goniewicz ML, Boykan R, Messina CRet al. High exposure to nicotine among adolescents who use Juul and other vape pod systems (‘pods’). 

5. Romijnders KAGJ, van Osch L, de Vries H, Talhout R. Perceptions and reasons regarding e-cigarette use among users and non-users: A narrative literature review. 

6. Jarmul S, Aherrera A, Rule A, et al. Lost in e-cigarette clouds: A culture on the rise. 

7. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. Updated February 25, 2020. Accessed May 11, 2021. 

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

8. Griffiths A, Rauzi A, Stadheim K, Wheeler W. Lung injury associated with e-cigarette or vaping product use. 

9. Striley CW, Nutley SK. World vaping update. 

10. Ben Taleb Z, Kalan ME, Bahelah R, et al. Vaping while high: Factors associated with vaping marijuana among youth in the United States. 

11. FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint. US Food and Drug Administration. March 24, 2020. Accessed May 11, 2021. 

https://www.fda.gov/news-events/press-announcements/fda-finalizes-enforcement-policy-unauthorized-flavored-cartridge-based-e-cigarettes-appeal-children

12. FDA commits to evidence-based actions aimed at saving lives and preventing future generations of smokers. US Food and Drug Administration. April 29, 2021. Accessed May 11, 2021. 

https://www.fda.gov/news-events/press-announcements/fda-commits-evidence-based-actions-aimed-saving-lives-and-preventing-future-generations-smokers

13. Hartmann-Boyce J, McRobbie H, Lindson N, et al. Electronic cigarettes for smoking cessation. 

14. Wang RJ, Bhadriraju S, Glantz SA. E-cigarette use and adult cigarette smoking cessation: A meta-analysis. 

15. Evans-Polce RJ, Patrick ME, Lanza ST, Miech RA, O'Malley PM, Johnston LD. Reasons for Vaping Among U.S. 12th Graders. 

. 2018;62(4):457-462. doi:10.1016/j.jadohealth.2017.10.009

16. Prochaska JJ, Benowitz NL. Current advances in research in treatment and recovery: Nicotine addiction. 

17. QuitGuide. Smokefree.gov. Accessed May 11, 2021. 

https://smokefree.gov/tools-tips/apps/quitguide 

18. Tobacco information and tips for quitting smoking. BeTobaccoFree. Accessed May 11, 2021. 

19. Smoking—Medicines to help you quit. US Food and Drug Administration. 2019. Accessed May 11, 2021. 

https://www.fda.gov/consumers/free-publications-women/smoking-medicines-help-you-quit

20. Smoking cessation information & programs. Tobacco Free Florida. Accessed May 11, 2021. 

21. Berg CJ, Krishnan N, Graham AL, Abroms LC. A synthesis of the literature to inform vaping cessation interventions for young adults. 

22. Cuccia AF, Patel M, Amato MS, et al. Quitting e-cigarettes: Quit attempts and quit intentions among youth and young adults. 

23. Amato MS, Bottcher MM, Cha S, et al. “It’s really addictive and I’m trapped:” A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people. 

24. US Preventive Services Task Force, Krist AH, Davidson KW, et al. Interventions for tobacco smoking cessation in adults, including pregnant persons: US preventive services task force recommendation statement. 

25. This is quitting. The Truth Initiative. Accessed May 11, 2021. 

https://www.thetruth.com/article/this-is-quitting

26. Chamberlain C, O’Mara-Eves A, Oliver S, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. 

27. Notley C, Gentry S, Livingstone‐Banks J, et al. Incentives for smoking cessation. 

28. Livingstone‐Banks J, Norris E, Hartmann‐Boyce J, et al. Relapse prevention interventions for smoking cessation. 

Healthy lungs are at risk—what can you do as a clinician to help patients quit vaping?

Vaping: What Psychiatrists Need to Know

May is Maternal Mental Health Month, and moms around the world could probably use a break. During the COVID-19 pandemic, they have done even more of the childcare and housework, while also, in many cases, 

. How has the pandemic affected their mental health—either by creating new problems or by exacerbating 

, Anita H. Clayton, MD, explores the wide and varied field of maternal mental health. Along with the effects of the pandemic, Clayton discusses prenatal mental health care, new and emerging treatments for postpartum depression and psychosis, and how what she saw in a courtroom set her on a path to becoming a renowned expert on maternal wellness.

Dr Clayton will speak further on these issues at the 

Annual Psychiatric TimesTM World CME Conference.

is the David C. Wilson Professor and chair of the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia, with a secondary appointment as professor of clinical obstetrics and gynecology. She is the author of 

Satisfaction: Women, Sex, and the Quest for Intimacy

 published by Ballantine Books in 2007, and an editor of the 2005 

Women’s Mental Health: A Comprehensive Textbook

. She is also a program co-chair of the Annual 

What are the implications of maternal mental health not only for mothers, but also for children, families, and society as a whole?   

Substance Use Disorder

Varenicline and Tardive Dyskinesia in Schizophrenia

Lessons from Novel Harm Reduction Methods

Vaping: What Psychiatrists Need to Know

More Than Postpartum Depression: Addressing Maternal Mental Health Through the Life Cycle

What About Us? The Marginalization of Serious Mental Health and Substance Use

Confronting the Methamphetamine Epidemic

Highlighting Brain-Based Inequalities for Women: From Bedside and Boardroom to Policy

A Tale of Two Crises: Fighting the Overdose Problem During the Pandemic

Samidorphan: Scheduled Substance No More

Clearing the Smoke: FDA Working Toward Tobacco Flavor Ban to Save Lives, Promote Health Equity