Cannabis Policy Impacts Public Health and Health Equity (2024)
Chapter: Appendix C: Data Sources Available for Cannabis Surveillance
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Appendix C
BOX C-1
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Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
Appendix C
Data Sources Available for Cannabis Surveillance
Numerous data sources could be used to monitor cannabis’s public health effects, including poisonings, exposure biomonitoring, survey data, regulatory data, administrative data, traffic data, and mortality data.
POISONING DATA
The American Association of Poison Control Centers administers the National Poison Data System (NPDS). Each of the 55 poison control centers in the United States submits de-identified data on exposures (which do not necessarily represent a poisoning or overdose) to NPDS. The exposures are reported by individuals or by trained health officials who make calls to one of the national poison control centers. These data were used to find, for example, that an increase in cannabis exposures reported to poison control centers follows states’ legalization of adult cannabis use (Shi and Liang, 2021) and that reported childhood exposures to edible cannabis products increased between 2017 and 2019 (Whitehill, 2021).
BIOMONITORING DATA
The CDC uses biomonitoring to measure chemicals or their metabolites (breakdown products) in human tissues and fluids to determine exposure to environmental chemicals. The agency’s National Health and Nutrition Examination Survey (NHANES) conducts biomonitoring on a large scale. Using a multistage probability design to sample the noninstitutionalized
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
civilian population in all 50 states, biological specimens from approximately 10,000 people in each 2-year survey cycle were collected for laboratory testing. These specimens include blood samples, urine, and saliva. Currently, these fluids are used to monitor for the nicotine metabolite cotinine. Still, this tool could also be used for any metabolites of cannabis exposure, as CDC laboratories have measured cannabis metabolites for research purposes (Sangmo, 2021).
SURVEY DATA
Survey data (Table C-1) are used to monitor exposure to and public health effects of cannabis, including several national and state-specific health surveys. Surveys capturing nationally representative samples of the household population include the National Survey on Drug Use or Health (NSDUH), the Behavioral Risk Factor Surveillance System (BRFSS), the National Health Interview Survey (NHIS), the National Health and Nutrition Examination Survey (NHANES), Monitoring the Future (MTF), Youth Risk Behavior Surveillance System (YRBSS)/National Youth Risk Behavior Survey (YRBS), National Epidemiological Survey on Alcohol and Related Conditions (NESARC I, II and III), Population Assessment of Tobacco and Health (PATH), Pregnancy Risk Assessment Monitoring System (PRAMS), and the International Cannabis Policy Study (ICPS). Examples of state-specific surveys include the California Health Interview Survey and Washington State Healthy Youth Survey (HYS).
A central advantage of these surveys is that they capture a broad range of people who use cannabis, including those who seldom interact with the healthcare system. Moreover, national surveys such as NSDUH, and YRBSS can produce state-level estimates of the prevalence of use in the past year or month, though often only through restricted-use datasets. Not all states include the questions about cannabis use (called the marijuana module) in BRFSS, and some states do not have adequate response rates to report population estimates from YRBSS (Geissler, 2020). Moreover, these surveys do not ask about the types of cannabis products used, mode of administration, and total quantity consumed, as it is difficult to make changes to adapt to the rapidly changing marketplace.
Several datasets (e.g., MTF, PATH, ICPS) do not consistently capture state-representative samples, which means they are not ideal for evaluating state policy changes even though they provide state identifiers. Similarly, the NSDUH, while it captures state representative samples, does not provide state identifiers in public-use data files.
There are several disadvantages to using household surveys for cannabis surveillance, such as potential inaccurate reporting of cannabis
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
use, insufficient detail on cannabis/cannabinoid use, and selection bias of the sample. Cannabis use is often underreported in surveys due to the associated stigma. The underreporting may confound the relationship between cannabis use and legalization because as states legalize cannabis, cannabis use may become more socially acceptable or less stigmatized (Le, 2022; Smart, 2019). Response or desirability bias (such as underreporting of cannabis use) may occur when the survey is not designed or administered correctly (such as if a bystander can hear the question and the answer given). Selection bias may occur because surveys often exclude populations who may have the highest use, such as those who are not in a traditional household and those living in institutions (for example, a correctional institution or a residential nursing or mental health care facility) or those on active duty in the Armed Forces. Finally, most large-scale population surveys contain insufficient detail about the frequency of cannabis use, the specific cannabis products used (and the THC or other cannabinoids contained within them), the modes of administration used, the amounts consumed, or the individual’s reason for use. Such details are needed to understand which products people use that could affect public health.
HEALTH CARE DATA
Health care data (Table C-2) for cannabis policy surveillance include health insurance claims, electronic health records, and facility-level health record data. Evaluating cannabis-related health events using health-care data presents both opportunities and challenges. While leading health care systems with systematic screening for cannabis use offer valuable insights, such data are typically limited to subsets of patients (e.g., pregnant individuals, adolescents, primary care patients; see Appendix D) and are not publicly available. Further, emerging cannabis-related health outcomes (e.g., cannabinoid hyperemesis syndrome) are not consistently coded or documented in health care settings as there currently is no universal international classification of diseases code for cannabinoid hyperemesis syndrome. Publicly accessible datasets, like aggregated claims data or outpatient records, also rely on clinician coding practices, which can be inconsistent, especially since cannabis use screening is not as widely implemented as tobacco screening, leading to under-ascertainment. Free-text notes capture cannabis consumption only if reported by the patient and recorded by the provider, both of which are likely to be inconsistent because of legal prohibitions and cultural attitudes about cannabis use, among other reasons. Pharmacy dispensing records generally do not include information for drugs obtained outside the pharmacy.
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
TABLE C-1 Survey Data Sources Available for Cannabis Surveillance
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Self-report surveys | |||||||
| National Survey on Drug Use or Health (NSDUH) Cross-sectional, in-person survey (some online during the COVID-19 pandemic) of civilian, noninstitutionalized population of U.S. individuals aged 12 and older |
No | Recency of use, frequency of use, age of first use; perceived risk and approval; DSM-IV/ DSM-5 | Not assessed, but respondents are asked if any or all of their use was recommended by a doctor or other health professional | CUD, driving impaired, other substance use; substance use disorders; substance use risk and protective factors; availability of substance use treatment; any mental illness and serious mental illness; suicidal thoughts and behaviors; mental health treatment | Nationally and state representative samples began in 1999, but geocoded data (state, county) restricted to public | Annual periodically since 1971, annually since 1990. In 2002, name changed from National Household Survey on Drug Abuse to NSDUH. | The public use file (PUF) does not contain state or any other geographic identifiers. Changes were made to NSDUH sampling design and questionnaire in 2014 and 2015, respectively |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Behavioral Risk Factor Surveillance System (BRFSS) Cross-sectional telephone survey of noninstitutionalized U.S. adults (aged 18+) |
No | Frequency, route of administration | Medical and recreational | Health status, healthy days, chronic health conditions, health-related behaviors | State-/territory-based sample of noninstitutionalized U.S. adults (18+); produces national- and state-level estimates; selected states design substate samples; cannabis module introduced in 2016 but not all states opt in, so cannabis use cannot be surveyed across all 50 states | Annual 1984–current Became a nationwide surveillance system in 1993 |
In 2022, 24 jurisdictions opted to use the marijuana module |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| National Health Interview Survey (NHIS) Cross-sectional, multistage, probability household interview survey of the civilian non-institutionalized population residing in the U.S. |
No | No | Unspecified | Variety of acute and chronic health conditions; functioning; risk factors and health behaviors | Uses geographically clustered sampling techniques to randomly select one sample adult (18+) and one sample child (<18) in each dwelling unit so that each month’s sample is nationally and regionally representative; the sampling plan is redesigned after every decennial Census | Annual 1957–present |
From 1997 to 2018, the NHIS also included a family questionnaire. In 2019, a structure of annual questions (demographic, health insurance, chronic conditions, health care access, health-related behaviors, functioning/disability) and rotating questions (mental health, service utilization, preventive services, injuries, chronic pain) was implemented |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| National Health and Nutrition Examination Survey (NHANES) Cross-sectional self-reported interview and examination survey; in-home personal interviews and physical examinations and laboratory tests in mobile examination centers (MEC) |
No | Recency of use, frequency of use, age of first use, age of frequent use, quantity | Unspecified | Variety of acute and chronic health conditions; functioning; risk factors and health behaviors | Nationally representative multiyear, multistage, stratified, clustered sample of civilian noninstitutionalized populations (adults and children); cannabis data (drug module) introduced in 2005 and collected from participants aged 12–69 years only by interview at the Mobile Examination Center; however, data files only contain data from participants aged 18–69 years | Annual From 1960–1994, a total of seven national examination surveys were conducted Beginning in 1999, the survey has been conducted continuously |
Because of COVID, data collection for the NHANES 2019–2020 cycle was not completed, and the collected data are not nationally representative Therefore, data collected from 2019–March 2020 have been combined with data from the NHANES 2017–2018 cycle to form a nationally representative sample of NHANES 2017–March 2020 pre-pandemic data Starting in 2023, NHANES is undergoing a substantial survey redesign Therefore, NHANES 2021–2022 is the last cycle of a continuous survey that began in 1999 collecting data annually and publicly releasing data every 2 years |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| International Cannabis Policy Study (ICPS) Cross-sectional web-based survey of respondents aged 16–65 collected in the fall of each year. Respondents are recruited using non-probability sampling methods through the Nielsen Consumer Insights Global Panel and their partner panels. Post stratification weights are constructed and used to generate samples more representative of either the nation or particular states. |
No | Recency of use, frequency, times per day; age of first use; products used; route of administration; amount typically used | Medical and recreational use enquired separately | CUD; general health status; past year adverse/negative health effects; past year ED visits; past year health visits | Cross-sectional data are post-weighted to generate samples more representative of national population living in states with or without medical and/or adult use laws. Post-sampling weights include sex, age, region, race, education and smoking status | Annual (1998–current), although sample size is increasing, particularly in a few states requesting state-specific estimates (e.g. WA, MA) |
This sample is based off marketing panels, not stratified samples of any specific population As such, they may not capture representative behavior of cannabis users Furthermore, sample sizes in some states are very small, limiting utility for examining effects of policy changes |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Monitoring the Future (MTF) Ongoing survey of 8th, 10th, and 12th graders Cross-sectional, in-school survey that is self-administered using machine-readable questionnaires They then moved to tablet-based questionnaires, starting with a random half in 2019 Approximately 16,000 students in 133 public and private high schools participate annually in the 12th grade study 8th and 10th grade surveys started in 1991 Data are collected in spring of each year using a multistage random sampling design |
No | Recency of use (lifetime, past year, past 30 days), frequency of use, age of first use; daily use in the past 30 days; vaping cannabis (as of 2017); synthetic marijuana use (as of 2011 for 12th graders, 2012 for 8th and 10th graders Perceived health risks of occasional and frequent cannabis use are also obtained | Recreational use is the focus of the survey, but starting in 2017, MTF asked if cannabis was used under a doctor’s orders | Problems with use; drive with impaired driver; mental health status; use of tobacco, alcohol and other substances Survey also contains information on healthy lifestyle behaviors (nutrition, sleep, and exercise) |
Nationally representative survey However, geocoded data (state, county) are not publicly available and can only be accessed through a special process Samples are not state representative |
Annual 1976–current year for 12th graders, although detailed measures of cannabis use have been expanded over time 1991–current period for 8th and 10th graders Similar expansion of measures over time |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Youth Risk Behavior Surveillance System (YRBSS)/National Youth Risk Behavior Survey (YRBS) YRBSS include school-based national, state, tribal, and large urban school district surveys of representative samples of high school students and, in certain sites, representative state, territorial, and large urban school district surveys of middle school students; includes YRBS |
No | Lifetime frequency, age of first use, 30-day frequency, synthetic cannabis use | Unspecified |
Six categories of priority health-risk behaviors:
|
Three-stage cluster sample design producing nationally representative estimates | Biennial 1991–current |
In 2021, 45 states participated in YRBS |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| National Longitudinal Survey of Youth 1997 (NLSY97) Ongoing nationally representative longitudinal survey of American youths between the ages of 12–16 in December 1996 The first wave of the survey, fielded in 1997 and 1998, collected information on 8,984 individuals (4,599 males and 4,385 females) |
No | Age of first cannabis use, recency of use (use since last interview, use in past month), frequency of use (number of days used in past month) | Not specified | Use while pregnant, risky sexual behavior, other substance use, mental health (MHI-5), general health behaviors | Cohort representative of youth between the ages of 12–16 living in the United States in 1996 | Annual survey from 1997–2011, and then biennial afterwards. Cannabis questions are not included in every survey after 2011 | Data have limited utility for studying behavior of youth given the cohort ages out of youth by 2004 |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| National Epidemiological Survey on Alcohol and Related Conditions (NESARC I, II and III) Designed to assess the prevalence of alcohol use disorders and their associated disabilities in the general U.S. household population More than 43,000 were interviewed in NESARC I, with nearly 35,000 followed up in NESARC II NESARC III was a separate cross-sectional sample of 36,000 individuals |
None collected | Initiation, use during the past 12 months and over lifetime, DSM-IV measures of cannabis abuse and dependence; daily or near daily cannabis use | Not specified | Self-reported receipt of treatment for CUD by treatment modality; self-reported cannabis withdrawal symptoms, DSM-IV or V mood disorders (depression, dysthymia, bipolar I and II), anxiety disorders, self-reported psychotic disorders; PTSD, and personality disorders Physical disability measured using SF-12 Other substance abuse/dependence (DSM-IV or V) also captured |
NESARC I and III are a probability sample representative of the U.S. adults population 18 years and older NESARC II was a longitudinal follow up of the same respondents in NESARC I |
The survey was only conducted three times: 2001–2002, 2004–2005, and then a new cross-sectional sample in 2011 |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Population Assessment of Tobacco and Health (PATH) Ongoing, nationally representative, longitudinal cohort study of noninstitutionalized adults and youth in the U.S., multistage stratified area probability design; 2-phase selection procedure used at final stage that oversampled adults who use tobacco, young adults, and Black adults Data collection in-person using audio computer-assisted self-interviewing (ACASI) instruments and a computer-assisted personal-interviewing (CAPI) parent instrument |
No | Ever cannabis use; past-year cannabis use; time since last used cannabis; past-year vaping of cannabis; past-year blunt use | Not assessed | Tobacco use behaviors, including patterns of use, attitudes, beliefs, exposures, and health outcomes | The PATH study is a national longitudinal cohort study of 45,971 adults and youth 12 years of age and older; oversampling of tobacco users, Black individuals, and young adults aged 18-24 Wave 4 employed a probability replenishment sample to account for loss of cohort members during follow-up |
~Annual (5 waves; 2013–2019) | The research community can request access; data are placed in the repository ~1 year following the completion of each wave Care is needed in selecting the appropriate weights and understanding the population of inference Some variables are only available in a subset of waves |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Pregnancy Risk Assessment Monitoring System (PRAMS) State/jurisdiction-specific, mixed-mode population-based surveillance system |
No | Core questions include screening of cannabis use during prenatal care, prenatal use, use during pregnancy State-specific standard questions vary | Unspecified | Variety of maternal outcomes (e.g., preeclampsia, postpartum depression) and neonatal outcomes (e.g., NICU admission, mortality, low birthweight, preterm birth) | Sample of women who have had a recent live birth drawn from the jurisdiction’s birth certificate file Each participating site samples between 1,000 and 3,000 women per year Women from some groups are sampled at a higher rate to ensure adequate data are available in smaller but higher risk populations |
Annual 1998–current Cannabis questions were first introduced in 2009 |
Forty-six states, the District of Columbia, New York City, Northern Mariana Islands, and Puerto Rico currently participate in PRAMS The births in the 50 jurisdictions that participate in PRAMS are 81% of all live births in the U.S. In 2017, the survey included the Marijuana and Prescription Drug Use Supplement, which was fielded by 6 states (AK, ME, NM, NY, PA, WV) |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Includes core questions (i.e., asked by all participating jurisdictions) and standard questions (i.e., chosen by jurisdictions from a pretested list of Centers for Disease Control and Prevention (CDC) questions or state-developed) | |||||||
| Examples of State-Specific Surveys | |||||||
| California Health Interview Survey (CHIS) Mixed mode (web and telephone) survey uses address-based sampling to select one adult in each randomly sampled and participating household Adolescents are interviewed with parental permission |
No | Adults: Ever use, last use, method (one, >1 method), CBD (cannabidiol) ever use, frequency of use past 30 days, method of use (CBD added in 2021) Adolescents: Ever use, past year use, frequency of past month use |
Not assessed In 2001, adolescents were asked whether their doctor talked to them about marijuana use during an exam | Health status, health conditions, mental health, health behaviors, neighborhood and housing, adverse childhood experiences, access to and use of health care, health insurance, public program eligibility | Nation’s largest state health survey Representative of the state of California |
Annual (2001–current) | Public use files are available; can apply to get confidential data Questions asked change across years CHIS data can be analyzed at the county level for the 41 most populated counties and the remaining 17 counties are combined into 3 groups |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| WA Healthy Kids Cross-sectional survey administered to students in grades 6–12 in Washington State Primarily administered in-person in public schools, but private schools may gain access upon request, as can Alternative Learning Experiences, or online learning programs, where survey can be administered remotely |
No | Frequency of use, age of first use, co-use with alcohol in past 30 days, driving within 3 hours after use, mode of administration, use of vaping products | Not assessed | Use of other substances, alcohol use, violence (e.g. firearm possession, gang involvement, fighting), depression, attempt at suicide | About 200,000 students in grades 6–12 across the state of Washington take the survey every two years | Fall of even years 2002–2018 Shift to odd years beginning 2021–present |
NOTES: CUD = cannabis use disorder; DSM = Diagnostic and Statistical Manual; ED = Emergency Department; EMR = Electronic Medical Record; MHI-5 = Revised Mental Health Inventory-5; NICU = neonatal intensive care unit; PTSD = Post-traumatic stress disorder; SF-12 = 12-Item Short-Form Survey.
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
TABLE C-2 Healthcare Administrative Data Useful for Public Health Surveillance of Cannabis
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Health Insurance System Claims Data | |||||||
| Medicare Administrative claims data are collected on all Medicare Part A (inpatient), Medicare Part B (outpatient and physician care) and Medicare Part D (prescription drug) claims for those in FFS plans Medicare Advantage (Part C) encounter data may also be available for some enrollees Enrollees are tracked with unique I.D. to view longitudinally |
Pre-2015: ICD-9 and CPT codes; 2015 forward: ICD-10 and CPT codes These codes available for any cannabis or other health condition |
ICD-9 diagnoses for cannabis abuse, dependence, poisonings, or cannabis-induced psychosis | Not indicated | ICD-9/ICD-10 diagnoses or health events including place of service, CPT codes and NDC codes for prescription drugs; injuries and poisonings included; total charges Information includes timing and cost of the claims, demographic, and eligibility information about the beneficiaries, prescriber and pharmacy I.D., and national drug code |
Varies on user’s access to the data May be full Medicare population, so all services provided to a Medicare beneficiary that are billed to Medicare, or a 5%–20% random sample of beneficiaries across all states Inclusion of Medicare Advantage (Part C) data varies by access of user |
Data are released in annual increments but include dates reflecting day of services rendered | Medicare cover those eligible due to either age (65 years or older) or formal disability status (a 2-year process) Only episodes of care paid for by Medicare are included in the claims data |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Medicaid State Information System (MSIS)/Medicaid Analytic eXtract (MAX) data Person-level data files derived from eligible enrollees in each state’s Medicaid program while covered by Medicaid insurance |
Pre-2015: ICD-9 and CPT codes; 2015 forward: ICD-10 and CPT codes These codes available for any cannabis or other health condition |
ICD-9 diagnoses for cannabis abuse, dependence, poisonings, or cannabis-induced psychosis | Not indicated | ICD-9 /ICD-10 diagnoses or health events including place of service, CPT codes and NDC codes for prescription drugs; injuries and poisonings included; total charges Information includes timing and cost of the claims, demographic, and eligibility information about the beneficiaries, prescriber and pharmacy I.D., and national drug code |
Data represent the universe of enrollees receiving health care paid for through FFS Medicaid plans within the state, deidentified and without geocoded data about the patient for the duration they are covered by Medicaid Some states also include and release encounter data capturing service utilization without diagnoses from Medicaid enrollees in managed care plans |
Annual for each calendar year, although includes service dates so utilization can be examined on a weekly, monthly, or quarterly basis | Data are only available for approved research activity under a DUA with CMS Only records services paid for by Medicaid are included Some states only provide data on FFS plan enrollees, while others include encounter data for managed care Medicaid plans Encounters lack diagnostic and procedural details, so many analyses use only FFS data |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Marketscan Commercial Claims and Encounters and Medicare Supplemental Databases Initially compiled by Truven Health in 1995 and taken over by IBM in 2016, the Marketscan data is a family of fully adjudicated claims-based data aggregated across different insurers/employers on a large number of individuals (>270 million in 2021) enabling examination in healthcare utilization, medication history, and history of diseases among the commercially ensured Data include eligibility, adjudicated claims, encounters (for managed care patients), Rx claims, diagnoses, and benefit plan info |
Pre-2015: ICD-9 and CPT codes; 2015 forward: ICD-10 and CPT codes These codes available for any cannabis or other health condition |
ICD-9 diagnoses for cannabis abuse, dependence, poisonings, or cannabis-induced psychosis Inpatient and outpatient lab tests are also included for some enrollees starting in 2005 |
Not indicated | ICD-9/ICD-10 diagnoses or health events including place of service, CPT codes, and NDC codes for prescription drugs; injuries and poisonings included; total charges Information includes timing and cost of the claims, eligibility information about the beneficiaries, prescriber and pharmacy I.D., and national drug code |
The data represent a very large convenience sample from more than 120 contributing employers and 40 contributing health plans, including 9–12 state Medicaid agencies who are customers of IBM Health and agreed to contribute data (numbers reflect those who contributed in 2021) Subsamples from Medicare (retirees who possess employer-sponsored Medicare-paid plans) |
Data are released in annual increments but include dates reflecting day of services rendered | While these data include information on many commercially insured, the data are neither state nor nationally representative of all patients, and inclusion/exclusion of particular plans and employers can cause shifts in results |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| IQVIA Databases This is a suite of different health databases providing different looks at utilization and cost of different healthcare system utilization either cross-sectionally and longitudinally since 2006, including IQVIA PharMetrics Plus; Medical and Institutional Claims (history and diagnosis); and Ambulatory EMR, containing various types of healthcare/medical data |
ICD-9, ICD-10, and CPT codes included in IQVIA EMR and claims data | ICD-9 diagnoses for cannabis abuse, dependence, poisonings, or cannabis-induced psychosis Inpatient and outpatient lab tests are available in EMR database |
Not indicated, but pharmacy data enable identification of patients using FDA-approved cannabis-based medications using NDC codes | ICD-9 /ICD-10 diagnoses or health events including place of service, CPT codes, and NDC codes for prescription drugs; injuries and poisonings included; total charges Information includes timing and cost of the claims, eligibility information about the beneficiaries, prescriber and pharmacy I.D., and national drug code |
IQVIA databases are all convenience samples of large panels of patients serving different purposes PharMetrics Plus contains nearly 4 billion Rx claims per year, covering approx. 90% of the retail pharmacy channel, 60–85% of Rx mail service, and 75–80% long term care providers |
Data are released in annual increments but include dates reflecting day of services rendered | Same limitations as mentioned for Marketscan |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Dx and Hx data collects unadjudicated office and medical claim data on 191 million patients A-EMR collects patient vitals, health behaviors and risk factors for diagnosis and treatment linked to clinical diagnoses from 71 million patients |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Electronic Health Record Data | |||||||
| Health Systems Node (HSN) of the National Institute on Drug Abuse Clinical Trials Network (CTN) | Each of the 16 HSN health systems maintain integrated electronic health records as well as highly curated virtual data warehouses Pre-2015: ICD-9 codes; 2015 forward: ICD-10 These codes available for any cannabis or other health condition |
Screening for cannabis use varies across health systems (see examples from KPNC and KPWA below) | Varies (see examples from KPNC and KPWA below) | CUD; ICD-9/ ICD-10 diagnoses; prescription medications; health care utilization; cost data | Data represent the universe of members across 16 health plans across the United States | Continuous | Programmers at each site transform EHR and claims data elements from local data systems to a virtual data warehouse standardized set of variable definitions, names, and codes This distributed data model offers an efficient means to conduct multisite studies, |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| while protecting the identity of patients, providers, and health systems and allowing researchers to access data from larger, more diverse populations than they would otherwise be able to access within their own institution |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Kaiser Permanente Northern California (KPNC) | Pre-2015: ICD-9 codes; 2015 forward: ICD-10 These codes available for any cannabis or other health condition |
Pregnant patients: Self-reported frequency of cannabis use during the year before pregnancy and since pregnancy (assessed at the entrance to prenatal care) and urine toxicology tests done as part of standard prenatal care Self-reported mode of cannabis use assessed beginning in 2020/2021 |
Not assessed | CUD; ICD-9/ICD-10 diagnoses; prescription medications; healthcare utilization; cost data Can link mothers with their offspring and assess pregnancy, fetal, and neonatal outcomes associated with maternal prenatal use |
KPNC serves >4.6 million patients with a sociodemographic profile similar to the local and statewide California population, although the extremes of the income distribution are underrepresented Patient addresses are geocoded |
ICD-based diagnoses (continuous) Prenatal cannabis use (beginning in 2009, continuous) Adolescent past-year cannabis use (beginning in 2015, continuous) AMRS data (continuous) |
Available in limited settings to connected researchers |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Adolescents: Self-reported use of any cannabis during the past year Patients in AMRS: Urine toxicology testing, self-reported frequency of use Emergency department: Urine toxicology testing (targeted; not universal) |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Kaiser Permanente Washington (KPWA) | Pre-2015: ICD-9 codes; 2015 forward: ICD-10 These codes available for any cannabis or other health condition |
Adults: Prevalence and frequency of self-reported past-year cannabis use in primary care patients using validated single-item screening Daily or near-daily responses trigger additional assessment for CUD, with the psychometrically validated 11-item Substance Use Symptom Checklist to help clinicians assess CUD symptoms | Not assessed | CUD; ICD-9/ICD-10 diagnoses; prescription medications; healthcare utilization; cost data | KPWA serves ~700,000 patients, with a predominantly non-Hispanic, White, insured patient population However, patients have a sociodemographic profile similar to the local and statewide Washington population |
Beginning in 2015 (continuous) | Available in limited settings to connected researchers |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Patients attending KPWA mental health care are also regularly screened with a behavioral health monitoring tool that includes the single item cannabis screen and prompts for the Substance Use Symptom Checklist Adolescents: Frequency of past-year cannabis use assessed with S2BI Urgent Care: Urine toxicology testing (targeted; not universal) |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| University of California, Los Angeles (UCLA) (Exemplar of a localized medical health system data EMR) | Pre-2015: ICD-9 codes; 2015 forward: ICD-10 These codes available for any cannabis or other health condition | Self-administered, automated, EHR-based screening for cannabis ever use, past-3-month prevalence and frequency of self-reported cannabis use, use for recreational reasons, medical reasons, or both, symptoms for which they used cannabis, and mode of use among adult primary care patients ASSIST is used to identify risky use among those who use | Medical and recreational (using smart text) | CUD; ICD-9/ ICD-10 diagnoses; prescription medications; healthcare utilization; cost data | The UCLA healthcare system serves a geographically diverse area with over 200 clinics and 4 hospitals and an estimated 250,000 unique patients annually | Beginning in 2021 (continuous) | Available in limited settings to connected researchers |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Veterans Health Administration (VHA) | Yes | Use based on urine toxicology tests in certain settings (e.g., emergency department) | Not assessed | CUD; ICD-9/ICD-10 diagnoses; prescription medications; healthcare utilization; cost data | Largest integrated healthcare system in the U.S., providing care to >5.5 million veterans across the U.S. | Continuous | Available through VHA Corporate Data Warehouse, a data repository for all documented care provided at a VHA facility |
| Health Facility-Level Administrative data | |||||||
| Healthcare Cost and Utilization Project (HCUP) Longitudinal, all-payer, encounter-level administrative data; includes 5 nationwide databases (Nationwide Inpatient Sample [NID], Kids’ Inpatient Database [KID], Nationwide Readmissions Database [NRD], Nationwide Ambulatory Surgery Sample [NASS], |
As many as 30 diagnoses are collected with the actual number depending on the state data source | None | Unspecified | ICD-9 /ICD-10 diagnoses or health events; injuries and poisonings; total charges | NID = nationally representative sample from the universe of inpatient visits in hospitals among all participating states KID = nationally representative sample from the universe of pediatric inpatient visits in hospitals among all participating states |
Annual 1988–current | Data are submitted by hospitals to statewide data organizations; so, the number of participating states and patterns of variables collected depend on the state data source Participating states grow in number over time and range from 27 states (SASD) to 49 states (NID, KID) |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Nationwide Emergency Department Sample [NEDS]) and 3 statewide databases (State Inpatient Databases [SID], State Ambulatory Surgery and Services Databases [SASD], State Emergency Department Databases [SEDD]) | SID = state-level census of inpatient visits at hospitals in each participating state NRD = nationally representative sample from the universe of readmissions in hospitals among all participating states NASS = nationally representative sample from the universe of ambulatory surgery encounters in hospitals among all participating states |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| SASD = state-level census of ambulatory surgery encounters and other outpatient services in hospitals in each participating state NEDS = nationally representative sample from the universe of ED visits in hospitals among all participating states SEDD = state-level census of ED visits at hospitals in each participating state |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| National Ambulatory Medical Care Survey (NAMCS) Cross-sectional national, multistage, probability sample survey of patient visits to nonfederal office-based physicians |
Up to 5 diagnosis codes | Medication data collected and medical and nonmedical cannabis codes available | Unspecified | Patient-reported reason(s) for visit; ICD-9/10 diagnoses; indicator for injury, trauma, overdose, poisoning or adverse effect | National, multilevel probability sample survey, which can produce estimates at national- and regional-levels | Annual 1973–current | While the survey is designed to provide national and regional estimates, from 2012–2015, the NAMCS sampling design changed to allow estimates to be made for the most populous states In 2006, NAMCS added a sample of physicians and advanced practice clinicians in community health centers (CHCs) These were included in NAMCS through 2011 |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| National Hospital Ambulatory Medical Care Survey (NHAMCS) Cross-sectional national, multistage probability sample survey of ambulatory medical care in hospital emergency and outpatient departments |
Up to 5 diagnosis codes | Medication data collected and medical cannabis code available | Unspecified | Patient-reported reason(s) for visit; ICD-9/10 diagnoses; indicator for injury, trauma, overdose, poisoning or adverse effect of treatment | Approximately 500 nationally representative hospitals, which can produce estimates at national and regional levels | Annual 1992–2022 | In 2012, CHCs became a separate component of the survey NHAMCS is made up of three components: hospital OPD, hospital ED, and hospital-based ASL Starting in 2018, the survey collected data only on ED visits After the collection and processing of the 2022 data file, NHAMCS was discontinued |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis-Related Diagnosis Codes | Cannabis Use Variable(s) | Reason for Cannabis Use | Cannabis-Related Health Effect(s) | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|---|---|
| Treatment Episode Data System (TEDS) Admissions Data (TEDS-A) and Discharge Data (TEDS-D) |
ICD-9/10 codes, up to 3 substances | Primary, secondary, and tertiary substances used by the subject, and their route of administration, frequency of use, and age at first use; number of prior treatment episodes, cannabis abuse, cannabis dependence | Not assessed | CUD, number of previous treatment admissions, other substance use disorder | Represents annual admissions from treatment facilities that receive public funding (including Federal Block Grant funds) Facilities are identified from state licensing records and/or SSA agencies, and hence differences in state systems of licensure, certification, accreditation, and disbursement of public funds affect the scope of facilities included in TEDS across states over time Started in 1992 |
Annual data with date of service, so episodes can be constructed on a monthly basis Generally released in fall on a 2-year delay |
While it is well-understood that facilities operated by private for-profit agencies, hospitals, and the state correctional system are not necessarily included in TEDS, nor are data on facilities operated by federal agencies (e.g., the Bureau of Prisons, the Department of Defense, and the VA), the uniqueness of state licensing requirements and SSA funding requirements can generate significantly different rules of inclusion across states and within a state over time |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Drug Abuse Warning Network A nationally representative sample of 53 hospitals collecting data on substance-involved ED visits using trained medical record abstractors who review electronic medical records at participating E.Ds Data include information on patient age, sex, race, ethnicity, census region as well as use of alcohol, illicit drugs, prescription medications, OTC medications, dietary supplements, and non-pharmaceutical inhalants |
ICD-10 and lab test results | ICD-10 diagnoses for cannabis abuse, dependence, poisonings, or cannabis-induced psychosis Laboratory test results are also used to identify cannabis use Drugs are classified based on the drug’s molecular structure, action in the body, toxicity and misuse potential |
Unspecified | Any event generating the medical need for an ED visit, including poisoning, accident, psychosis, heart attack, difficulty breathing or any other acute health event | Every patient visiting the ED at one of the 53 participating hospitals who saw an ED clinician and was not admitted to the hospital subsequently is included in the study Participating hospitals are selected to be geographically representative of the U.S. population |
Annual from 2021 forward Data are released annually, but information is provided on a quarterly basis |
Data reflect information on people willing to seek ED care from the participating hospitals; this may not be representative of the population impacts overall |
NOTES: AMRS = Addiction Medicine Recovery Services; ASL = Ambulatory Surgery Locations; CMS = Centers for Medicaid & Medicare Services; CPT = Current Procedural Terminology; CUD = Cannabis Use Disorder; DSM = Diagnostic and Statistical Manual; DUA = data use agreement; ED = Emergency Department; EHR = Electronic Health Record; EMR = Electronic Medical Record; FFS = Fee-for-service; Hx = history; ICD = International Classification of Disease; NDC = National Drug Code; OPD = Outpatient Departments; OTC = Over the Counter; Rx = prescription; S2BI = Screening to Brief Intervention; SSA = State Substance Abuse; VHA = Veteran’sHealth Administration.
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
ADMINISTRATIVE DATA
Administrative data (Table C-3) can be used to monitor several cannabis-related events. Birth records provide information on prenatal cannabis exposure and potential neonatal outcomes. The Fatal Analysis Reporting System (FARS) offers insights into cannabis-associated motor vehicle fatalities. Crime data, including Uniform Crime Reports (UCR) and National Incident-Based Reporting System (NIBRS) arrest data, can reflect potential associations between cannabis and criminal activity. Additionally, mortality data and post-mortem toxicology data (Box C-1), encompassing both drug overdose deaths and suicide statistics, can be a crucial indicator for potential cannabis-related public health concerns.
BOX C-1
Post-mortem Toxicology for Cannabis Related Deaths Is Not Forensically Reliable
Postmortem redistribution (PMR): Tetrahydrocannabidiol (THC) may move from organs to blood after death, making it challenging to use post-mortem THC levels to estimate THC levels at the time of death. Studies show that due to PMR, THC concentration may be higher in peripheral blood (like femoral blood, which is typically used for post-mortem toxicology) compared to blood in the central blood body cavity.
Analyte stability: THC degrades over time in storage, especially at warmer temperatures. This further complicates the interpretation of postmortem blood THC levels.
Limited interpretation in living subjects: Even in living people, THC concentration does not directly indicate impairment or time of last use.
No established lethal concentration: There is no defined lethal dose of THC, making concentration levels not helpful for determining the cause of death. However, THC can contribute to deaths from impaired driving, etc.
SOURCE: Adapted from Kacinko, 2024.
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
TABLE C-3 Other Administrative Data Useful for Public Health Surveillance of Cannabis
| Datasets | Cannabis Use Variable(s) | Cannabis-Related Health Effect or Other Outcome | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|
| Birth certificate data | No | Infant birthweight, length of gestation, neonatal intensive care unit admission, delivery mode and birth history; maternal tobacco use during pregnancy, maternal morbidity | All births | Continuous, state and county jurisdictions began keeping birth records at different times | Available with state IRB approval and payment Can be linked to maternal prenatal substance use information |
| National Poison Data System (NPDS) Network of U.S. poison control call centers who report call information from adverse or unexpected acute events involving more than 466,000 different products in near real-time to a central location |
Self-reported incidences involving severe adverse reactions or toxicities associated with use of cannabis product or synthetic cannabis Information is reported on cannabis product description, route of exposure, intentional vs unintentional exposure, product dose, product manufacture source, product ownership source, initial vital signs, clinical signs and symptoms, and subject disposition |
Adverse event/unexpected reaction associated with acute use of a cannabis product | NPDS is a data warehouse of all poison center calls made to the nation’s 55 poison centers The number of included poison calls has grown over time |
Data are extracted by the Poison Control Association of America upon request, so data can be constructed weekly, monthly, quarterly or annually | This data system captures reported incidences, not all ED incidences, and only reflect suspected substance; actual substance generating the adverse reaction may differ from what is reported |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis Use Variable(s) | Cannabis-Related Health Effect or Other Outcome | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|
| Fatality Analysis Reporting System (FARS) is a nationwide census of all motor vehicle traffic crashes involving a fatality (whether it was a pedestrian, driver, or rider) reported to the National Highway Traffic Safety Administration (NHTSA) | Blood, urine or saliva testing depending on the state and year Different metabolites/cannabinoids tested for over the years 1991–1992 tested for cannabinol; 1993 and later tested for cannabinoids |
Crash involving a fatality | Census of all fatal injuries suffered in motor vehicle crash at state and national level Cannabis testing not done on all cases in all states |
Collected and reported annually since 1975, but details of what/how cannabis was tested for change over the years | Before 2018, FARS recorded drug-involvement for up to 3 substances based on a hierarchy, with narcotics at the top, then depressants, stimulants, hallucinogens, and finally cannabinoids Starting in 2018, FARS began reporting all substances for which there was a positive indication However, not all states uniformly test for cannabinoids and the FARS coding system does not distinguish between active and inactive cannabinoid metabolites |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Civil Rights Data Collection (CRDC) Biennial survey required by the U.S. Department of Education’s Office for Civil Rights (OCR) |
No | Discipline, referrals to law enforcement and school-related arrests, offenses, harassment/bullying, restraint and seclusion, student enrollment | Collects data from all local public educational agencies and schools that receive federal financial assistance, including justice facilities, charter schools, and alternative schools | Biennial (1968/1969–present) | Data available to download from website |
| Uniform Crime Reporting (UCR) Program National and state crime estimates for violent and property crime, in addition to 20 other crime categories (including drug possession and drug sales) Data are compiled from law enforcement reports to the FBI or other centralized agency that reports to the FBI |
Cannabis use is not measured UCR records instances of cannabis possession, cannabis use in public, and the sale, manufacturing or illicit distribution of cannabis |
Cannabis-related misdemeanor or felony offense (possession, use in public, possession with the intent to sale, sale, manufacturing, growing, or distribution) | Voluntary reporting by over 18,000 participating law enforcement agencies of all crimes and arrests Non-reporting agencies are imputed in some months/years, but systematic non-reporters are not reported, so data are lacking for some states and years due to incomplete reporting |
Data updated annually, although arrests for some jurisdictions are reported monthly | There are several problems with the UCR data, including the application of the hierarchal rule in reporting: that is, only the most serious offense charged is recorded in the instance, not all related offenses So, cannabis-involvement in other higher order crimes (possession of a concealed weapon, assault) would not be captured offense/crime, or if the crime gets adjudicated down is not recorded in the system |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| Datasets | Cannabis Use Variable(s) | Cannabis-Related Health Effect or Other Outcome | Sample Representation | Frequency | Notes |
|---|---|---|---|---|---|
| National Incidence Base Reporting System (NIBRS) The new FBI standard from 2021 for collecting crime/arrest data Each single incident records all offenses involved (hierarchy rule removed) in addition to information on victims, known offenders, relationship between victims and offenders, arrestees, and property involved in the crime Info on 24 offense categories and 52 offense types included |
Cannabis use of only two types is captured:
|
Cannabis-related misdemeanor or felony offense (possession, use in public, possession with the intent to sale, sale, manufacturing, growing, or distribution NIBRS documents cannabis-involved criminal offenses, similar to UCR, but also records law enforcement perception of the offender being under the influence of alcohol or drugs at the time of offense, with up to 3 different drugs being recorded NIBRS captures the types of drugs or narcotics seized during the incident, the amount present, and whether an offender was suspected of using drugs or alcohol at or near the time of the offense |
As of 2023, all 50 states and District of Columbia are certified to report incident-based crime/arrest data to NIBRS 77% of the U.S. population is covered by NIBRS-reporting law enforcement agencies There are 119 NIBRS-certified agencies serving cities and counties with a population of at least 250K |
Data collected from regional offices on an ongoing basis but synthesized and reported out annually Date and time of day of the incident is recorded in the data, so crimes can be evaluated on a daily, weekly, monthly, quarterly or annual basis |
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
| National Violent Death Reporting System (NVDRS) Collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports State-based active surveillance system that collects data on the characteristics and circumstances associated with violence-related deaths among participating states, and D.C. |
No | Toxicology test results for decedents tested | Deaths collected by NVDRS include suicides, homicides, legal intervention deaths (i.e., deaths caused by law enforcement acting in the line of duty and other persons with legal authority to use deadly force, excluding legal executions), unintentional firearm deaths, and deaths of undetermined intent that might have been because of violence | NVDRS data collection began in 2003 with six participating states (MD, MA, NJ, OR, SC, and VA) and has expanded incrementally over time Since 2018, CDC has provided NVDRS funding to all 50 states, the District of Columbia, and Puerto Rico |
NOTES: ED = Emergency Department; IRB = institutional review board.
Suggested Citation:
"Appendix C: Data Sources Available for Cannabis Surveillance." National Academies of Sciences, Engineering, and Medicine. 2024. Cannabis Policy Impacts Public Health and Health Equity. Washington, DC: The National Academies Press.
doi: 10.17226/27766.
REFERENCES
Geissler, K. H., K. Kaizer, J. K. Johnson, S. M. Doonan, and J. M. Whitehill. 2020. Evaluation of availability of survey data about cannabis use. JAMA Network Open 3(6):e206039–e206039.
Kacinko, S. L., D. S. Isenschmid, and B. K. Logan. 2024. Are postmortem cannabinoid concentrations forensically reliable? The American Journal of Forensic Medicine and Pathology 45(1).
Le, A., B. H. Han, and J. J. Palamar. 2022. Underreporting of past-year cannabis use on a national survey by people who smoke blunts. Substance Abuse 43(1):349–355.
Sangmo, L., T. Braune, B. Liu, L. Wang, L. Zhang, C. S. Sosnoff, B. C. Blount, and K. M. Wilson. 2021. Secondhand marijuana exposure in a convenience sample of young children in New York City. Pediatric Research 89(4):905–910.
Shi, Y., and D. Liang. 2020. The association between recreational cannabis commercialization and cannabis exposure was reported to the US National Poison Data System. Addiction 115(10):1890–1899.
Smart, R., and R. L. Pacula. 2019. Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations. American Journal of Drug and Alcohol Abuse 45(6):644–663.
Whitehill, J. M., J. A. Dilley, A. Brooks-Russell, L. Terpak, and J. M. Graves. 2021. Edible cannabis exposures among children: 2017-2019. Pediatrics 147(4).
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