NSAG · Module M4 · Healthcare & Clinical
Cannabis Public Health Infrastructure
Standalone deployment retired
Cannabis is pharmacologically active in about 35% of your patient population. It is documented in about 5% of their medical records. The gap is an institutional design problem.
What this address is
This hostname served a standalone copy of NSAG module M4. That copy was retired on 15 August 2026, and the page you are reading replaced it. The deployment stays online so that links already published against it keep resolving, and so that anyone arriving here is sent to the material that is still maintained.
The module's current scope, its evidence base, and its release status are published on the NSAG hub at nsag-site.vercel.app/m4. Where this page and the hub disagree, the hub is correct.
What the module examines
The cannabis documentation gap has a verified primary source: Lapham et al. (2022) found that 35.1% of primary care patients reported implicit medical cannabis use while only 4.8% had EHR documentation — from the same patient population, measured simultaneously. Cannabis is metabolized through cytochrome P450 pathways shared with warfarin, antiepileptics, antidepressants, antifungals, and immunosuppressants. Prescribing decisions are being made without complete pharmacological information in a significant proportion of patients. The governance response addresses the institutional design failures that create the gap, so the fix sits with the system rather than with patients who don't disclose.
M4 sits in the Healthcare & Clinical group of the framework.
What the assessment measured
The module organised a structured self-assessment across six governance dimensions:
- 1Cannabis Screening Standards
- 2Provider Training Standards
- 3EHR Documentation Architecture
- 4Disclosure Safety Infrastructure
- 5Regulatory Compliance & Legal Review
- 6Quality Improvement Metrics
Each dimension was described against tiers running from early stage up to the fully implemented tier the framework calls PIONEERING, with observable criteria written for each level, so that an institution could locate its own arrangements rather than receive a score. It was a self-assessment framework for institutional reflection, and never a validated instrument, an audit, an accreditation, or a compliance determination.
Who it was written for
Primary care practices · Hospitals and health systems · FQHCs · Pharmacy programs · Cannabis healthcare providers · State health departments · EHR vendors
And any patient carrying an undocumented interaction. If you use cannabis and it isn’t in your chart, this governance is what closes the gap before it reaches a decision about your care.
Why the standalone deployment was retired
The fifteen modules were first published as fifteen separate deployments. Scope, evidence, and release status then had to be maintained in fifteen places, and they drifted apart. The hub now holds one canonical page per module, and these fifteen addresses point at it.
Assessment collection is paused across all fifteen modules. The published operations matrix records the same position for every one of them: the canonical route is reachable, collection is paused, and advisory work is delivered by a person rather than by automated scoring. This page is a static record. It carries no forms and collects nothing.