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.
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.
35.1% implicit medical cannabis use vs. 4.8% EHR-documented. Verified 7:1 gap from the same patient population.
64% decrease in opioid use among 244 medical cannabis patients. Clinically significant and pharmacologically invisible without screening.
CYP450 pathways: CYP3A4, CYP2C9, CYP2C19, CYP1A2. Documented interaction risk with warfarin, antiepileptics, and immunosuppressants.
The prototype organizes reflection across six proposed governance dimensions. It does not produce a validated institutional score, audit, accreditation, or certification.
Validated cannabis screening at every patient contact (≥85% completion); all providers trained in CYP450 interactions within 2 years; structured EHR cannabis fields (≥85% completion); written disclosure safety policy communicated at intake; documented legal guidance updated within 3 years; cannabis documentation rate as tracked QI metric.
The full tier operationalization — PIONEERING through EARLY STAGE, with specific observable criteria for all six dimensions — is documented in the Framework Foundation.
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.
Review the module scope and proposed dimensions. The assessment remains an educational prototype; no email report or institutional finding is active.