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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Appendix B

Study Approach

In response to its charge, the committee developed a process defined by discrete actions building toward an evidence base that would eventually inform the committee’s findings and conclusions. This process is depicted in Figure B-1.

The following sections detail the process by which the committee came to their conclusions about the weight of evidence regarding the association between cannabis and specific health endpoints. The steps include the literature search, the refinement of the specific health endpoints of medical and public health importance to be assessed, the identification and assessment of relevant literature (including published systematic reviews and primary literature), and the development of consistent and specific language to describe the integration of the literature to reflect the weight of evidence.

LITERATURE SEARCH

A professional research librarian worked with the committee to conduct the literature searches used to identify relevant research. Six searches were conducted. An initial search (Search 1) of Medline, Embase, and the Cochrane Database of Systematic Reviews found 19,189 total articles reporting on associations between cannabis exposure and health endpoints. Search 1 included articles that were published between January 1999 and June 2016 and that included a cannabis search term and search terms relevant to health effects of interest in at least one of several search

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Image
FIGURE B-1 Summary of the committee’s process.

fields (e.g., title, abstract, subject heading). A partial review of the search results found a large number of irrelevant documents. For this reason, a second and more limited search strategy was developed.

Search 2 involved the same databases as Search 1 but used different search terms to identify articles associated with specific health endpoints, and it excluded articles with specific terms (e.g., “animal,” “spice”) in the title or abstract. Search 2 produced 2,092 articles between 1999 and the 2016. The substantial reduction in articles indicated that the more limited search strategy caused relevant research to be excluded; consequently, a third and broader search strategy was developed.

Search 3 of the same databases produced 7,198 total articles reporting on associations between cannabis exposure and any health endpoint. This search included articles published between 1999 and 2016, excluded articles with specific terms (e.g., “mice,” “spice”) in the title or abstract, and limited articles by study design (e.g., clinical trial, observational study, systematic review).

The results of Search 2 and Search 3 were combined, and three additional searches were conducted in order to address potential gaps in the overall search results. Search 4 identified 1,396 articles in the PsycINFO database, filling gaps in the committee’s collection of literature on the effects of cannabis exposure on mental health and psychosocial endpoints. Using the search term “Nabilone” (a synthetic cannabinoid), Search 5 identified 33 articles in Medline, Embase, and the Cochrane Database of Systematic Reviews that previous searches had not included. Search 6 identified 389 articles and brought the literature up to date by extending the date of publication parameter to August 2, 2016, and including articles published electronically ahead of print. The terms and strategies used in these searches are provided on page 419 of this appendix. In addition to these six searches, committee members also reviewed their personal libraries, and added potentially relevant articles from these collections to the combined search results.

The results from searches 2 through 6 were combined to create a master library containing 10,759 unique articles, including 1,488 articles initially categorized as systematic reviews. These articles were then sorted into seven major health endpoint topic areas: injury and mortality; car-

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

diovascular and respiratory symptoms and conditions; cancer, immune function, and infections; mental health symptoms and conditions; prenatal, perinatal, and postnatal health effects; psychosocial health effects; and therapeutic health effects.1 Upon further reflection and review of the available literature, the committee decided to separate the original cardiovascular and respiratory topic area into two individual research topics, as well as to separate out two additional research topics—problem cannabis use, and cannabis use and abuse of other substances—from the original mental health topic area. This final list of topic areas was subsequently divided into the 11 health endpoint topic areas covered in the chapters that comprise parts II and III of the report. Within each of these topic areas the committee identified specific research questions relating to health endpoints of medical and public health importance that would be the focus of the report. They based this list on their public health and medical expertise, their knowledge of the cannabis literature, input from the sponsors at the first meeting, and other key reviews about the health effects of cannabis. This process, which reduced the total number of articles to be reviewed by the committee, was necessary to make the scope of the report manageable, but it may have resulted in the exclusion of certain health outcomes of interest to health professionals, researchers, policy makers, or the public. Below, Box B-1 lists the health topic areas and specific health endpoints selected for review by the committee.

After filtering the original search results for articles relevant to the health endpoints of interest, 6,540 primary literature articles and 288 systematic reviews were left to be reviewed by the committee. Given the large number of potentially relevant articles, the committee decided to begin by reviewing the identified systematic reviews. To accomplish this, the committee modified previously developed approaches for evaluating the quality of the systematic reviews and primary literature. These approaches are described in the systematic review: identification and quality review, “Primary Literature: Identification and Quality Review,” and “Data Synthesis and Strength of Evidence Assessment” sections below.

The committee identified articles as possibly being systematic reviews based on abstracts or keyword searches, and then they evaluated each of the identified articles for the presence of the key elements of a systematic review by asking the following questions:

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1 The organization of Search 2 results involved different search terms and tools than the organization of Search 3 results. Search 2 topic groups were developed using unique search terms, online databases (Medline, Embase, Cochrane Database of Systematic Reviews), and Ovid search functions. Search 3 topics groups were developed using unique search terms, the Search 3 EndNote library, and the EndNote full-text keyword search function.

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
  1. Does the article describe a search involving at least two databases?
  2. Does the article describe a search involving appropriate search terms?
  3. Does the article describe a search involving prespecified eligibility criteria?
  4. Does the article include a risk-of-bias discussion and/or quality assessment?
  5. Does the article include a meta-analysis or qualitative synthesis of findings?
  6. Does the article report on one or more health effects of cannabis on humans?
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

Articles that were deemed true systematic reviews using the above questions as a guideline were then assessed for quality based on five attributes adapted from other sources (Higgins et al., 2011). In their assessment of the quality of a systematic review, committee members considered the study eligibility criteria, how studies were identified and considered for inclusion, how data were collected and appraised by the authors, the methods by which study findings were selected and synthesized, and whether any conflict of interests were addressed. Box B-2 lists the specific questions committee members were asked to consider in the quality assessment.

Based on the responses to these questions, the overall quality of the systematic review was rated as good, fair, or poor. To ensure the accuracy

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

of quality assessments, all systematic reviews were rated independently by at least two committee members. Disagreements among committee members regarding the overall quality of a systematic review were resolved through deliberation or by the assessment of a third committee member. Only those systematic reviews rated as good or fair quality were used to inform the report’s findings, conclusions, and recommendations.

PRIMARY LITERATURE: IDENTIFICATION AND QUALITY REVIEW

For those health endpoints addressed by more than one good- or fair-quality systematic review, the committee gave primacy to the most recently published systematic reviews (since 2011). Any deviations in this process are detailed in the chapter text. For every health endpoint with an associated good- or fair-quality systematic review, the committee also reviewed relevant primary literature published after the cutoff date of the literature search used in that systematic review. For endpoints not addressed by at least one good- or fair-quality systematic review, the committee reviewed all relevant primary literature published between January 1, 1999, and August 2, 2016.

Committee members first reviewed article abstracts to identify and remove editorials, opinion pieces, grey literature, and other documents that were not peer-reviewed cross-sectional studies, case-control studies, cohort studies, randomized controlled trials (RCTs), or nonsystematic literature reviews. During this preliminary review, committee members also assessed the relevance of the article to the health endpoint question.

In their in-depth review of the primary literature, committee members were guided by the Cochrane Quality Assessment for randomized controlled trials and the Newcastle–Ottawa Scale for cohort and case-control studies.2 For a depiction of the flow of articles through the search and selection process, see Figure B-2.

DATA SYNTHESIS AND STRENGTH OF EVIDENCE ASSESSMENT

After completing the identification and quality-assessment process described above, the committee formulated its findings and conclusions.

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2 The Cochrane Risk Assessment Tool was designed to assess for a risk of bias consequent to flaws in the design, conduct, analysis, and reporting of randomized trials (Higgins, 2011). The Newcastle–Ottawa Scale (NOS) was designed to assess the quality of nonrandomized trials to be included in a systematic review. The NOS assesses studies along three dimensions: selection of study groups, comparability of study groups, and determination of endpoints and exposures (Wells et al., 2011).

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Image
FIGURE B-2 Search and selection process flow chart.
NOTE: Totals within and across searches and health topic areas may not sum due to duplication of articles and hand-searching efforts.
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

The committee employed two strategies to ensure that report conclusions and recommendations were based on the best available evidence and that the strength of the evidence informing the conclusions was explicitly articulated. First, the committee privileged evidence drawn from RCTs, followed by nonrandomized controlled trials, prospective controlled studies, and case-control studies. Case series and case studies were referenced only in the absence of higher-quality studies. Second, the committee developed a set of standardized terms to describe the strength of the evidence informing every conclusion. Informed by the reports of previous Institute of Medicine (IOM)3 committees, the committee developed standard language to categorize the weight of evidence regarding whether cannabis or cannabinoid use (for therapeutic purposes) is an effective or ineffective treatment for the prioritized health endpoints of interest, or whether cannabis or cannabinoid use (primarily for recreational purposes) is statistically associated with the prioritized health endpoints of interest. The weight of the evidence was determined during private deliberations of subgroups of the committee. This hierarchy of evidence does not imply the magnitude of the observed effect or the importance of the health effect from an individual or population standpoint. Instead, these terms reflect the quality, quantity, and consistency of the evidence supporting a conclusion. See Box B-3 for the terms and their descriptions.

DISCUSSION

The search strategies and processes described above were developed and adopted by the committee in order to adequately address a broad statement of task in a limited time frame, while adhering to the National Academies of Sciences, Engineering, and Medicine’s high standards for the quality and rigor of committee reports. Some limitations to these strategies and processes are discussed below.

First, the committee was not tasked to conduct a systematic review, which would have required a lengthy and robust series of processes. The committee did, however, adopt key features of that process: a comprehensive literature search, assessments by more than one person of the quality (risk of bias) of key literature and the conclusions, prespecification of the questions of interest before conclusions were formulated, standard language to allow comparisons between conclusions, and declarations of conflict of interest via the National Academies conflict of interest policies. Second, there is a possibility that some literature was missed because of the practical steps taken to narrow a very large literature to one that was

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3 As of March 2016, the Health and Medicine Division continues the consensus studies and convening activities previously carried out by the Institute of Medicine (IOM).

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

manageable within the time frame available to the committee. Furthermore, very good research may not be reflected in this report because it did not directly address the health endpoint questions that the committee formulated.

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

SEARCH STRATEGIES

Search 2
Date: June 27, 2016

Total citations:

Systematic reviews: 541

Primary literature: 1,551

Total: 2,092

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

Databases (search engine): Medline (Ovid); Embase (Ovid); Cochrane (Ovid)

Note: Ovid command-line syntax is provided below. Terms immediately followed by a forward slash (/) are Medical Subject Headings (MESH headings from MEDLINE) or EMTREE terms (from the EMBASE controlled vocabulary). The fields searched by a .mp in Embase and Medline include title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, and unique identifier. The fields searched by a .mp in Cochrane include title, short title, abstract, full text, keywords, caption text.

Search No. Search Syntax
Beneficial
1 marijuana.mp. or cannabis/
2 cannabis.mp.
3 cannabinoids.mp. or cannabinoid/
4 tetrahydrocannabinol.mp. or tetrahydrocannabinol/
5 dronabinol.mp. or dronabinol/
6 cannabidiol.mp. or cannabidiol/
7 cannabinol.mp. or cannabinol/
8 THC.mp.
9 marinol.mp.
10 or/1–9
11 spice.ti,ab.
12 K2.ti,ab.
13 or/11–12
14 10 not 13
15 Rats/ or rats.ti,ab.
16 Mice/ or mice.ti,ab.
17 animals/ or animals.ti,ab.
18 or/15–17
19 14 not 18
20 Therapeutics/
21 “therapeutic use”.mp.
22 benefits.mp.
23 treatment.mp.
24 therapy.mp.
25 Palliative Care/ or palliation.mp.
26 “Quality of Life”/
27 or/20–26
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
28 19 and 27
29 Nausea/ or nausea.mp.
30 Vomiting/
31 vomiting.mp.
32 or/28–30
33 28 and 31
34 limit 32 to (abstracts and English language and humans and yr=“1999–Current”)
35 Analgesia/ or Analgesia.mp.
36 28 and 35
37 limit 36 to (English language and humans and yr=“1999–Current”)
38 Anxiety/ or anxiety relief.mp. or Anxiety Disorders/
39 28 and 38
40 limit 39 to (English language and humans and yr=“1999–Current”)
41 irritable bowel syndrome.mp. or Irritable Bowel Syndrome/
42 28 and 41
43 limit 42 to (English language and humans and yr=“1999–Current”)
44 improved sexual function.mp. or Sexual Behavior/
45 sexual function.mp.
46 or/44–45
47 28 and 46
48 limit 47 to (English language and humans and yr=“1999–Current”)
49 Interpersonal Relations/ or social relationships.mp.
50 28 and 57
51 limit 50 to (English language and humans and yr=“1999–Current”)
52 increased appetite.mp. or Appetite/ or Eating/
53 wasting.mp. or Wasting Syndrome/
54 or/52–53 28 and 54
55 limit 54 to (English language and humans and yr=“1999–Current”)
56 Substance-Related Disorders/ or addiction.mp.
57 28 and 56
58 limit 57 to (English language and humans and yr=“1999–Current”)
59 intraocular pressure.mp. or Intraocular Pressure/
60 28 and 59
61 limit 60 to (English language and humans and yr=“1999–Current”)
62 PTSD.mp. or Stress Disorders, posttraumatic/
63 trauma.mp.
64 or/62–63
65 28 and 64
66 limit 65 to (English language and humans and yr=“1999–Current”)
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
67 Premenstrual Syndrome/ or Premenstrual Dysphoric Disorder/ or premenstrual.mp.
68 28 and 67
69 limit 68 to (English language and humans and yr=“1999–Current”)
70 Epilepsy/ or seizure control.mp. or Seizures/
71 28 and 70
72 limit 71 to (English language and humans and yr=“1999–Current”)
73 sleep disorders.mp. or Sleep Wake Disorders/
74 insomnia.mp. or “Sleep Initiation and Maintenance Disorders”/
75 or/73–74
76 28 and 75
77 limit 76 to (English language and humans and yr=“1999–Current”)
78 Muscle Spasticity/ or Spasticity.mp.
79 Pain/
80 Multiple Sclerosis/
81 or/78–80
82 28 and 81
83 limit 82 to (English language and humans and yr=“1999–Current”)
84 cancer treatment.mp.
85 cancer prevention.mp.
86 or/84–85
87 28 and 86
88 limit 87 to (English language and humans and yr=“1999–Current”)
89 brain injury.mp. or Brain Injuries/
90 28 and 89
91 limit 90 to (English language and humans and yr=“1999–Current”)
92 34 or 37 or 40 or 43 or 48 or 51 or 55 or 58 or 61 or 66 or 69 or 72 or 77 or 83 or 88 or 91
93 limit 92 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
94 34 or 37 or 40 or 43 or 48 or 51 or 55 or 58 or 61 or 66 or 69 or 72 or 77 or 83 or 88 or 91
95 limit 94 to (meta-analysis or systematic reviews)
Search No. Search Syntax
Cancer
1 marijuana.mp. or cannabis/
2 cannabis.mp.
3 cannabinoids.mp. or cannabinoid/
4 tetrahydrocannabinol.mp. or tetrahydrocannabinol/
5 dronabinol.mp. or dronabinol/
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
6 cannabidiol.mp. or cannabidiol/
7 cannabinol.mp. or cannabinol/
8 THC.mp.
9 marinol.mp.
10 or/1–9
11 spice.ti,ab.
12 K2.ti,ab.
13 or/11–12
14 Rats/ or rats.ti,ab.
15 Mice/ or mice.ti,ab.
16 animals/ or animals.ti,ab.
17 or/14–16
18 10 not 13
19 cancer.mp. or Neoplasms/
20 lung cancer.mp. or Lung Neoplasms/
21 Esophageal Neoplasms/ or Pharyngeal Neoplasms/ or Laryngeal Neoplasms/ or “Head and Neck Neoplasms”/ or upper aerodigestive tract cancer.mp. or Mouth Neoplasms/
22 testicular cancer.mp. or Testicular Neoplasms/
23 childhood cancer.mp.
24 immune system.mp. or Immune System/
25 Immunity/
26 immunity.mp.
27 or/19–26
28 18 and 27
29 28 not 17
30 limit 29 to (human and English language and yr=“1999–Current”)
31 limit 30 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
32 limit 30 to (meta analysis or systematic reviews)
Search No. Search Syntax
Cardiovascular
1 marijuana.mp. or cannabis/
2 cannabis.mp.
3 cannabinoids.mp. or cannabinoid/
4 tetrahydrocannabinol.mp. or tetrahydrocannabinol/
5 dronabinol.mp. or dronabinol/
6 cannabidiol.mp. or cannabidiol/
7 cannabinol.mp. or cannabinol/
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
8 THC.mp.
9 marinol.mp.
10 or/1–9
11 Cardiovascular Abnormalities/ or Cardiovascular Diseases/ or cardiovascular.mp.
12 cerebrovascular.mp. or Cerebrovascular Disorders/
13 Peripheral Vascular Diseases/ or peripheral vascular.mp.
14 heart attack.mp. or Myocardial Infarction/
15 Stroke/ or stroke risk.mp.
16 thromboangiitis obliterans.mp. or Thromboangiitis Obliterans/
17 spice.ti,ab.
18 K2.ti,ab.
19 or/17–18
20 10 not 19
21 Rats/ or rats.ti,ab.
22 Mice/ or mice.ti,ab.
23 animals/ or animals.ti,ab.
24 or/21–23
25 or/11–16
26 20 and 25
27 26 not 24
28 27
29 limit 28 to (English language and humans and yr=“1999–Current”)
30 limit 29 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
31 limit 29 to (meta analysis or systematic reviews)
Search No. Search Syntax
Injury
1 marijuana.mp. or cannabis/
2 cannabis.mp.
3 cannabinoids.mp. or cannabinoid/
4 tetrahydrocannabinol.mp. or tetrahydrocannabinol/
5 dronabinol.mp. or dronabinol/
6 cannabidiol.mp. or cannabidiol/
7 cannabinol.mp. or cannabinol/
8 THC.mp.
9 marinol.mp.
10 or/1–9
11 spice.ti,ab.
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
12 K2.ti,ab.
13 or/11–12
14 Rats/ or rats.ti,ab.
15 Mice/ or mice.ti,ab.
16 animals/ or animals.ti,ab.
17 or/14–16
18 injury.mp. or “Wounds and Injuries”/
19 10 and 18
20 19 not 13
21 20 not 17
22 21
23 limit 22 to (English language and humans and yr=“1999–Current”)
24 Accidents, Traffic/ or motor vehicle accident.mp.
25 motor vehicle crash.mp.
26 or/24–25
27 10 and 26
28 27 not 13
29 28 not 17
30 29
31 limit 30 to (English language and humans and yr=“1999–Current”)
32 all-cause death.mp.
33 Death/
34 or/32–33
35 10 and 34
36 35 not 13
37 36 not 17
38 37
39 limit 38 to (English language and humans and yr=“1999–Current”)
40 Drug Overdose/
41 overdose death.mp.
42 or/40–41
43 10 and 42
44 43 not 13
45 44 not 17
46 45
47 limit 46 to (English language and humans and yr=“1999–Current”)
48 limit 23 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
49 limit 31 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
50 limit 39 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
51 limit 47 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
52 limit 23 to (meta analysis or systematic reviews)
53 limit 31 to (meta analysis or systematic reviews)
54 limit 39 to (meta analysis or systematic reviews)
55 limit 47 to (meta analysis or systematic reviews)
Search No. Search Syntax
Mental Health
1 marijuana.mp. or cannabis/
2 cannabis.mp.
3 cannabinoids.mp. or cannabinoid/
4 tetrahydrocannabinol.mp. or tetrahydrocannabinol/
5 dronabinol.mp. or dronabinol/
6 cannabidiol.mp. or cannabidiol/
7 cannabinol.mp. or cannabinol/
8 THC.mp.
9 marinol.mp.
10 or/1–9
11 spice.ti,ab.
12 K2.ti,ab.
13 or/11–12
14 Rats/ or rats.ti,ab.
15 Mice/ or mice.ti,ab.
16 animals/ or animals.ti,ab.
17 or/14–16
18 10 not 13
19 mental disease/ or mental health/
20 18 and 19
21 20 not 17
22 21
23 limit 22 to (human and English language and yr=“1999–Current”)
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
24 limit 23 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial)
25 limit 24 to (journal and article)
26 limit 24 to (meta analysis or “systematic review”)
27 limit 26 to (journal and (article or review))
28 cannabis addiction/
29 drug abuse/ or drug misuse/
30 cannabis dependence.mp.
31 or/28–30
32 18 and 31
33 32 not 17
34 33
35 limit 34 to (human and english language and yr=“1999–Current”)
36 limit 35 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial)
37 limit 36 to (journal and article)
38 limit 35 to (meta analysis or “systematic review”)
39 limit 38 to (journal and (article or review))
40 alcohol abuse/
41 tobacco dependence/ or tobacco consumption/
42 “tobacco use”/
43 drug abuse/
44 drug dependence/
45 or/40–44
46 18 and 45
47 46 not 17
48 47
49 limit 48 to (human and English language and yr=“1999–Current”)
50 limit 49 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial)
51 limit 50 to (journal and article)
52 limit 49 to (meta analysis or “systematic review”)
53 limit 52 to (journal and (article or review))
54 schizophrenia/
55 psychosis/
56 psychotic disorder.mp.
57 or/54–56
58 18 and 57
59 58 not 17
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
60 59
61 limit 60 to (human and English language and yr=“1999–Current”)
62 limit 61 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial)
63 limit 62 to (journal and article)
64 limit 61 to (meta analysis or “systematic review”)
65 limit 64 to (journal and (article or review))
66 depression/
67 18 and 66
68 67 not 17
69 68
70 limit 69 to (human and English language and yr=“1999–Current”)
71 limit 70 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial)
72 limit 71 to (journal and article)
73 limit 70 to (meta analysis or “systematic review”)
74 limit 73 to (journal and (article or review))
75 suicide/
76 18 and 75
77 76 not 17
78 77
79 limit 78 to (human and English language and yr=“1999–Current”)
80 limit 78 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial)
81 limit 80 to (journal and article)
82 limit 79 to (meta analysis or “systematic review”)
83 limit 82 to (journal and (article or review))
84 anxiety/
85 18 and 84
86 85 not 17
87 86
88 limit 87 to (human and English language and yr=“1999–Current”)
89 limit 88 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial)
90 limit 89 to (journal and article)
91 limit 88 to (meta analysis or “systematic review”)
92 limit 91 to (journal and (article or review))
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
Pregnancy
1 marijuana.mp. or cannabis/
2 cannabis.mp.
3 cannabinoids.mp. or cannabinoid/
4 tetrahydrocannabinol.mp. or tetrahydrocannabinol/
5 dronabinol.mp. or dronabinol/
6 cannabidiol.mp. or cannabidiol/
7 cannabinol.mp. or cannabinol/
8 THC.mp.
9 marinol.mp.
10 or/1–9
11 spice.ti,ab.
12 K2.ti,ab.
13 or/11–12
14 Rats/ or rats.ti,ab.
15 Mice/ or mice.ti,ab.
16 animals/ or animals.ti,ab.
17 or/14–16
18 10 not 13
19 pregnancy outcomes.mp. or pregnancy outcome/
20 low birthweight.mp. or low birth weight/
21 premature labor/ or pre term delivery.mp.
22 birth defects.mp.
23 stillbirth/
24 miscarriage.mp. or spontaneous abortion/
25 neonatal mortality.mp. or newborn mortality/
26 physical growth.mp. or growth/
27 18 and 19
28 27 not 17
29 28
30 limit 29 to (human and english language)
31 18 and 20
32 31 not 17
33 32
34 limit 33 to (human and English language and yr=“1999–Current”)
35 18 and 21
36 35 not 17
37 36
38 limit 37 to (human and English language and yr=“1999–Current”)
39 18 and 22
40 39 not 17
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
41 40
42 limit 41 to (human and English language and yr=“1999–Current”)
43 or/23–25
44 18 and 43
45 18 and 43
46 45 not 17
47 46
48 46
49 limit 48 to (human and English language and yr=“1999–Current”)
50 18 and 26
51 50 not 17
52 51
53 limit 52 to (human and English language and yr=“1999–Current”)
54 limit 30 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
55 limit 30 to (meta analysis or systematic reviews)
56 limit 34 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
57 limit 34 to (meta analysis or systematic reviews)
58 limit 38 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
59 limit 38 to (meta analysis or systematic reviews)
60 limit 42 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
61 limit 42 to (meta analysis or systematic reviews)
62 limit 49 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
63 limit 49 to (meta analysis or systematic reviews)
64 limit 53 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
65 limit 53 to (meta analysis or systematic reviews)
66 breast feeding.mp. or Breast Feeding/
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
67 18 and 66
68 67 not 17
69 68
70 limit 69 to (English language and humans and yr=“1999–Current”)
71 Pregnancy/
72 71 and 18
73 72 not 17
74 73
75 limit 74 to (English language and humans and yr=“1999–Current”)
76 limit 70 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
78 limit 70 to (meta analysis or systematic reviews)
80 limit 75 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
82 limit 75 to (meta analysis or systematic reviews)
Search No. Search Syntax
Psychosocial
1 marijuana.mp. or cannabis/
2 cannabis.mp.
3 cannabinoids.mp. or cannabinoid/
4 tetrahydrocannabinol.mp. or tetrahydrocannabinol/
5 dronabinol.mp. or dronabinol/
6 cannabidiol.mp. or cannabidiol/
7 cannabinol.mp. or cannabinol/
8 THC.mp.
9 marinol.mp.
10 or/1–9
11 spice.ti,ab.
12 K2.ti,ab.
13 or/11–12
14 Rats/ or rats.ti,ab.
15 Mice/ or mice.ti,ab.
16 animals/ or animals.ti,ab.
17 or/14–16
18 10 not 13
19 psychosocial.mp. or Social Adjustment/
20 psychosocial effects.mp.
21 or/19–20
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
22 21 and 18
23 22 not 17
24 limit 23 to (English language and humans and yr=“1999–Current”)
25 cognitive development.mp.
26 Cognition/
27 Achievement/ or academic achievement.mp.
28 or/25–27
29 28 and 18
30 29 not 17
31 30
32 limit 31 to (English language and humans and yr=“1999–Current”)
33 cognitive impairment.mp. or Cognition Disorders/
34 33 and 18
35 34 not 17
36 limit 35 to (English language and humans and yr=“1999–Current”)
37 Employment/
38 Income/
39 or/37–38
40 39 and 18
41 40 not 17
42 limit 41 to (English language and humans and yr=“1999–Current”)
43 Interpersonal Relations/ or social relationships.mp.
44 43 and 18
45 44 not 17
46 45
47 limit 46 to (English language and humans and yr=“1999–Current”)
48 Social Behavior/ or social roles.mp.
49 48 and 18
50 49 not 17
51 limit 50 to (English language and humans and yr=“1999–Current”)
52 24 or 32 or 36 or 42 or 47 or 51
53 limit 52 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
54 24 or 32 or 36 or 42 or 47 or 51
55 limit 54 to (meta analysis or systematic reviews)
Search No. Search Syntax
Respiratory
1 marijuana.mp. or cannabis/
2 cannabis.mp.
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
3 cannabinoids.mp. or cannabinoid/
4 tetrahydrocannabinol.mp. or tetrahydrocannabinol/
5 dronabinol.mp. or dronabinol/
6 cannabidiol.mp. or cannabidiol/
7 cannabinol.mp. or cannabinol/
8 THC.mp.
9 marinol.mp.
10 or/1–9
11 spice.ti,ab.
12 K2.ti,ab.
13 or/11–12
14 10 not 13
15 Rats/ or rats.ti,ab.
16 Mice/ or mice.ti,ab.
17 animals/ or animals.ti,ab.
18 or/15–17
19 pulmonary.mp. or Pulmonary Disease, Chronic Obstructive/
20 lung disease.mp. or Lung Diseases/ or Respiratory Tract Diseases/ or respiratory disease.mp. or COPD.mp.
21 or/19–20
22 21 and 14
23 22 not 18
24 23
25 limit 24 to (human and English language and yr=“1999–Current”)
26 limit 25 to (meta analysis or systematic reviews)
27 limit 25 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)

Search 3
Date: July 6, 2016

Total citations:

Systematic Reviews: 912

Primary Literature: 6,286

Total: 7,198

Databases (search engine): Medline (Ovid); Embase (Ovid); Cochrane (Ovid)

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

Note: Ovid command-line syntax is provided below. Terms immediately followed by a forward slash (/) are Medical Subject Headings (MESH headings from MEDLINE) or EMTREE terms (from the EMBASE controlled vocabulary). The fields searched by a .mp in Embase and Medline include title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, and unique identifier. The fields searched by a .mp in Cochrane include title, short title, abstract, full text, keywords, caption text.

Search No. Search Syntax
1 Cannabis/
2 Marijuana Smoking/
3 Marijuana Abuse/
4 Medical Marijuana/
5 Cannabinoids/
6 Dronabinol/
7 (cannabis or marijuana or cannabinoid or dronabinol or marinol). ti,ab.
8 THC.ti,ab
9 or/1–8
10 k2.ti,ab.
11 spice.ti,ab.
12 or/10–11
13 9 not 12
14 Mice/ or mice.ti,ab.
15 Rats/ or rats.ti,ab.
16 or/14–15
17 13 not 16
18 17
19 limit 18 to (English language and humans)
20 limit 19 to (classical article or clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or comparative study or controlled clinical trial or evaluation studies or guideline or journal article or multicenter study or observational study or practice guideline or pragmatic clinical trial or randomized controlled trial or validation studies)
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
21 limit 19 to (addresses or autobiography or bibliography or biography or case reports or clinical conference or comment or congresses or consensus development conference or consensus development conference, NIH or “corrected and republished article” or dataset or dictionary or directory or duplicate publication or editorial or english abstract or festschrift or government publications or historical article or in vitro or interactive tutorial or interview or introductory journal article or lectures or legal cases or legislation or letter or meta analysis or news or newspaper article or overall or patient education handout or periodical index or personal narratives or portraits or published erratum or research support, non us gov’t or retracted publication or “retraction of publication” or “review” or “scientific integrity review” or systematic reviews or technical report or video-audio media or webcasts)
22 20 not 21
23 limit 22 to yr=1999-current
24 limit 19 to (meta analysis or “review” or systematic reviews)
25 limit 19 to (addresses or autobiography or bibliography or biography or case reports or clinical conference or comment or congresses or consensus development conference or consensus development conference, NIH or “corrected and republished article” or dataset or dictionary or directory or duplicate publication or editorial or english abstract or festschrift or government publications or historical article or in vitro or interactive tutorial or interview or introductory journal article or lectures or legal cases or legislation or letter or news or newspaper article or overall or patient education handout or periodical index or personal narratives or portraits or published erratum or research support, non us gov’t or retracted publication or “retraction of publication” or “scientific integrity review” or technical report or video-audio media or webcasts)
26 24 not 25
27 limit 26 to yr=1999-current

Search 4
Date: July 8, 2016

Total citations:

Systematic Reviews: 20

Primary Literature: 1,376

Total: 1,396

Database (search engine): PsycINFO (ProQuest)

Note: Terms with SU in front of them are Subject Headings taken from the Thesaurus of Psychological Index Terms.

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
Systematic Reviews + Meta Analysis ((SU(“Cannabinoids” OR “Cannabis” OR “Marijuana Usage” OR “Marijuana”) OR TI,AB(cannabis OR marijuana OR cannabinoid OR dronabinol) NOT TI,AB(“K-2” OR spice)) AND peer(yes) AND (la.exact(“ENG”))) AND (me.exact((“Systematic Review” OR “Meta Analysis”) NOT (“Empirical Study” OR “Quantitative Study” OR “Interview” OR “Longitudinal Study” OR “Followup Study” OR “Prospective Study” OR “Literature Review” OR “Treatment Outcome/Clinical Trial” OR “Qualitative Study” OR “Brain Imaging” OR “Clinical Case Study” OR “Retrospective Study” OR “Mathematical Model” OR “Twin Study” OR “Focus Group” OR “Field Study” OR “Experimental Replication” OR “Scientific Simulation” OR “Nonclinical Case Study”)) AND rtype. exact((“Journal” OR “Peer-reviewed Journal” OR “Journal Article”) NOT (“Comment/reply” OR “Editorial” OR “Letter” OR “Erratum/ correction” OR “Review-book” OR “Column/opinion” OR “Abstract Collection” OR “Reprint” OR “Review-media” OR “Obituary”)) AND po.exact((“Male” OR “Human” OR “Female” OR “Outpatient” OR “Inpatient”) NOT “Animal”) AND pd(19990101-20161231) AND PEER(yes))
Peer-reviewed Literature (SU(“Cannabinoids” OR “Cannabis” OR “Marijuana Usage” OR “Marijuana”) OR TI(cannabis OR marijuana OR cannabinoid OR dronabinol) NOT TI,AB(“K-2” OR spice)) AND peer(yes) AND (la. exact(“ENG”) AND me.exact((“Empirical Study” OR “Quantitative Study” OR “Longitudinal Study” OR “Followup Study” OR “Prospective Study” OR “Treatment Outcome/Clinical Trial” OR “Clinical Case Study” OR “Twin Study”) NOT (“Interview” OR “Literature Review” OR “Qualitative Study” OR “Brain Imaging” OR “Mathematical Model” OR “Systematic Review” OR “Meta Analysis” OR “Field Study” OR “Focus Group”)) AND rtype.exact((“Journal” OR “Peer-reviewed Journal” OR “Journal Article”) NOT (“Comment/ reply” OR “Editorial” OR “Letter” OR “Erratum/correction” OR “Review-book” OR “Column/opinion” OR “Abstract Collection” OR “Reprint” OR “Review-media” OR “Obituary”))) AND pd(19990101-20160601)

Search 5
Date: July 15, 2016

Total citations:

Systematic Reviews: 10

Primary Literature: 23

Total: 33

Database (search engine): Medline (Ovid); Embase (Ovid); Cochrane (Ovid)

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

Note: Ovid command-line syntax is provided below. Terms immediately followed by a forward slash (/) are Medical Subject Headings (MESH headings from MEDLINE) or EMTREE terms (from the EMBASE controlled vocabulary). The fields searched by a .mp in Embase and Medline include title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, and unique identifier. The fields searched by a .mp in Cochrane include title, short title, abstract, full text, keywords, caption text.

Search No. Search Syntax
1 nabilone.mp
2 spice.ti,ab.
3 K2.ti,ab.
4 or/2–3
5 1 not 4
6 Rats/ or rats.ti,ab.
7 Mice/ or mice.ti,ab.
8 animals/ or animals.ti,ab.
9 or/6–8
10 5 not 9
11 limit 10 to (English language and yr=“1999-Current”)
12 limit 11 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
13 limit 11 to (meta-analysis or systematic reviews)

Search 6
Date: August 2, 2016

Search Parameters: Published June 30, 2016–August 2, 2016

Total citations:

Systematic Reviews: 32

Primary Literature: 357

Total: 389

Database (search engine): Embase (Ovid)

Note: The Medline search was duplicated in PubMed to ensure that all e-pub and non-indexed / in-process citations were captured.

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

Epub Ahead of Print, In-Process, and Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R), 1946 to Present

Search No. Search Syntax
1 Cannabis/
2 Marijuana Smoking/
3 Marijuana Abuse/
4 Medical Marijuana/
5 Cannabinoids/
6 Dronabinol/
7 (cannabis or marijuana or cannabinoid or dronabinol or marinol). ti,ab.
8 nabilone.ti,ab.
9 or/1–8
10 k2.ti,ab.
11 spice.ti,ab.
12 or/10–11
13 9 not 12
14 Mice/ or mice.ti,ab.
15 Rats/ or rats.ti,ab.
16 or/14–15
17 13 not 16
18 17
19 limit 18 to (English language and humans)
20 limit 19 to (classical article or clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or comparative study or controlled clinical trial or evaluation studies or guideline or journal article or multicenter study or observational study or practice guideline or pragmatic clinical trial or randomized controlled trial or validation studies)
21 limit 19 to (addresses or autobiography or bibliography or biography or case reports or clinical conference or comment or congresses or consensus development conference or consensus development conference, NIH or “corrected and republished article” or dataset or dictionary or directory or duplicate publication or editorial or Dnglish abstract or festschrift or government publications or historical article or in vitro or interactive tutorial or interview or introductory journal article or lectures or legal cases or legislation or letter or meta analysis or news or newspaper article or overall or patient education handout or periodical index or personal narratives or portraits or published erratum or research support, non us gov’t or retracted publication or “retraction of publication” or “review” or “scientific integrity review” or systematic reviews or technical report or video-audio media or webcasts)
22 20 not 21
23 limit 22 to ed=20160630-20160901
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
24 limit 19 to (meta-analysis or “review” or systematic reviews)
25 limit 19 to (addresses or autobiography or bibliography or biography or case reports or clinical conference or comment or congresses or consensus development conference or consensus development conference, NIH or “corrected and republished article” or dataset or dictionary or directory or duplicate publication or editorial or English abstract or festschrift or government publications or historical article or in vitro or interactive tutorial or interview or introductory journal article or lectures or legal cases or legislation or letter or news or newspaper article or overall or patient education handout or periodical index or personal narratives or portraits or published erratum or research support, non us gov’t or retracted publication or “retraction of publication” or “scientific integrity review” or technical report or video-audio media or webcasts)
26 24 not 25
27 limit 26 to ed=20160630-20160901
Embase (Ovid)
Search No. Search Syntax
1 major clinical study/
2 clinical article/
3 case report/
4 clinical trial/
5 controlled clinical trial/
6 phase 1 clinical trial/
7 phase 2 clinical trial/
8 phase 3 clinical trial/
9 phase 4 clinical trial/
10 randomized controlled trial/
11 double blind procedure/
12 single blind procedure/
13 crossover procedure/
14 multicenter study/
15 controlled study/
16 “clinical trial (topic)”/
17 “controlled clinical trial (topic)”/
18 “phase 1 clinical trial (topic)”/
19 “phase 2 clinical trial (topic)”/
20 “phase 3 clinical trial (topic)”/
21 “phase 4 clinical trial (topic)”/
22 “randomized controlled trial (topic)”/
23 “multicenter study (topic)”/
24 cannabis/
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×
Search No. Search Syntax
25 cannabis addiction/ or medical cannabis/ or “cannabis use”/ or cannabis smoking/ or cannabis derivative/
26 cannabinoid/
27 dronabinol/
28 nabilone/
29 (Cannabis or marijuana or cannabinoid or dronabinol or nabilone or marinol).ti,ab.
30 or/24–29
31 k2.ti,ab.
32 spice.ti,ab.
33 or/31–32
34 30 not 33
35 Mice/ or mice.ti,ab.
36 Rats/ or rats.ti,ab.
37 or/35–36
38 34 not 37
39 or/1–23
40 38 and 39
41 limit 40 to (journal and article)
42 limit 40 to (book or book series or chapter or conference abstract or conference paper or conference proceeding or “conference review” or editorial or erratum or letter or note or “review” or short survey or trade journal)
43 41 not 42
44 case report/
45 43 not 44
46 45
47 limit 46 to (human and English language)
48 limit 47 to yr=“2016–Current”
49 limit 48 to dd=20160630-20161231
50 meta analysis/
51 “meta analysis (topic)”/
52 “meta analysis (topic)”/
53 “systematic review (topic)”/
54 or/50–53
55 38 and 54
56 limit 55 to (journal and (article or review))
57 56
58 limit 57 to (human and English language)
59 58
60 limit 59 to yr=“2016–Current”
61 limit 60 to dd=20160630-20161231
Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

REFERENCES

Higgins, J. P. T., D. G. Altman, P. C. Gøtzsche, P. Jüni, D. Moher, A. D. Oxman, J. Savovic, K. F. Schulz, L. Weeks, J. A. Sterne, the Cochrane Bias Methods Group, and the Cochrane Statistical Methods Group. 2011. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi:10.1136/bmj.d5928.

Wells, G. A., B. Shea, D. O’Connell, J. Peterson, V. Welch, M. Losos, P. Tugwell. 2011. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed November 28, 2016).

Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
×

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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Suggested Citation:"Appendix B Study Approach." National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. doi: 10.17226/24625.
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Significant changes have taken place in the policy landscape surrounding cannabis legalization, production, and use. During the past 20 years, 25 states and the District of Columbia have legalized cannabis and/or cannabidiol (a component of cannabis) for medical conditions or retail sales at the state level and 4 states have legalized both the medical and recreational use of cannabis. These landmark changes in policy have impacted cannabis use patterns and perceived levels of risk.

However, despite this changing landscape, evidence regarding the short- and long-term health effects of cannabis use remains elusive. While a myriad of studies have examined cannabis use in all its various forms, often these research conclusions are not appropriately synthesized, translated for, or communicated to policy makers, health care providers, state health officials, or other stakeholders who have been charged with influencing and enacting policies, procedures, and laws related to cannabis use. Unlike other controlled substances such as alcohol or tobacco, no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.

Shifting public sentiment, conflicting and impeded scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives, and this lack of aggregated knowledge has broad public health implications. The Health Effects of Cannabis and Cannabinoids provides a comprehensive review of scientific evidence related to the health effects and potential therapeutic benefits of cannabis. This report provides a research agenda—outlining gaps in current knowledge and opportunities for providing additional insight into these issues—that summarizes and prioritizes pressing research needs.

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