Outdated tools, underestimated harm: Modernizing cannabis surveillance in a post-legalization era

Area of Science:

• Public Health
• Cannabis Research
• Health Surveillance

Background:

• Canada's 2018 non-medical cannabis legalization aimed to shift use from criminalization to regulation.
• Cannabis access and consumption have increased, but harm monitoring systems lag behind.
• Current surveillance focuses on use patterns, not harm indicators like cannabis use disorder (CUD).

Purpose of the Study:

• Evaluate the adequacy of Canada's current surveillance tools for detecting and tracking CUD.
• Identify limitations in national surveys and administrative health records regarding CUD assessment.
• Highlight the need for improved CUD detection, treatment, and funding.

Main Methods:

• Analysis of national surveys and primary mental health surveillance tools for CUD assessment capabilities.
• Review of administrative health records for CUD coding practices and diagnostic accuracy.
• Assessment of exclusion criteria in surveys affecting high-risk populations.

Main Results:

• Current surveillance tools use outdated frameworks (e.g., DSM-IV) and exclude individuals with lower use levels.
• Key CUD symptoms (loss of control, impairment, withdrawal) are not adequately assessed.
• Administrative data obscure CUD due to underdiagnosis, inconsistent coding, and lack of validated tools.

Conclusions:

• Canada requires a modernized surveillance infrastructure for CUD.
• Updated tools must align with current diagnostic standards (e.g., DSM-5) and improve sensitivity.
• Incorporating equity metrics and enabling reliable clinical data detection of CUD is crucial.