User:AidanMedEditor/sandbox

Cannabis use disorder - Literature Search
Wikipedia Literature Search - Aidan Pucchio (20093878)

Article: Cannabis Use Disorder

Information to add: The effects of cannabis on adolescents

Note, no sources were published as part of a special edition journal or were invited articles (both bad in the context of sourcing for Wikipedia).

PubMed search
Search term: "Adolescent"[Mesh] AND "Marijuana Abuse"[Mesh] AND Review[ptyp]

Lorenzetti, V., Alonso-Lana, S., Youssef, G., Verdejo-Garcia, A., Suo, C., Cousijn, J… Solowij, N. (2016). Adolescent Cannabis Use: What is the Evidence for Functional Brain Alteration? Current Pharmaceutical Design, 22(42), 6353–6365. doi: 10.2174/1381612822666160805155922


 * Reason for selection
 * Moderate impact factor journal (2.412), peer-reviewed
 * Specific to adolescent use and has a well focused question (functional brain alteration)
 * Strong study design: well identified question, reproducible search criteria, identification of limitations
 * Wikipedia criteria
 * Secondary source, review paper (high on evidence quality chart)
 * Conducted within last 5 years
 * No potential conflicts of interest
 * High quality sources
 * Purpose of selection
 * Address the role of cannabis use in adolescents in altering brain function à A high risk population

Hanna, R. C., Perez, J. M., & Ghose, S. (2016). Cannabis and development of dual diagnoses: A literature review. The American Journal of Drug and Alcohol Abuse, 43(4), 442–455. doi: 10.1080/00952990.2016.1213273


 * Reason for selection
 * Moderate impact factor journal (2.16) ), peer-reviewed
 * Explores relationship between age of cannabis use and psychiatric disorders
 * Thorough study design
 * Wikipedia criteria
 * Secondary source, review paper (high on evidence quality chart)
 * Conducted 2 years ago
 * No potential conflicts of interest
 * High quality sources
 * Purpose of selection
 * Explore relationship between age of use and potentially adverse effects à Are youth at a higher risk of damage from cannabis use disorder

Other potential source:

Walther, L., Gantner, A., Heinz, A., & Majiić, T. (2016). Evidence-based Treatment Options in Cannabis Dependency. Deutsches Aerzteblatt Online. doi: 10.3238/arztebl.2016.0653

Google Scholar search
Search term: adolescent cannabis review

Volkow, N. D., Swanson, J. M., & Evans, E. A. (2016). Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry, 73(3), 292–297. doi: 10.1107/s0108270113015370/sk3488sup1.cif


 * Reason for selection
 * VERY high impact factor (15.16) ), peer-reviewed
 * While not exclusive to adolescent populations, it does explore the effects of cannabis on adolescents in a moderate capacity
 * Very comprehensive exploration of cannabis effects
 * Fantastic study design
 * Wikipedia criteria
 * Secondary source, review paper (high on evidence quality chart)
 * Published in the last 5 years
 * No conflicts of interest
 * Huge reference list, high quality sources
 * Purpose of selection
 * Can explore many facets of cannabis use in both adolescents and adults
 * Great source for many parts of the “cannabis use disorder” Wikipedia page

Swift, W., Coffey, C., Carlin, J. B., Degenhardt, L., & Patton, G. C. (2008). Adolescent cannabis users at 24 years: trajectories to regular weekly use and dependence in young adulthood. Addiction, 103(8), 1361–1370. doi: 10.1111/j.1360-0443.2008.02246.x


 * Reason for selection
 * Peer-reviewed
 * Explores detrimental effects of adolescent cannabis use on education and addiction
 * Psychiatric based paper (as is the Wikipedia article)
 * Wikipedia criteria
 * Secondary source, review paper (high on evidence quality chart)
 * Old source, not ideal
 * No conflicts of interest
 * High quality sources
 * Purpose of selection
 * Good insight into youth cannabis addiction

Final article selection

Volkow, N. D., Swanson, J. M., & Evans, E. A. (2016). Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry, 73(3), 292–297. doi: 10.1107/s0108270113015370/sk3488sup1.cif

I plan on using this source because it has the highest impact, has the most comprehensive information, and provides information about other areas of the cannabis use disorder article. I plan on using this article to add information about the effect of cannabis in adolescents, and verifying information in other sections.

Proposed Changes (Assignment 3)
Previously the adolescents section said:

Adolescents
Young people are at greater risk of developing cannabis dependence because of the association between early initiation into substance use and subsequent problems such as dependence, and the risks associated with using cannabis at a developmentally vulnerable age. Plan: To remove this sentence entirely. The source is an Australian government report that is hard/not possible to access. It is specific to one population, may be outdated and is not accessible.

Propose changes:
1) Adolescent cannabis use is associated with increased cannabis misuse as an adult, challenges learning, long-term cognitive complications, and poor psychiatric outcomes including suicidality and addiction.

Levine, A., Clemenza, K., Rynn, M., & Lieberman, J. (2017). Evidence for the Risks and Consequences of Adolescent Cannabis Exposure. Journal of the American Academy of Child & Adolescent Psychiatry, 56(3), 214–225. doi: 10.1016/j.jaac.2016.12.014

2) The endocannabanoid system is directly involved in adolescent neurodevelopment, meaning adolescent cannabis users are particularly vulnerable to the potential adverse effects of cannabis use.

Volkow, N. D., Swanson, J. M., & Evans, E. A. (2016). Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry, 73(3), 292–297. doi: 10.1107/s0108270113015370/sk3488sup1.cif

3) Delete the current paragraph about adolescent cannabis use.

Rationale for proposed changes:
1) I think that adding an overview of the issues that adolescents are at risk of when using/misusing cannabis is important. There are many studies linking cannabis use as a youth to misuse as an adult, poor psychiatric outcomes and challenges learning or succeeding in school. These issues are explored in a lot of cannabis research, and are not anomalies of one or two poorly written papers. The high-quality secondary source referenced above conclude that these are potential complications, so I think they are appropriate for use in a Wikipedia article - if a reader decides to access them they will clearly see these issues identified in the study.

I think there is potential for controversy given this statement. Note I used the word 'association', since there is no definitive link. It doesn't really fit the style requirements (or assignment requirements) to say something along the lines of "A 2017 paper found a link between..." but in an ideal world it would say just that. A big issue in cannabis research, particularly in adolescents, is the challenge of controlling for confounding factors. One of the sources I used says "Imaging studies often are limited by a low number of participants, and behavioral measures of human function vary widely in their precision and concordance. Some studies have even failed to replicate findings of functional deficits in adults who used cannabis as adolescents when controlling for one or more confounders, such as personality traits or childhood trauma. (Levine, Clemenza, Rynn, & Lieberman, 2017)". I think that this is a problem in all research, but one exacerbated by the illegality of cannabis in much of the world and the vulnerability of the population being studied. As such I can see people being upset that we are highlighting associations and presenting them as fact. This is circumvented by selecting high quality studies as reference, studies that explain their shortcomings and the shortcomings with cannabis research at large.

2) I think it is important to add a sentence that explains why adolescents might be at higher risk (rather than just how). I also believe some explanation of potential mechanisms will help to alleviate potential controversy of the first statement. If there is a feasible mechanism it makes the outcomes more believable to a lay audience, especially one that might be very pro-cannabis (as the talk page would suggest). In the context of heavy cannabis use, as we would see in cannabis use disorder, providing some mechanism of damage that would explain why youth are a particularly vulnerable population to experience adverse effects is important.

Critique of source
Much of the cannabis research is deeply flawed. It does not explain what type of cannabis is used, methods of consumption, quantity of use. There are also issues with confounders in almost all papers, as explained above.

Levine, A., Clemenza, K., Rynn, M., & Lieberman, J. (2017). Evidence for the Risks and Consequences of Adolescent Cannabis Exposure. Journal of the American Academy of Child & Adolescent Psychiatry, 56(3), 214–225. doi: 10.1016/j.jaac.2016.12.014


 * 6.391 impact factor is high, meaning there is important and well curated research in this journal
 * Source is 2 years old, which meets the criteria for modern sources
 * Drs. Levine, Rynn, Lieberman, and Ms. Clemenza report no biomedical financial interests or potential conflicts of interest
 * Methods are sound:
 * Search terms are well identified, as are the databases searched
 * Multiple and varied databases are used
 * Exclusion and inclusion criteria are not included in the main text, but are in the supplementary documents
 * As mentioned above, there are issues with confounders identified in this paper such as other drug use, smoking and alcohol, and the literature is not in consensus (some papers reported no adverse affects)
 * Paper explains these issues stating "One of the reasons that the findings are not conclusive is that clinical research specific to children and adolescents is restricted by a number of logical and ethical limitations"
 * The paper is transparent about the quality of the evidence, and suggests that the findings urgently require more investigation as opposed to claiming cannabis is a definitive problem
 * This review article didn't really impact my plans to share this information but rather provided a concise and high quality review that summarized it

Volkow, N. D., Swanson, J. M., & Evans, E. A. (2016). Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry, 73(3), 292–297. doi: 10.1107/s0108270113015370/sk3488sup1.cif

''
 * 15.916 impact factor is very high, meaning there is important and well curated research in this journal
 * Source is 3 years old, which meets the criteria for modern sources
 * Again the paper states "There are areas that require further research" which seems to be common for almost every cannabis review paper
 * "Current efforts to normalize cannabis use are being driven largely by a combination of grassroots activism, pharmacological ingenuity, and private profiteering, with a worrisome disregard for scientific evidence, gaps in our knowledge, or the possibility of unintended consequences."
 * There is no explanation of search terms and methods, which a is a potential serious source of bias
 * It is assumed they are in the supplementary information but I could not find or access them
 * There is funding from a variety of sources, but the paper states "The funding agencies did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript."
 * This is a fantastic paper... While it is not exclusively about adolescents, it does lay out many complications with adolescent cannabis use and potential biological mechanisms
 * The paper is also not specific to cannabis use disorder, but I think that it is relevant as presumably an adolescent with cannabis use disorder uses cannabis frequently ''