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1 Introduction
Pages 25-42

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From page 25...
... reported using cannabis in the past 30 days, and between 2002 and 2015 the percentage of past month cannabis users in this age range has steadily increased (CBHSQ, 2016)
From page 26...
... Current challenges include the existence of certain regulations and policies that restrict access to cannabis products suited for research purposes (e.g., Schedule 1 status; regulatory approvals) , the limited availability of funding for comprehensive cannabis research, and crosscutting methodological challenges.
From page 27...
... In conducting its work, the committee will conduct a comprehensive review of the evidence, using accepted approaches of literature search, evidence review, grading and synthesis. Studies reviewed regarding health risks should be as broad as possible, including but not limited to epidemiology and clinical studies, and toxicology and animal studies when determined appropriate by the committee.
From page 28...
... In 1997 the White House Office of National Drug Control Policy contracted with the IOM to conduct a scientific review of available literature to determine the potential health benefits and risks of marijuana and its constituent cannabinoids. The resulting report, Marijuana and Medicine (IOM, 1999)
From page 29...
... • S  cientific data indicate the potential therapeutic value of cannabinoid drugs, primarily tetrahydrocannabinol (THC) , for pain relief, control of nau sea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances.
From page 30...
... The scientific literature on cannabis use has grown substantially since the publication of Marijuana and Medicine in 1999. The current committee conducted an extensive search of relevant databases, including Medline, Embase, the Cochrane Database of Systematic Reviews, and PsycINFO,
From page 31...
... Where no systematic review existed, the committee reviewed all relevant primary research from January 1, 1999, through August 1, 2016. Primary research was evaluated using global assessments of the quality of available studies guided by standard approaches and methodologies (Cochrane Quality Assessment [Higgins et al., 2011]
From page 32...
... ; asthma Immunity • Immune function; infectious disease Informed by the reports of previous IOM committees,3 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)
From page 33...
... First, the committee was not tasked with conducting multiple systematic reviews, which would have implied a lengthy and robust series of processes. The committee adopted key features of that process; however, a comprehensive literature search; assessments by more than one person of the quality (risk of bias)
From page 34...
... SUBSTANTIAL EVIDENCE For therapeutic effects: There is strong evidence to support the conclusion that cannabis or cannabinoids are an effective or ineffective treatment for the health endpoint of interest. For other health effects: There is strong evidence to support or refute a statisti cal association between cannabis or cannabinoid use and the health endpoint of interest.
From page 35...
... No conclusion can be made because of substantial uncertainty due to chance, bias, and confounding factors. Special Considerations for the Report Biological Plausibility After careful consideration, the committee chose not to attempt to review basic, nonhuman research in order to attempt to bolster evidence for identified health outcomes from cannabis exposure.
From page 36...
... Considerations of Observational Studies The vast majority of the systematic reviews, meta-analyses, and primary literature reviewed in Part III: Other Health Effects consists of observational studies. This is in contrast to the literature base in other fields such as therapeutics (discussed in Part II: Therapeutic Effects)
From page 37...
... Reasons for this may include variations in study methodologies, instrumentation, populations, or research designs. Despite these special considerations regarding the use of systematic reviews, meta-analyses, and primary literature of observational studies, the committee determined that using recent good- or fair-quality systematic reviews was the most appropriate approach to adequately address the committee's broad statement of task and comprehensive, prioritized research questions while maintaining a high standard for quality and rigor.
From page 38...
... provides an overview of cannabis use in the United States and reviews policy related to cannabis legislation. 4 Cannabinoids are a group of active chemical compounds found in cannabis.
From page 39...
... Most of the evidence reviewed in Part III derives from epidemiological research primarily focusing on smoked cannabis. It is of note that several of the prioritized health conditions discussed in Part III are also reviewed in Part II, albeit from the perspective of effects associated with using cannabis for primarily recreational, as opposed to therapeutic, purposes.
From page 40...
... 2016. State medical marijuana laws.
From page 41...
... 2016. ROBIS: A new tool to assess risk of bias in systematic reviews was developed.


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