The use of cannabis for medicinal purposes has increased globally over the past decade since patient access to medicinal cannabis has been legislated across jurisdictions in Europe, the United Kingdom, the United States, Canada, and Australia. Yet, evidence relating to the effect of medical cannabis on the management of symptoms for a suite of conditions is only just emerging. Although there is considerable engagement from many stakeholders to add to the evidence base through randomized controlled trials, many gaps in the literature remain. Data from real-world and patient reported sources can provide opportunities to address this evidence deficit. This real-world data can be captured from a variety of sources such as found in routinely collected health care and health services records that include but are not limited to patient generated data from medical, administrative and claims data, patient reported data from surveys, wearable trackers, patient registries, and social media. In this systematic scoping review, we seek to understand the utility of online user generated text into the use of cannabis as a medicine. In this scoping review, we aimed to systematically search published literature to examine the extent, range, and nature of research that utilises user-generated content to examine to cannabis as a medicine. The objective of this methodological review is to synthesise primary research that uses social media discourse and internet search engine queries to answer the following questions: (i) In what way, is online user-generated text used as a data source in the investigation of cannabis as a medicine? (ii) What are the aims, data sources, methods, and research themes of studies using online user-generated text to discuss the medicinal use of cannabis. We conducted a manual search of primary research studies which used online user-generated text as a data source using the MEDLINE, Embase, Web of Science, and Scopus databases in October 2022. Editorials, letters, commentaries, surveys, protocols, and book chapters were excluded from the review. Forty-two studies were included in this review, twenty-two studies used manually labelled data, four studies used existing meta-data (Google trends/geo-location data), two studies used data that was manually coded using crowdsourcing services, and two used automated coding supplied by a social media analytics company, fifteen used computational methods for annotating data. Our review reflects a growing interest in the use of user-generated content for public health surveillance. It also demonstrates the need for the development of a systematic approach for evaluating the quality of social media studies and highlights the utility of automatic processing and computational methods (machine learning technologies) for large social media datasets. This systematic scoping review has shown that user-generated content as a data source for studying cannabis as a medicine provides another means to understand how cannabis is perceived and used in the community. As such, it provides another potential ‘tool’ with which to engage in pharmacovigilance of, not only cannabis as a medicine, but also other novel therapeutics as they enter the market.
Citation: Hallinan CM, Khademi Habibabadi S, Conway M, Bonomo YA (2023) Social media discourse and internet search queries on cannabis as a medicine: A systematic scoping review. PLoS ONE 18(1): e0269143. https://doi.org/10.1371/journal.pone.0269143
Editor: Quinn Grundy, University of Toronto, CANADA
Received: May 12, 2022; Accepted: December 15, 2022; Published: January 20, 2023
Copyright: © 2023 Hallinan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: This systematic scoping review was supported by the Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), funded by the National Health and Medical Research Council (NHMRC) through the Centre of Research Excellence scheme (NHMRC CRE APP1135054) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Genetic analysis of ancients cannabis indicates the plant cannabis sativa was first cultivated for use as a as a medicinal agent up to 2400 years ago . From the 1800’s, people in the United States (US), widely used cannabis as a medicine by either prescription or as an over the counter therapeutic . Yet by the mid-20th century, cannabis use was prohibited in many parts of the developed world with the passing of legislation in the US, the United Kingdom (UK) and various European countries that proscribed its use [3–6]. Since the 2000s, the use of cannabis for medicinal purposes has been decriminalized in many countries including Israel, Canada, Netherlands, United States, United Kingdom, and Australia [7–9]. More recently, new evidence regarding the clinical effect of medical cannabis on the management of symptoms for some conditions  has triggered public interest in cannabis and cannabis-derived products [11,12], resulting in a global trend towards public acceptance, and subsequent legalisation of cannabis for both medicinal and non-medicinal use.
There is emerging evidence of cannabis efficacy for childhood epilepsy, spasticity, and neuropathic pain in multiple sclerosis, acquired immunodeficiency syndrome (AIDS) wasting syndrome, and cancer chemotherapy-induced nausea and vomiting [13–15]. Although researchers are investigating cannabis for treating cancer, psychiatric disorders , sleep disorders , chronic pain  and inflammatory conditions such as rheumatoid arthritis , there is currently insufficient evidence to support its clinical use. Scientific studies on emerging therapeutics typically exclude vulnerable populations such as pregnant women, young people, the elderly, patients with multimorbidity and polypharmacy, and this limits the availability of evidence for cannabis effectiveness across these population groups .
Cannabis as medicine is associated with a rapidly expanding industry . Patient demand is increasing, as is reflected in an increasing number of approvals for prescriptions over time , with one study showing that 61% of Australian GPs surveyed reported one or more patient enquiries regarding medical cannabis . With this increasing demand, is sophisticated marketing by medicinal cannabis companies that leverages evidence from a small number of studies to promote their products [24,25]. In light of this, concerns regarding patient safety is warranted especially when marketing for some cannabinoid products is associated with inadequate labelling and/or inappropriate dosage recommendations . These concerns are compounded by the downscheduling of over-the-counter cannabis products which do not require a prescription  and the illicit drug market . Given this dynamic interplay between marketing, product innovation, regulation, and consumer demand, innovative methods are required to augment existing established approaches to the surveillance and monitoring of emerging and unapproved drugs.
Although there is considerable engagement from many stakeholders to improve the scientific evidence regarding the efficacy and safety of cannabis through randomised controlled trials, many gaps remain in the literature . Yet data from real-world and patient reported data sources could provide opportunities to address this evidence deficit . This real-world data can be captured from a variety of sources such as found in routinely collected health care and health services records that include but are not limited to patient generated data from medical, administrative and claims data, as well as patient reported data from surveys, wearable trackers, patient registries, and social media [31–33].
People readily consult the internet when looking for and sharing health information [34,35]. According to 2017 survey of Health Information National Trends, almost 78% of US adults used online searches first to inquire about health or medical information . Data resulting from these online activities is labelled ‘user generated’ and is increasingly becoming a component of surveillance systems in the health data domain . Monitoring user-generated data on the web can be a timely and inexpensive way to generated population-level insights . The collective experiences and opinions shared online are an easily accessible wide-ranging data source for tracking emerging trends–which might be unavailable or less noticeable by other surveillance systems.
The objective of this systematic scoping review is to understand the utility of online user generated text in providing insight into the use of cannabis as a medicine. In this review, we aim to systematically search published literature to examine the extent, range, and nature of research that utilises user-generated content to examine cannabis as a medicine [38–40]. The objective of this review is to synthesise primary research that uses social media discourse and internet search engine queries to answer the following questions:
- In what way, is online user-generated text used as a data source in the investigation of cannabis as a medicine?
- What are the aims, data sources, methods, and research themes of studies using online user-generated text to discuss the medicinal use of cannabis?
Materials and methods
For this review, we used an established methodological framework for scoping reviews to inform our methodology and we reported the review in accordance with the PRISMA reporting guidelines [38–41]. Literature database queries were developed for four categories of studies. The first three categories used social media text as a data source, the fourth relied on internet search engine query data. For the first category, the database queries combined words used to describe social media forums, and cannabis-related keywords and general medical-related keywords (Table 1 Category 1). The second category also included the social media and cannabis-related keywords, but used keywords specific to psychiatric disorders, for which the use of medical cannabis has been described. Our search terms for this second category were informed by a systematic review of medicinal cannabis for psychiatric disorders  (Table 1 Category 2). The third category included social media and cannabis related keywords but focused on non-psychiatric medical conditions for which cannabis is sometimes used (Table 1 Category 3). The fourth category included studies using Internet search engine queries as a data source, there were no medical conditions included in these searches (Table 1 Category 4). A manual search of MEDLINE: Web of Science (1900–2022), Embase: OVID (1974–2022), Web of Science: Core Collection (1900–2022), and Scopus (1996–2022) databases was conducted by SKH and CMH in May 2021 and again in October 2022. The search was limited to English-language studies that were published between January 1974 and April 2022 (S1 Appendix).
The inclusion criteria for this review were: (i) peer reviewed research studies, (ii) peer reviewed conference papers (iii) studies which used online user-generated text as a data source, and (iv) social media research that was either directly focused on cannabis and cannabis products that have an impact on health, or were health-related studies that found medicinal use of cannabis.
Exclusion criteria comprised: (i) editorials, letters, commentaries, surveys, protocols and book chapters; (ii) studies that used social media for recruiting participants; (iii) studies where the full text of the publication was not available; (iv) conference abstracts (iv) studies primarily focused on electronic nicotine delivery systems adapted to deliver cannabinoids; (v) studies that used bots or autonomous systems as the main data source and (vi) studies that focused exclusively on synthetic cannabis.
All studies captured by the search queries listed in Table 1 were uploaded into excel to enable all duplicates to be removed. Following this all titles and abstracts were reviewed independently and in duplicate by CMH and SKH. Records were excluded based on title and abstract screening as well as publication type.
The full text articles that were identified for inclusion following screening process were then independently critiqued by pairs of reviewers using a checklist developed for this study. The purpose of the checklist that we developed for this systematic scoping review was to provide an overall assessment of quality rather than generate a specific score, (S2 Appendix). Assessments of quality in each study were based on evidence of relative quality in the aims or objectives, main findings, data collection method, analytic methods, data source, and evaluation and interpretations of the study. CMH and SKH critiqued all articles, and YB and MC each critiqued a selection of studies to ensure each article had been independently reviewed by two researchers. Where initial disagreement existed between reviewers regarding the inclusion of a study, team members met to discuss the disputed article’s status until consensus was achieved.
Assessments of quality in each study were based on evaluating each study’s aims and objectives, main findings, data collection and analytic methods, data sources, and evaluation and interpretations of the results. Social media studies were included if there were no major biases affecting the internal, external or construct validity of the study . In doing so, the internal validity of each study was determined by the quality of the data and analytic processes used, the external validity determined by the extent to which the findings can be generalised to other contexts, and the construct validity was ascertained by the extent to which the chosen measurement tool correctly measured what the study aimed to measure (S3 Appendix).
Of the 1556 titles identified in the electronic database searches, 859 duplicate articles were removed, 450 were excluded following the screening of title and abstracts and 195 were excluded based on publication type (i.e., survey, letter, comment, abstract). This screening process provided fifty-two potentially relevant full text primary research studies to be included in the review (Fig 1). Of these, five articles were not able to be retrieved, two out of forty-seven articles had initial disagreement. Upon consensus, five were excluded with reasons (S3 Appendix) using the quality assessment checklist as described above. This provided forty-two papers for inclusion in this systematic scoping review published between 2014 and 2022. Regarding publication type, the majority were journal articles 40/42 (95.2%), and two were conference-based publications 2/42 (4.8%). Although the first study was published eight years ago, nearly two-thirds 24/42 (57%), have been published over the last four years. Table 2 provides a summary of each paper that includes author names, publication year, data source, duration of the study, number of collected posts, number of analysed posts, and the coding or labelling approach used.
Data collection and annotation
The largest manually annotated dataset that contained 47,000 labelled tweets was published by Thompson et al. in 2015 . This paper was one of 22 studies included in this review (52.4%) that either collected a limited number of data points, or sampled their collected data, and manually coded the data to gain an in-depth understanding of the domain [44–65]. Four of the 42 studies (9.5%) used existing meta-data including Google trends summary data [66–68], and geo-location data . Two (4.8%) studies used data that was manually coded using crowdsourcing services [45,49], and two (4.8%) used automated coding supplied by a social media analytics company [70,71]. Fifteen of the forty-two studies (35.7%) used automated methods for labelling data, which included the use of machine learning, lexicon, and rule-based algorithms [60,72–85]. Automated coding was increasingly used as an analytic tool for social media data on this topic from 2017 onward (Table 2).
For the studies that were manually labelled, analysis included the calculation of proportions and trends, and the development of repeating and emergent themes. [43,44,46,47,49,50,54–56,60,61,64,65,82,86–94]. Leas, Nobles et al. 2019, Shi, Brant et al. 2019, and Saposnik and Huber 2020, reported on Google trends data that delivered an index of Google search trends over time [66–68]. Daniulaityte, Nahass et al. 2015, processed Twitter data that contained existing geographical fields to identify geolocation at source . The studies that utilised a large volume of data used advanced computational methods, which included sentiment analysis, topic modelling, and rule-based text mining [60,72,77–82,85]. The use of sentiment analysis in the [60,80,95] enabled the analysis of people’s sentiments, opinions, and attitudes. Topic modelling in the [74,76,79,80,85] studies enabled the development of themes via automatic machine learning methods. The use of rule-based text mining such as found in the [60,72,83,96,97] studies enabled the classification of posts into pre-existing health-related categories.
In this review, we categorized the forty-two research articles into six broad themes. Themes were based on the research questions motivating the studies, where each paper was classified as belonging a primary theme, based on alignment with the research aims (Table 3).
General cannabis-related conversations.
Nine studies were included in the theme relating to cannabis-related conversations (Table 4). The main keywords used in these studies included general terms such as ‘cannabis’, ‘marijuana’, ‘pot’, and ‘weed’. The major aim of these studies was to either identify topics of conversations regarding cannabis, or to examine the role of normative and valence information in the perception of medicinal cannabis. These studies are included because they reported on conversations around cannabis use for medical purposes, the valence associated with perceptions of health benefits of cannabis, and reports of adverse effects. For example, a study on veterans use of cannabis found that cannabis is used to self-medicate a number of health issues, including Post-Traumatic Stress Disorder (PTSD), anxiety and sleep disorder . Seven of the studies used Twitter as a data source [43,73,78,87,96,98,99], one examined the content of YouTube videos about cannabis , one investigated online self-help forums  and another used Reddit data .
Cannabis mode of use.
Seven studies were included in the theme relating to the mode of use of cannabis as a medicine (Table 5). These studies collected data using keywords such as ‘vape,’ ‘vaping’, ‘dabbing’, and ‘edibles’. Conversations around modes of use revealed a theme about lacking, seeking, or sharing knowledge about health consequences of the modes of use. Another theme was around the perceived health benefits of cannabis and the various modes of use of cannabinoids that included sleep improvement and relaxation resulting from dabbing oils  or consuming ‘edibles’ . The findings suggest that for emerging modes of use such as dabbing, where the availability of evidence-based information is limited, people seek information from others’ experiences.
Cannabis as a medicine for a specific health issue.
Six studies were included in the theme relating to cannabis as a medicine for a specific health issue (Table 6). These studies investigated conversations around the use of cannabis or cannabidiol (CBD) for a specific health issue. The health conditions included glaucoma , PTSD , cancer [65,101], Attention Deficit Hyperactivity Disorder (ADHD) , and pregnancy . These studies mostly discovered that conversations claimed benefits of cannabis as an alternative treatment for these health conditions, although mentions of harm, and both harm and therapeutic effects, were also present .
Cannabis as a medicine as part of discourse on illness and disease.
Twelve studies were included in the theme relating to cannabis as a medicine as part of discourse on illness and disease (Table 7). In this theme, the research focus was on social media topics relating to management and treatment options for a range of health conditions rather than on medicinal cannabis per se. Health conditions discussed included inflammatory and irritable bowel disease , opioid use disorder [70,103,104], pain , ophthalmic disease , cluster headache and migraine , asthma , cancer [93,106], autism disorder , and brachial plexus injury .
There were seven studies in the cannabidiol category [61,80,82,89,90,108,109] (Table 8). These studies concentrated on conversations related to the benefits of CBD products, product sentiment (positive, negative, or neutral), the factors that impact on a person’s decision to use CBD products, and the trends in therapeutic use of CBD.
Adverse drug reactions and adverse effects.
One paper had a research question that explicitly focused on the detection of adverse events  (Table 9) This study explored the prevalence of internet search engine queries relating to the topic of adverse reactions and cannabis use. Seven other studies contained mentions of adverse effects which were associated with cannabis use [47,49,51,53,55,62,77,81], however these papers were not included under this theme, as their research questions were not centered around the explicit investigation of adverse events.
Currently, there exist systematic reviews of cannabis and cannabinoids for medical use based on clinical efficacy outcomes from randomised controlled trials  and reviews on the use of social media for illicit drug surveillance . However, following searches on PROSPERO and the databases listed above, to our knowledge, this paper constitutes the first systematic scoping review examining studies that used user-generated online text to understand the use of cannabis as a medicine in the global community.
Our scoping review found that the use of social media and internet search queries to investigate cannabis as a medicine is a rapidly emerging area of research. Over half of the studies included in this review were published within the last four years (24, 57.1%), this reflects not only increase community interest in the therapeutic potential of cannabinoids, but also world-wide trends towards cannabis legalisation [4,7–9,111,112]. Regarding social media platforms, Twitter was the data source in eighteen (42.9%) of the forty-two studies, almost three and a half times the number of studies using Reddit (6, 14.3%) and just under three times the number of studies using data from Online forums (5, 11.9%). Three (7.14%) GoFundMe studies and three (7.14%) Google Trends studies were also included in the review. Hence, much of the data in this systematic review comprised posts from the Twitter platform. Several factors may explain this finding, firstly Twitter is real-time in nature, it has a high volume of messages, and it is publicly accessible. These factors makes it a useful data source for public health surveillance .
Regarding the subjects of the studies, twelve (28.6%) focused on general user-generated content regarding the treatment of health conditions (glaucoma, autism, asthma, cancer, bowel disease, brachial plexus injury, cluster headaches, opioid disorder). These studies were either explicitly designed to investigate cannabis as a medicine or were studies that generated results that incidentally found cannabis mentioned as an alternative or complementary treatment (either formally prescribed or via self-medication).
Qualitative studies featured in the research, but while their contributions are valuable, especially in the context of hypothesis generation, they tend to be limited by their smaller datasets, which frequently comprise manually annotated samples. The recent emergence of powerful machine learning-based natural language processing (NLP) models suggests that it should be possible to automate the continuous processing of far larger datasets using NLP technologies, built upon the insights gained from initial qualitative studies, and even leveraging their annotated data for training purposes. Recent trends in the social science data landscape have shown a convergence between social science and computer science expertise, where the ability to use computational methods has greatly assisted the collection and validation of robust datasets that can form the basis of deeper social science research .
We found much heterogeneity in approaches applied to analyse user-related content, and inconsistent quality in the methodologies adopted. While we endeavored to include as many studies as possible, some of the publications initially identified as suitable for inclusion were not suitable based on a minimum quality requirements checklist (S1 Appendix). This checklist was designed to ensure that selection of data source, choice of platform, data acquisition and preparation, analysis and evaluation delivers data and conclusions that are appropriate for answering the research questions.
The utilisation of user-generated content for health research is subject to several inherent limitations which include; the lack of control that researchers have in relation to the credibility of information, the frequently unknown demographic characteristics and geographical location of individuals generating content, and the fact that social media users are not necessarily representative of the wider community . Furthermore, the uniqueness, volume, and salience of social media data has implications that need to be considered when used for health information analysis . Volume is usually inversely related to salience; a platform such as Twitter has a very high volume of information, much of which is not highly pertinent for the analysis of an effect, whereas the information contained in a blog will contain less volume, but will be more salient for analysis. Notwithstanding these limitations, user-generated content comprises large-scale data that provides access to the unprompted organic opinions and attitudes of cannabis users in their own words and is an effective medium through which to gauge public sentiment. To date, insights regarding cannabis as medicine have gained primarily through surveys or focus groups which have their own limitations regarding the format of data collection and potential bias in participant recruitment. A limitation of this scoping review was the lack of inclusion of a computational database such as IEEE Xplore in the search strategy, and the exclusion of the search terms ‘infodemiology’ and ‘infoveillance.’ Infodemiology and infoveillance studies explicitly use web-based data for research, and IEEE Xplore is a repository that contains technical papers and documents relating to computer science. However, our search was systematic, comprehensive and IEEE Xplore is Scopus-indexed, and we expect data loss to be minimal.
Our systematic scoping review reflects a growing interest in the use of user-generated content for public health surveillance. It also demonstrates there is a need for the development of a systematic approach for evaluating the quality of social media studies and highlights the utility of automatic processing and computational methods (machine learning technologies) for large social media datasets. This systematic scoping review has shown that user-generated content as a data source for studying cannabis as a medicine provides another means to understand how cannabis is perceived and used in the community. As such, it is another potential ‘tool’ with which to engage in pharmacovigilance of, not only cannabis as a medicine, but also other novel therapeutics as they enter the market.
S1 Appendix. Search strategies for each database.
- 1. Russo EB. History of cannabis and its preparations in saga, science, and sobriquet. Chemistry and Biodiversity. 2007;4(8):1614–48. pmid:17712811
- 2. Bridgeman MB, Abazia DT. Medicinal cannabis: history, pharmacology, and implications for the acute care setting. Pharmacy and therapeutics. 2017;42(3):180. pmid:28250701
- 3. Grinspoon L, Bakalar JB. Marihuana: the forbidden medicine. New Haven, USA: Yale University Press; 1993.
- 4. Kalant H. Medicinal use of cannabis: history and current status. Pain Research and Management. 2001;6(2):80–91. pmid:11854770
- 5. Taylor S. Medicalizing cannabis—Science, medicine and policy, 1950–2004: An overview of a work in progress. Drugs: Education, Prevention and Policy. 2008;15(5):462–74.
- 6. Musto DF. The marihuana tax act of 1937. Archives of General Psychiatry. 1972;26(2):101–8. pmid:4551255
- 7. EMCDDA. Cannabis policy: status and recent developments Lisbon, Portugal: The European Monitoring Centre for Drugs and Drug Addiction; 2021 [cited 2021 August]. Available from: https://www.emcdda.europa.eu/publications/topic-overviews/cannabis-policy/html_en.
- 8. Shover CL, Humphreys K. Six policy lessons relevant to cannabis legalization. Am J Drug Alcohol Abuse. 2019;45(6):698–706. Epub 2019/03/15. pmid:30870053; PubMed Central PMCID: PMC6745015.
- 9. CPFG. Home Office Circular 1 November 2018: Rescheduling of cannabis-based products for medicinal use in humans. In: Unit CDaA, editor. London, United Kingdom: Crime, Policing, and Fire Group (CPFG); 2018.
- 10. National Academies of S, Medicine E. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. 2017.
- 11. Hall W. Medical use of cannabis and cannabinoids: questions and answers for policymaking. 2018.
- 12. Aguilar S, Gutiérrez V, Sánchez L, Nougier M. Medicinal cannabis policies and practices around the world. International Drug Policy Consortium. 2018;(April):32.
- 13. TGA. Access to medicinal cannabis products Canberra, Australia: Therapeutic Goods Administration2021. Available from: Retrieved September, 2021, from https://www.tga.gov.au/access-medicinal-cannabis-products-1.
- 14. National Academies of Sciences EaM. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. 2017.
- 15. Pearlson G. Medical marijuana and clinical trials. Weed Science: Cannabis Controversies and Challenges Academic Press; 2020. p. 243–60.
- 16. Sarris J, Sinclair J, Karamacoska D, Davidson M, Firth J. Medicinal cannabis for psychiatric disorders: A clinically-focused systematic review. BMC Psychiatry. 2020;20(1):1–14. pmid:31948424
- 17. Suraev AS, Marshall NS, Vandrey R, McCartney D, Benson MJ, McGregor IS, et al. Cannabinoid therapies in the management of sleep disorders: A systematic review of preclinical and clinical studies. Sleep Medicine Reviews. 2020;53:101339–. pmid:32603954
- 18. Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA—Journal of the American Medical Association. 2015;313(24):2456–73. pmid:26103030
- 19. Schulze-Schiappacasse C, Durán J, Bravo-Jeria R, Verdugo-Paiva F, Morel M, Rada G. Are Cannabis, Cannabis-Derived Products, and Synthetic Cannabinoids a Therapeutic Tool for Rheumatoid Arthritis? A Friendly Summary of the Body of Evidence. JCR: Journal of Clinical Rheumatology. 2021;Publish Ah(00):1–5. pmid:33859125
- 20. Bonomo Y, Souza JDS, Jackson A, Crippa JAS, Solowij N. Clinical issues in cannabis use. British Journal of Clinical Pharmacology. 2018;84(11):2495–8. pmid:29968386
- 21. Owens B. The professionalization of cannabis growing. Nature. 2019;572(7771). pmid:31462785
- 22. Hallinan CM, Bonomo YA. ’The Rise and Rise of Medicinal Cannabis, What Now? Medicinal Cannabis Prescribing in Australia 2017–2022’. International Journal of Environmental Research and Public Health. 2022;ijerph–1806974. pmid:36011488
- 23. Karanges EA, Suraev A, Elias N, Manocha R, McGregor IS. Knowledge and attitudes of Australian general practitioners towards medicinal cannabis: a cross-sectional survey. British Medical Journal Open. 2018;8(7):e022101. Epub 2018/07/05. pmid:29970456; PubMed Central PMCID: PMC6042562.
- 24. Caputi TL. The medical marijuana industry and the use of “research as marketing”. American Journal of Public Health. 2020;110(2):174–5. pmid:31913671
- 25. Ayers JW, Caputi TL, Leas EC. The need for federal regulation of marijuana marketing. Jama. 2019;321(22):2163–4. pmid:31095243
- 26. Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling accuracy of cannabidiol extracts sold online. JAMA—Journal of the American Medical Association. 2017;318(17):1708–9. pmid:29114823
- 27. Hallinan CM, Eden E, Graham M, Greenwood LM, Mills J, Popat A, et al. Over the counter low-dose cannabidiol: A viewpoint from the ACRE Capacity Building Group. Journal of Psychopharmacology. 2021. pmid:34344208
- 28. Fitzcharles MA, Shir Y, Häuser W. Medical cannabis: Strengthening evidence in the face of hype and public pressure. Cmaj. 2019;191(33):E907–E8. pmid:31427354
- 29. Freeman TP, Hindocha C, Green SF, Bloomfield MAP. Medicinal use of cannabis based products and cannabinoids. BMJ (Online). 2019;365(April):1–7. pmid:30948383
- 30. Graham M, Martin JH, Lucas CJ, Hall W. Translational hurdles with cannabis medicines. 2020;(December 2019):1325–30. pmid:32281186
- 31. US Food and Drug Administration. Framework for FDA’s real world evidence program. 2018.
- 32. Nabhan C, Klink A, Prasad V. Real-world Evidence—What Does It Really Mean? JAMA Oncology. 2019;5(6):2019–21. pmid:31095259
- 33. Hallinan CM, Gunn JM, Bonomo YA. Implementation of medicinal cannabis in Australia: Innovation or upheaval? Perspectives from physicians as key informants, a qualitative analysis. BMJ Open. 2021;11(10):1–12. pmid:34686558
- 34. Finney Rutten LJ, Blake KD, Greenberg-Worisek AJ, Allen SV, Moser RP, Hesse BW. Online Health Information Seeking Among US Adults: Measuring Progress Toward a Healthy People 2020 Objective. Public Health Reports. 2019;134(6):617–25. pmid:31513756
- 35. Gualtieri LN. The doctor as the second opinion and the internet as the first. 2009. p. 2489–98.
- 36. Shakeri Hossein Abad Z, Kline A, Sultana M, Noaeen M, Nurmambetova E, Lucini F, et al. Digital public health surveillance: a systematic scoping review. npj Digital Medicine. 2021;4(1):41. pmid:33658681
- 37. Paul MJ, Sarker A, Brownstein JS, Nikfarjam A, Scotch M, Smith KL, et al. Social Media Mining for Public Health Monitoring and Surveillance. Pacific Symposium on Biocomputing. 2016;21(January):468–79.
- 38. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1):19–32.
- 39. Pawliuk C., Chau B., Rassekh S.R., McKellar T., H. S. Efficacy and safety of paediatric medicinal cannabis use: A scoping review. Paediatrics & Child Health. 2021;26:228–33. pmid:34131459
- 40. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology. 2018;18(1). pmid:30453902
- 41. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLOS Medicine. 2021;18. pmid:33780438
- 42. Olteanu A, Castillo C, Diaz F, Kıcıman E. Social Data: Biases, Methodological Pitfalls, and Ethical Boundaries. Frontiers in Big Data. 2019;2. pmid:33693336
- 43. Thompson L, Rivara FP, Whitehill JM. Prevalence of Marijuana-Related Traffic on Twitter, 2012–2013: A Content Analysis. Cyberpsychology, Behavior, and Social Networking. 2015;18(6):311–9. pmid:26075917
- 44. McGregor F, Somner JEA, Bourne RR, Munn-Giddings C, Shah P, Cross V. Social media use by patients with glaucoma: what can we learn? Ophthalmic and Physiological Optics. 2014;34(1):46–52. pmid:24325434
- 45. Cavazos-Rehg PA, Krauss M, Fisher SL, Salyer P, Grucza RA, Bierut LJ. Twitter chatter about marijuana. Journal of Adolescent Health. 2015;56:139–45. pmid:25620299.
- 46. Gonzalez-Estrada A, Cuervo-Pardo L, Ghosh B, Smith M, Pazheri F, Zell K, et al. Popular on YouTube: A critical appraisal of the educational quality of information regarding asthma. Allergy and Asthma Proceedings. 2015;36:e121–e6. pmid:26534743.
- 47. Krauss MJ, Sowles SJ, Mylvaganam S, Zewdie K, Bierut LJ, Cavazos-Rehg PA. Displays of dabbing marijuana extracts on YouTube. Drug Alcohol Depend. 2015;155:45–51. pmid:26347408
- 48. Thompson L, Rivara FP, Whitehill JM. Prevalence of Marijuana-Related Traffic on Twitter, 2012–2013: A Content Analysis. Cyberpsychology, Behavior, and Social Networking. 2015;18:311–9. pmid:26075917.
- 49. Cavazos-Rehg PA, Sowles SJ, Krauss MJ, Agbonavbare V, Grucza R, Bierut L. A content analysis of tweets about high-potency marijuana. Drug Alcohol Depend. 2016;166:100–8. pmid:27402550.
- 50. Lamy FR, Daniulaityte R, Sheth A, Nahhas RW, Martins SS, Boyer EW, et al. "Those edibles hit hard": Exploration of Twitter data on cannabis edibles in the U.S. Drug Alcohol Depend. 2016;164:64–70. pmid:27185160.
- 51. Mitchell JT, Sweitzer MM, Tunno AM, Kollins SH, Joseph McClernon F. "I use weed for my ADHD": A qualitative analysis of online forum discussions on cannabis use and ADHD. PloS one. 2016;11:1–13. pmid:27227537.
- 52. Andersson M, Persson M, Kjellgren A. Psychoactive substances as a last resort-a qualitative study of self-treatment of migraine and cluster headaches. Harm Reduction Journal. 2017;14:1–10. pmid:28870224.
- 53. Greiner C, Chatton A, Khazaal Y. Online self-help forums on cannabis: A content assessment. Patient Education and Counseling. 2017;100:1943–50. pmid:28602568.
- 54. Cavazos-Rehg PA, Krauss MJ, Sowles SJ, Murphy GM, Bierut LJ. Exposure to and Content of Marijuana Product Reviews. Prevention Science. 2018;19:127–37. pmid:28681195.
- 55. Meacham MC, Roh S, Chang JS, Ramo DE. Frequently asked questions about dabbing concentrates in online cannabis community discussion forums. International Journal of Drug Policy. 2019;74:11–7. pmid:31400582.
- 56. Jia J, Mehran N, Purgert R, Zhang Q, Lee D, Myers JS, et al. Marijuana and Glaucoma: A Social Media Content Analysis. Ophthalmology Glaucoma. 2020. pmid:33242684
- 57. Leas EC, Hendrickson EM, Nobles AL, Todd R, Smith DM, Dredze M, et al. Self-reported Cannabidiol (CBD) Use for Conditions With Proven Therapies. JAMA network open. 2020;3:e2020977. pmid:33057645.
- 58. Merten JW, Gordon BT, King JL, Pappas C. Cannabidiol (CBD): Perspectives from Pinterest. Substance Use & Misuse. 2020;55(13):2213–20. pmid:32715862
- 59. Song S, Cohen AJ, Lui H, Mmonu NA, Brody H, Patino G, et al. Use of GoFundMe® to crowdfund complementary and alternative medicine treatments for cancer. Journal of Cancer Research and Clinical Oncology. 2020;146:1857–65. pmid:32219517.
- 60. Meacham MC, Nobles AL, Tompkins DA, Thrul J. "I got a bunch of weed to help me through the withdrawals": Naturalistic cannabis use reported in online opioid and opioid recovery community discussion forums. PloS one. 2022;17(2):1–16. pmid:35134074
- 61. Zenone M, Snyder J, Crooks VA. What are the informational pathways that shape people’s use of cannabidiol for medical purposes? Journal of Cannabis Research. 2021;3(1). pmid:33957993
- 62. Pang RD, Dormanesh A, Hoang Y, Chu M, Allem J-P. Twitter Posts About Cannabis Use During Pregnancy and Postpartum:A Content Analysis. Substance Use & Misuse. 2021;56(7):1074–7. pmid:33821757
- 63. Rhidenour KB, Blackburn K, Barrett AK, Taylor S. Mediating Medical Marijuana: Exploring How Veterans Discuss Their Stigmatized Substance Use on Reddit. Health Communication. 2021:1–11. pmid:33602000
- 64. Smolev ET, Rolf L, Zhu E, Buday SK, Brody M, Brogan DM, et al. “Pill Pushers and CBD Oil”—A Thematic Analysis of Social Media Interactions About Pain After Traumatic Brachial Plexus Injury. Journal of Hand Surgery Global Online. 2021;3(1):36–40. pmid:33537664
- 65. Zenone M, Snyder J, Caulfield T. Crowdfunding cannabidiol (CBD) for cancer: Hype and misinformation on gofundme. American Journal of Public Health. 2020;110:S294–S9. pmid:33001729.
- 66. Leas EC, Nobles AL, Caputi TL, Dredze M, Smith DM, Ayers JW. Trends in Internet Searches for Cannabidiol (CBD) in the United States. JAMA network open. 2019;2:e1913853. pmid:31642924.
- 67. Shi S, Brant AR, Sabolch A, Pollom E. False News of a Cannabis Cancer Cure. Cureus. 2019;11(1):e3918–e. pmid:30931189.
- 68. Saposnik FE, Huber JF. Trends in web searches about the causes and treatments of autism over the past 15 years: Exploratory infodemiology study. JMIR Pediatrics and Parenting. 2020;3. pmid:33284128.
- 69. Daniulaityte R, Nahhas RW, Wijeratne S, Carlson RG, Lamy FR, Martins SS, et al. "Time for dabs": Analyzing Twitter data on marijuana concentrates across the U.S. Drug Alcohol Depend. 2015;155:307–11. pmid:26338481.
- 70. Nasralah T, El-gayar OF, Wang Y. What Social Media Can Tell Us About Opioid Addicts: Twitter Data Case Analysis. 2019.
- 71. Mullins CF, Ffrench-O’Carroll R, Lane J, O’Connor T. Sharing the pain: An observational analysis of Twitter and pain in Ireland. Regional Anesthesia and Pain Medicine. 2020;45(8):597–602. pmid:32503862
- 72. Dai H, Hao J. Mining social media data on marijuana use for Post Traumatic Stress Disorder. Computers in Human Behavior. 2017;70:282–90. S0747563216308949.
- 73. Turner J, Kantardzic M. Geo-social analytics based on spatio-temporal dynamics of marijuana-related tweets. ACM International Conference Proceeding Series. 2017;Part F1282:28–38.
- 74. Westmaas JL, McDonald BR, Portier KM. Topic modeling of smoking- and cessation-related posts to the American Cancer Society’s Cancer Survivor Network (CSN): Implications for cessation treatment for cancer survivors who smoke. Nicotine and Tobacco Research. 2017;19:952–9. pmid:28340059.
- 75. Yom-Tov E, Lev-Ran S. Adverse Reactions Associated With Cannabis Consumption as Evident From Search Engine Queries. JMIR Public Health and Surveillance. 2017;3:e77. pmid:29074469
- 76. Glowacki EM, Glowacki JB, Wilcox GB. A text-mining analysis of the public’s reactions to the opioid crisis. Substance Abuse. 2018;39:129–33. pmid:28723265.
- 77. Meacham MC, Paul MJ, Ramo DE. Understanding emerging forms of cannabis use through an online cannabis community: An analysis of relative post volume and subjective highness ratings. Drug Alcohol Depend. 2018;188:364–9. pmid:29883950.
- 78. Allem J-P, Escobedo P, Dharmapuri L. Cannabis Surveillance With Twitter Data: Emerging Topics and Social Bots. American Journal of Public Health. 2020;110(3):357–62. pmid:31855475. Language: English. Entry Date: 20200208. Revision Date: 20200303. Publication Type: Article.
- 79. van Draanen J, Tao H, Gupta S, Liu S. Geographic Differences in Cannabis Conversations on Twitter: Infodemiology Study. JMIR Public Health and Surveillance. 2020;6:e18540. pmid:33016888
- 80. Soleymanpour M, Saderholm S, Kavuluru R. Therapeutic Claims in Cannabidiol (CBD) Marketing Messages on Twitter. 2021 IEEE International Conference on Bioinformatics and Biomedicine (BIBM), Bioinformatics and Biomedicine (BIBM), 2021 IEEE International Conference on: IEEE; 2021. p. 3083–8.
- 81. Allem J-P, Majmundar A, Dormanesh A, Donaldson SI. Identifying Health-Related Discussions of Cannabis Use on Twitter by Using a Medical Dictionary: Content Analysis of Tweets. JMIR formative research. Canada: JMIR Publications; 2022. p. e35027.
- 82. Turner J, Kantardzic M, Vickers-Smith R. Infodemiological Examination of Personal and Commercial Tweets About Cannabidiol: Term and Sentiment Analysis. Journal of Medical Internet Research. 2022;23(12):e27307. pmid:34932014
- 83. Pérez-Pérez M, Pérez-Rodríguez G, Fdez-Riverola F, Lourenço A. Using twitter to understand the human bowel disease community: Exploratory analysis of key topics. Journal of Medical Internet Research. 2019;21. pmid:31411142.
- 84. Tran T, Kavuluru R. Social media surveillance for perceived therapeutic effects of cannabidiol (CBD) products. International Journal of Drug Policy. 2020;77:102688. pmid:32092666.
- 85. Janmohamed K, Soale AN, Forastiere L, Tang W, Sha Y, Demant J, et al. Intersection of the Web-Based Vaping Narrative with COVID-19: Topic Modeling Study. Journal of Medical Internet Research. 2020;22. pmid:33001829.
- 86. Andersson M, Persson M, Kjellgren A. Psychoactive substances as a last resort-a qualitative study of self-treatment of migraine and cluster headaches. Harm Reduction Journal. 2017;14(1):1–10. pmid:28870224
- 87. Cavazos-Rehg PA, Krauss M, Fisher SL, Salyer P, Grucza RA, Bierut LJ. Twitter chatter about marijuana. Journal of Adolescent Health. 2015;56(2):139–45. pmid:25620299
- 88. Greiner C, Chatton A, Khazaal Y. Online self-help forums on cannabis: A content assessment. Patient Education and Counseling. 2017;100(10):1943–50. pmid:28602568
- 89. Leas EC, Hendrickson EM, Nobles AL, Todd R, Smith DM, Dredze M, et al. Self-reported Cannabidiol (CBD) Use for Conditions With Proven Therapies. JAMA network open. 2020;3(10):e2020977–e. pmid:33057645
- 90. Merten JW, Gordon BT, King JL, Pappas C. Cannabidiol (CBD): Perspectives from Pinterest. Substance Use and Misuse. 2020;55(13):2213–20. pmid:32715862
- 91. Mitchell JT, Sweitzer MM, Tunno AM, Kollins SH, Joseph McClernon F. "I use weed for my ADHD": A qualitative analysis of online forum discussions on cannabis use and ADHD. PLoS ONE. 2016;11(5):1–13. pmid:27227537
- 92. Pang RD, Dormanesh A, Hoang Y, Chu M, Allem JP. Twitter Posts About Cannabis Use During Pregnancy and Postpartum:A Content Analysis. Substance Use and Misuse. 2021;0(0):1–4. pmid:33821757
- 93. Song S, Cohen AJ, Lui H, Mmonu NA, Brody H, Patino G, et al. Use of GoFundMe® to crowdfund complementary and alternative medicine treatments for cancer. Journal of Cancer Research and Clinical Oncology. 2020;146(7):1857–65. pmid:32219517
- 94. Rhidenour KB, Blackburn K, Barrett AK, Taylor S. Mediating Medical Marijuana: Exploring How Veterans Discuss Their Stigmatized Substance Use on Reddit. Health Communication. 2021;00(00):1–11. pmid:33602000
- 95. Yue L, Chen W, Li X, Zuo W, Yin M. A survey of sentiment analysis in social media. Knowledge and Information Systems. 2019;60(2):617–63.
- 96. Allem J-P, Majmundar A, Dormanesh A, Donaldson SI. Identifying Health-Related Discussions of Cannabis Use on Twitter by Using a Medical Dictionary: Content Analysis of Tweets. JMIR Form Res. 2022;6(2):e35027. pmid:35212637
- 97. Nasralah T, Spohn R. Social Media Text Mining Framework for Drug Abuse: An Opioid Crisis Case Analysis SOCIAL MEDIA TEXT MINING FRAMEWORK FOR DRUG ABUSE: AN OPIOID CRISIS CASE ANALYSIS A dissertation submitted to Dakota State University in partial fulfillment of the require. 2019.
- 98. van Draanen J, Tao H, Gupta S, Liu S. Geographic Differences in Cannabis Conversations on Twitter: Infodemiology Study. JMIR Public Health and Surveillance. 2020;6(4):e18540–e. pmid:33016888
- 99. Li M, Kakani N, li C, Park A. Understanding cannabis information on social media: Examining tweets from verified, regular, and suspended users2020. 1–10 p.
- 100. Cavazos-Rehg PA, Krauss MJ, Sowles SJ, Murphy GM, Bierut LJ. Exposure to and Content of Marijuana Product Reviews. Prevention Science. 2018;19(2):127–37. pmid:28681195
- 101. Shi S, Brant AR, Sabolch A, Pollom E. False News of a Cannabis Cancer Cure. Cureus. 2019;11(1):1–11. pmid:30931189
- 102. Pérez-Pérez M, Pérez-Rodríguez G, Fdez-Riverola F, Lourenço A. Using twitter to understand the human bowel disease community: Exploratory analysis of key topics. Journal of Medical Internet Research. 2019;21(8). pmid:31411142
- 103. Glowacki EM, Glowacki JB, Wilcox GB. A text-mining analysis of the public’s reactions to the opioid crisis. Substance Abuse. 2018;39(2):129–33. pmid:28723265
- 104. Meacham MC, Nobles AL, Tompkins DA, Thrul J. "I got a bunch of weed to help me through the withdrawals": Naturalistic cannabis use reported in online opioid and opioid recovery community discussion forums. PloS one. 2022;17(2):e0263583. Epub 20220208. pmid:35134074; PubMed Central PMCID: PMC8824349.
- 105. Gonzalez-Estrada A, Cuervo-Pardo L, Ghosh B, Smith M, Pazheri F, Zell K, et al. Popular on YouTube: A critical appraisal of the educational quality of information regarding asthma. Allergy and Asthma Proceedings. 2015;36(6):e121–e6. pmid:26534743
- 106. Westmaas JL, McDonald BR, Portier KM. Topic modeling of smoking- and cessation-related posts to the American Cancer Society’s Cancer Survivor Network (CSN): Implications for cessation treatment for cancer survivors who smoke. Nicotine and Tobacco Research. 2017;19(8):952–9. pmid:28340059
- 107. Saposnik FE, Huber JF. Trends in web searches about the causes and treatments of autism over the past 15 years: Exploratory infodemiology study. JMIR Pediatrics and Parenting. 2020;3(2). pmid:33284128
- 108. Leas EC, Nobles AL, Caputi TL, Dredze M, Smith DM, Ayers JW. Trends in Internet Searches for Cannabidiol (CBD) in the United States. JAMA network open. 2019;2(10):e1913853–e. pmid:31642924
- 109. Tran T, Kavuluru R. Social media surveillance for perceived therapeutic effects of cannabidiol (CBD) products. International Journal of Drug Policy. 2020;77:102688–. pmid:32092666
- 110. Kazemi DM, Borsari B, Levine MJ, Dooley B. Systematic review of surveillance by social media platforms for illicit drug use. Journal of Public Health (United Kingdom). 2017;39(4):763–76. pmid:28334848
- 111. Grinspoon L, Bakalar JB. Marihuana, the forbidden medicine: Yale University Press; 1997.
- 112. Belackova V, Ritter A, Shanahan M, Chalmers J, Hughes C, Barratt M, et al. Medicinal cannabis in Australia–Framing the regulatory options. Sydney: Drug Policy Modelling Program. 2015.
- 113. Lardon J, Bellet F, Aboukhamis R, Asfari H, Jaulent M, Beyens M, et al. Evaluating Twitter as a complementary data source for pharmacovigilance Expert Opinion on Drug Safety. 2018;17(8):763–74.
- 114. Bode L, Davis-Kean P, Singh L, Berger-Wolf T, Budak C, Chi G, et al. Study designs for quantitative social science research using social media. 2020.
- 115. Chancellor S, De Choudhury M. Methods in predictive techniques for mental health status on social media: a critical review. npj Digital Medicine. 2020;3(1). pmid:32219184
- 116. Abbasi A, Sarker A, Ginn R, Smit K, Oconnor K, Abbasi A. Social Media Analytics for Smart Health.