An overview of health and safety in the Colorado cannabis industry

Stress, Mental Health, and Coping Among Workers in the Northern California Cannabis Industry: A Qualitative Descriptive Analysis

California is home to a multibillion-dollar cannabis (marijuana) industry, but little is known about the occupational health and safety hazards faced by cannabis workers and even less of the stress, mental health, and coping mechanisms among these workers. Previous research has been based on long-term workers at legal businesses, but most California cannabis is produced and sold unlawfully. There are many seasonal workers whose experiences have not been studied. A qualitative study based on focus group discussions and key informant interviews was performed to understand cannabis workers' experiences, knowledge, and perceptions of occupational hazards. Participants reported sources of stress including production pressure and isolation, and mental health outcomes such as depression and mental fatigue. They described primarily maladaptive coping mechanisms. Unique characteristics of the cannabis industry, including criminalization and isolated, remote farms, make interventions challenging. However, policy approaches that involve community organizations could promote worker health.

The Emerging Spectrum of Respiratory Diseases in the U.S. Cannabis Industry

While the cannabis industry is one of the fastest growing job markets in the United States and globally, relatively little is known about the occupational hazards that cannabis production workers face. Based on the closely related hemp industry and preliminary studies from recreational cannabis grow facilities, there is concern for significant respiratory exposures to bioaerosols containing microbial and plant allergens, chemicals such as pesticides, volatile organic compounds, and other irritant gases. Components of the cannabis plant have also recently been identified as allergenic and capable of inducing an immunoglobulin E-mediated response. Accumulating evidence indicates a spectrum of work-related respiratory diseases, particularly asthma and other allergic diseases. Disentangling causal relationships is difficult given the heterogeneity of mixed exposures, diagnostic challenges, and confounding by personal cannabis use. Despite and because of these uncertainties, better regulatory guidance and exposure controls need to be defined in order to reduce the risk of work-related disease.

California cannabis cultivation and processing workers: A qualitative analysis of physiological exposures and health effects

INTRODUCTION

Cannabis is a multi-billion-dollar California industry, but little is known about the occupational hazards or health experiences of cannabis cultivation workers. Respiratory and dermal exposures, musculoskeletal hazards, and other agricultural hazards have been identified in previous research. Even in a post-legalization framework, cannabis work is stigmatized and most cannabis is still produced illegally. Qualitative research is essential for establishing rapport with cannabis workers to understand their experiences and concerns.

METHODS

We conducted semi-structured discussions with four focus groups including 32 cannabis workers total, and 9 key informants who were workers, industry experts, and business owners or managers. Transcribed results were analyzed to identify key themes on physiological exposures and health effects.

RESULTS

The majority (81.3%) of focus group participants were seasonal migrant cannabis trimmers. Themes emerged of respiratory and dermal exposures and outcomes, musculoskeletal disorders, and physical hazards including living conditions. Workers reported respiratory symptoms and rashes from exposure to cannabis, mold, and pesticides. Musculoskeletal pain was ubiquitous due to inadequate seating and long shifts performing repetitive tasks. Seasonal workers experienced chronic exposure to cold conditions and unsanitary housing. Management-level interviewees and other industry stakeholders described concerns and experiences that differed from those of workers.

DISCUSSION

The results were consistent with existing research on cannabis worker health, with workers reporting respiratory and dermal exposure and symptoms, musculoskeletal hazards, and physical hazards associated with agricultural work. In addition, we found that workers were affected by substandard living conditions, remote and isolated work environments, and an absence of training.

A Pilot Study of Respiratory and Dermal Symptoms in California Cannabis Cultivation Workers

Cannabis (Cannabis sativa, marijuana) is the largest cash crop in California. While it is difficult to characterize the size of the industry, the total production is estimated at 15 to 16 million pounds per year, with total revenues exceeding $10 billion per year. Despite the huge size and rapid growth of the industry, there has been little research on the health and safety of cannabis workers. The goal of this pilot study was to explore the feasibility of collecting cannabis worker health data with a self-administered survey and to analyze the first systematically collected data on occupational health symptoms among California cannabis cultivation workers. We performed a cross-sectional survey of demographic and job characteristics as well as eye, nasal, respiratory, and dermal symptoms among 29 workers at two cannabis farms in the Sacramento area, California. Most participants were men aged less than 30 years, with 48% of participants self-identifying as non-Hispanic white and 58% reporting at least some college education. The most frequently reported work-related symptom was nasal irritation, and 38% of the participants reported symptoms suggestive of asthma. The participants had a demographic makeup distinct from traditional California agricultural workers, and a very high prevalence of current use of cannabis (93%). The high proportion of respondents with symptoms suggestive of asthma raises concern; sensitization to the cannabis plant has been reported among cannabis workers and users and there are many well-documented agricultural exposures causing asthma and asthma-like syndrome.

Evaluation of an Occupational Safety and Health Training for Cannabis Cultivation Workers

OBJECTIVES

As the commercial cannabis industry grows, there is an increased need to characterize potentially hazardous workplace exposures and provide training to workers to mitigate these exposures with the goal of reducing accidents and injuries from cannabis cultivation, processing, and manufacturing. Public health and safety stakeholders in Colorado developed a worker-focused training designed to improve hazard awareness, recognition, and controls related to commercial cannabis cultivation. This paper describes the evaluation of this training.

METHODS

The training was a full day, in-person educational experience directed to workers in the cannabis cultivation industry. Training topics included an overview of occupational safety and health hazards, chemical exposures, slip, trips, and falls, repetitive motion, the application of the hierarchy of control including lockout/tagout, machine guarding, personal protective equipment, among others. Evaluation surveys assessed attendee demographics, perceived job hazards, confidence to change workplace practices, knowledge, training relevancy and quality, intent to change behavior, as well as barriers and resources.

RESULTS

A total of 208 people attended the safety trainings. One hundred and thirty-four participants (64%) completed the pre-training survey and 107 (51%) completed the post-training survey. Respondents provided high ratings for the quality and relevance of the training, with 91.3% of respondents rating the training very good or excellent. Before the training, the attendees listed their most concerning safety and health issues as exposure to pesticides and other chemicals (65.7%), absorbing chemicals through the skin (56.7%), slips, trips, and falls (52.2%), and respiratory hazards (50.7%). After the training, they reported the most concerning hazards to be slips, trips, and fall hazards (65.4%), ergonomic problems (64.5%), and respiratory issues (61.7%). There was a statistically non-significant increase in knowledge scores from 67.1% correct to 76.0% correct. Finally, 88.5% of respondents felt extremely or very confident that they could change their own health and safety practices at work.

CONCLUSIONS

The training successfully reached cannabis employees in cultivation, compliance, and management. Survey respondents felt that the training was of high quality and addressed gaps in their knowledge related to safety and health hazards in the cannabis industry. The workplace safety and health concerns shifted from pre- to post-training. There was a statistically non-significant increase in knowledge. Additional follow-up of training attendees would be beneficial to measure sustained impact of training.

Allergic and Respiratory Symptoms in Employees of Indoor Cannabis Grow Facilities

BACKGROUND

While little is known about the occupational hazards associated with Cannabis cultivation, both historical research in the hemp industry and preliminary data from modern grow houses, suggest that Cannabis workers may be at increased risk of respiratory and allergic diseases.

OBJECTIVES

We sought to investigate the association between workplace exposures and health symptoms in an indoor Cannabis grow facility in Washington State, USA.

METHODS

We performed a cross-sectional study with all consenting employees in an indoor Cannabis grow facility in Seattle, WA using a questionnaire. The questionnaire gathered data on respiratory, ocular, nasal, and dermal symptoms. A subset of employees with work-related symptoms underwent repeated cross-shift and cross-week measurement of spirometry, fractional exhaled nitrogen oxide (FeNO), and skin prick testing for Cannabis sensitization. Exposure to Cannabis dust was classified based on self-described tasks, expert opinion, and exposure monitoring of particulate matter. Multivariable logistic regression was undertaken to examine associations between exposure to Cannabis dust (classified as low, medium, and high) and health symptoms. Linear mixed effects models examined the relationship between cross-shift and cross-week changes in spirometry and FeNO.

RESULTS

Ninety-seven percent (97%) of the employees (n = 31) surveyed were recreational cannabis users, with 81% (n = 25) smoking cannabis multiple times per day. Twenty-two (71%) employees reported one or more work-related symptoms: 65% respiratory, 39% ocular, 32% nasal, and 26% dermal symptoms. There was a trend toward increased likelihood of work-related symptoms with increasing exposure to Cannabis dust, although none of these results were statistically significant. Of the 10 employees with work-aggravated symptoms, 5 had borderline-high or high FeNO, 7 had abnormal spirometry, and 5 had evidence of Cannabis sensitization on skin prick testing. FeNO increased by 3.78 ppb (95% confidence interval 0.68-6.88 ppb) across the work-week and there was a trend toward cross-week and cross-shift reduced airflow.

CONCLUSIONS

We found a high prevalence of work-related allergic- and particularly respiratory symptoms in the employees of one indoor Cannabis grow facility in Washington State. A high proportion of employees with work-aggravated symptoms had findings consistent with probable work-related asthma based on high FeNO, airflow obstruction on spirometry, and Cannabis sensitization on skin prick testing. However, due to the high incidence of recreational cannabis use among these workers, the relative influence of occupational versus recreational exposure to Cannabis dust on the respiratory health and sensitization status of these workers could not be resolved in this study.

High Risk? Indoor Cannabis Producers' Perceptions of Occupational Health and Safety

Introduction: Recent legal changes mean Canadian cannabis production has moved from an illegally grown crop to a potentially common one. However, little is known about the needs of long-time producers accustomed to operating outside a legal framework. In order to develop effective safety communication strategies, there is a need to better understand cannabis producers' perceptions of OHS regulations, OHS controls, and sources of OHS information.Methods: The specific objectives of this study are to (1) Describe production tasks and identify potential hazards related to these tasks and (2) describe workers' current sources of OHS information.This study gathered two types of information: facility and production information gathered from key informants during three facility walkthroughs, and health and safety perceptions gathered during face to face interviews with nine cannabis production workers. Interviews were thematically analyzed using interpretive description.Results: Cannabis production and related occupational health and safety issues occur within a larger context, and descriptions of contextual factors were interwoven with workers' responses which, on the whole, expressed positive views of occupational health and safety. Perceived barriers to OHS included cost, lack of specialized skills, and lack of worker consultation, while named sources of OHS information included courses, requests to OHS agencies, and the internet.Conclusion: It is hoped that an enhanced understanding of Canadian cannabis producers can inform the development of effective occupational health and safety interventions to promote the health and productivity in this workforce.

Interpol review of controlled substances 2016-2019

This review paper covers the forensic-relevant literature in controlled substances from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20Papers%202019.pdf.

Evaluation of Pesticides Found in Oregon Cannabis from 2016 to 2017

Pesticide use and worker exposures to pesticides in the US cannabis industry have not been studied due to cannabis being illegal at the federal level. Without knowing the types of pesticides being used in this industry, it is difficult to assess whether workers are being exposed to potentially dangerous pesticides. When recreational cannabis became legal in the state of Oregon in 2014, the Oregon Department of Agriculture (ODA) published a list of recommended pesticides for use in the cannabis industry and developed the state's pesticide testing regulations for all cannabis products, medicinal and recreational. Using the state's pesticide testing data, the aim of this study was to investigate the types of pesticides being used in the Oregon cannabis industry and if they present a hazard to cannabis workers. Both recreational and medicinal cannabis samples contained high levels of residual pesticides and pesticides not legally allowed to be used on cannabis products. Medicinal cannabis products were found to have mean levels of residual pesticides that were 3–12 times higher than recreational products. Nine of the 50 pesticides identified were classified highly or extremely hazardous by the World Health Organization.

Potential occupational and respiratory hazards in a Minnesota cannabis cultivation and processing facility

BACKGROUND

Cannabis has been legalized in some form for much of the United States. The National Institute for Occupational Safety and Health (NIOSH) received a health hazard evaluation request from a Minnesota cannabis facility and their union to undertake an evaluation.

METHODS

NIOSH representatives visited the facility in August 2016 and April 2017. Surface wipe samples were collected for analysis of delta-9 tetrahydrocannabinol (Δ9-THC), delta-9 tetrahydrocannabinol acid (Δ9-THCA), cannabidiol, and cannabinol. Environmental air samples were collected for volatile organic compounds (VOCs), endotoxins (limulus amebocyte lysate assay), and fungal diversity (NIOSH two-stage BC251 bioaerosol sampler with internal transcribed spacer region sequencing analysis).

RESULTS

Surface wipe samples identified Δ9-THC throughout the facility. Diacetyl and 2,3-pentanedione were measured in initial VOC screening and subsequent sampling during tasks where heat transference was greatest, though levels were well below the NIOSH recommended exposure limits. Endotoxin concentrations were highest during processing activities, while internal transcribed spacer region sequencing revealed that the Basidiomycota genus, Wallemia, had the highest relative abundance.

CONCLUSIONS

To the authors' knowledge, this is the first published report of potential diacetyl and 2,3-pentanedione exposure in the cannabis industry, most notably during cannabis decarboxylation. Endotoxin exposure was elevated during grinding, indicating that this is a potentially high-risk task. The findings indicate that potential health hazards of significance are present during cannabis processing, and employers should be aware of potential exposures to VOCs, endotoxin, and fungi. Further research into the degree of respiratory and dermal hazards and resulting health effects in this industry is recommended.