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DOI: 10.1055/s-0043-1766116
The Emerging Spectrum of Respiratory Diseases in the U.S. Cannabis Industry
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Abstract
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.
Publication History
Article published online:
04 April 2023
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References
- 1 Barcott B, Whitney BBJ. Leafly Jobs Report 2022. 2022 Leafly Holdings, Inc. Accessed March 14, 2023, at: https://leafly-cms-production.imgix.net/wp-content/uploads/2022/02/18122113/Leafly-JobsReport-2022-12.pdf
- 2 New Cannabis Jobs Report Reveals Marijuana Industry's Explosive Employment Growth. Accessed February 8, 2023, at: https://www.forbes.com/sites/ajherrington/2022/02/23/new-cannabis-jobs-report-reveals-marijuana-industrys-explosive-employment-growth/?sh=57f7b1123f2a
- 3 Reports Global Cannabis Sales Will Grow BDSA. 10% in 2022; Forecasts $57 Billion Market by 2026. Accessed September 17, 2022, at: https://apnews.com/article/united-states-5571a211c1dca06e198f947cefe6e96c
- 4 State Medical Cannabis Laws. Accessed February 8, 2023, at: https://www.ncsl.org/health/state-medical-cannabis-laws
- 5 Marijuana Occupational Health and Safety Work Group. Guide to Worker Safety and Health in the Marijuana Industry_ FULL REPORT.pdf - Google Drive. Colorado Department of Public Health & Environment. Published; 2017. Accessed September 4, 2019, at: https://drive.google.com/file/d/0B0tmPQ67k3NVb1IydUQxSkZRS1U/view
- 6 Couch JR, Grimes GR, Green BJ, Wiegand DM, King B, Methner MM. Review of NIOSH cannabis-related health hazard evaluations and research. Ann Work Expo Health 2020; 64 (07) 693-704
- 7 Simpson C. Editorial Occupational Health and Safety in the Cannabis Industry. Annals of Work Exposures and Health 2020; 64 (07) 677-678
- 8 Industrial Hemp Production. Accessed September 17, 2022, at: https://extension.psu.edu/industrial-hemp-production
- 9 Ramazzini B. De morbis artificum diatriba [diseases of workers]. 1713. Am J Public Health 2001; 91 (09) 1380-1382
- 10 Er M, Emri SA, Demir AU. et al. Byssinosis and COPD rates among factory workers manufacturing hemp and jute. Int J Occup Med Environ Health 2016; 29 (01) 55-68
- 11 Bouhuys A, Zuskin E. Chronic respiratory disease in hemp workers. A follow-up study, 1967-1974. Ann Intern Med 1976; 84 (04) 398-405
- 12 Zuskin E, Kanceljak B, Pokrajac D, Schachter EN, Witek Jr TJ. Respiratory symptoms and lung function in hemp workers. Br J Ind Med 1990; 47 (09) 627-632
- 13 Valić F, Zuskin E, Walford J, Kersić W, Pauković R. Byssinosis, chronic bronchitis, and ventilatory capacities in workers exposed to soft hemp dust. Br J Ind Med 1968; 25 (03) 176-186
- 14 Lai PS, Christiani DC. Long-term respiratory health effects in textile workers. Curr Opin Pulm Med 2013; 19 (02) 152-157
- 15 McL Niven R, Pickering CA. Byssinosis: a review. Thorax 1996; 51 (06) 632-637
- 16 Kennedy SM, Christiani DC, Eisen EA. et al. Cotton dust and endotoxin exposure-response relationships in cotton textile workers. Am Rev Respir Dis 1987; 135 (01) 194-200
- 17 Castellan RM, Olenchock SA, Kinsley KB, Hankinson JL. Inhaled endotoxin and decreased spirometric values. An exposure-response relation for cotton dust. N Engl J Med 1987; 317 (10) 605-610
- 18 Martyny JW, Serrano KA, Schaeffer JW, Van Dyke MV. Potential exposures associated with indoor marijuana growing operations. J Occup Environ Hyg 2013; 10 (11) 622-639
- 19 Potter DJ. A review of the cultivation and processing of cannabis (Cannabis sativa L.) for production of prescription medicines in the UK. Drug Test Anal 2014; 6 (1-2): 31-38
- 20 Davidson M, Reed S, Oosthuizen J. et al. Occupational health and safety in cannabis production: an Australian perspective. Int J Occup Environ Health 2018; 24 (3-4): 75-85
- 21 Sack C, Ghodsian N, Jansen K, Silvey B, Simpson CD. Allergic and respiratory symptoms in employees of indoor cannabis grow facilities. Ann Work Expo Health 2020; 64 (07) 754-764
- 22 Walters KM, Fisher GG, Tenney L. An overview of health and safety in the Colorado cannabis industry. Am J Ind Med 2018; 61 (06) 451-461
- 23 Skypala IJ, Jeimy S, Brucker H. et al; International Cannabis Allergy Collaboration. Cannabis-related allergies: an international overview and consensus recommendations. Allergy 2022; 77 (07) 2038-2052
- 24 Poole JA, Romberger DJ. Immunological and inflammatory responses to organic dust in agriculture. Curr Opin Allergy Clin Immunol 2012; 12 (02) 126-132
- 25 Sigsgaard T, Basinas I, Doekes G. et al. Respiratory diseases and allergy in farmers working with livestock: a EAACI position paper. Clin Transl Allergy 2020; 10 (01) 29
- 26 Schenker MB, Christiani D, Cormier Y. et al. Respiratory health hazards in agriculture. Am J Respir Crit Care Med 1998; 158 (5 Pt 2): S1-S76
- 27 Fishwick D, Allan LJ, Wright A, Curran AD. Assessment of exposure to organic dust in a hemp processing plant. Ann Occup Hyg 2001; 45 (07) 577-583
- 28 Green BJ, Couch JR, Lemons AR. et al. Microbial hazards during harvesting and processing at an outdoor United States cannabis farm. J Occup Environ Hyg 2018; 15 (05) 430-440
- 29 Silvey B, Seto E, Gipe A, Ghodsian N, Simpson CD. Occupational exposure to particulate matter and volatile organic compounds in two indoor cannabis production facilities. Ann Work Expo Health 2020; 64 (07) 715-727
- 30 Punja ZK, Collyer D, Scott C, Lung S, Holmes J, Sutton D. Pathogens and molds affecting production and quality of Cannabis sativa L. Front Plant Sci 2019; 10: 1120
- 31 Root KS, Magzamen S, Sharp JL, Reynolds SJ, Van Dyke M, Schaeffer JW. Application of the environmental relative moldiness index in indoor marijuana grow operations. Ann Work Expo Health 2020; 64 (07) 728-744
- 32 California Department of Pesticide Regulation. A pocket guide to Pesticides found in illegal cannabis grow operations. Accessed March 14, 2023 at: https://www.cdpr.ca.gov/docs/cannabis/pocket_guide.pdf
- 33 Pesticide Use | Washington State Department of Agriculture. Accessed October 24, 2022, at: https://agr.wa.gov/departments/marijuana/pesticide-use
- 34 Which Pesticides Can I Use on Cannabis in California? Accessed October 24, 2022, at: https://www.cdpr.ca.gov/docs/cannabis/questions.htm
- 35 Pesticide Use in Cannabis Production Information | Department of Agriculture. Accessed October 24, 2022, at: https://ag.colorado.gov/plants/pesticides/pesticide-use-in-cannabis-production-information
- 36 Evoy R, Kincl L. Evaluation of pesticides found in Oregon cannabis from 2016 to 2017. Ann Work Expo Health 2020; 64 (07) 770-774
- 37 Cuypers E, Vanhove W, Gotink J, Bonneure A, Van Damme P, Tytgat J. The use of pesticides in Belgian illicit indoor cannabis plantations. Forensic Sci Int 2017; 277: 59-65
- 38 Seltenrich N. Odor control in the cannabis industry: lessons from the new kid on the block. Environ Health Perspect 2022; 130 (06) 62001
- 39 Silvey B. Characterization of Occupational Exposure to Airborne Contaminants in an Indoor Cannabis Production Facility. Seattle, WA: University of Washington; 2019
- 40 Samburova V, McDaniel M, Campbell D, Wolf M, Stockwell WR, Khlystov A. Dominant volatile organic compounds (VOCs) measured at four Cannabis growing facilities: pilot study results. J Air Waste Manag Assoc 2019; 69 (11) 1267-1276
- 41 de Ferreyro Monticelli D, Bhandari S, Eykelbosh A, Henderson SB, Giang A, Zimmerman N. Cannabis cultivation facilities: a review of their air quality impacts from the occupational to community scale. Environ Sci Technol 2022; 56 (05) 2880-2896
- 42 Couch J, Wiegand D, Grimes GR. Centers for Disease Control and Prevention. Evaluation of a Medicinal Cannabis Manufacturing Facility with an Indoor and Outdoor Grow Operation. National Institute for Occupational Health and Human Safety, Health Hazard Evaluation Report. accessed March 14, 2023 at: https://www.cdc.gov/niosh/hhe/reports/pdfs/2016-0090-3317revised082019.pdf
- 43 Couch JR, Grimes GR, Wiegand DM. et al. Potential occupational and respiratory hazards in a Minnesota cannabis cultivation and processing facility. Am J Ind Med 2019; 62 (10) 874-882
- 44 Souza JDS, Fassoni-Ribeiro M, Batista RM. et al. Case report: cannabidiol-induced skin rash: a case series and key recommendations. Front Pharmacol 2022; 13: 881617
- 45 Decuyper II, Rihs HP, Van Gasse AL. et al. Cannabis allergy: what the clinician needs to know in 2019. Expert Rev Clin Immunol 2019; 15 (06) 599-606
- 46 Ocampo TL, Rans TS. Cannabis sativa: the unconventional “weed” allergen. Ann Allergy Asthma Immunol 2015; 114 (03) 187-192
- 47 Chatkin JM, Zani-Silva L, Ferreira I, Zamel N. Cannabis-associated asthma and allergies. Clin Rev Allergy Immunol 2019; 56 (02) 196-206
- 48 Decuyper II, Van Gasse AL, Faber MA. et al. Exploring the diagnosis and profile of cannabis allergy. J Allergy Clin Immunol Pract 2019; 7 (03) 983-989.e5
- 49 Decuyper II, Green BJ, Sussman GL. et al. Occupational allergies to cannabis. J Allergy Clin Immunol Pract 2020; 8 (10) 3331-3338
- 50 Herzinger T, Schöpf P, Przybilla B, Ruëff F. IgE-mediated hypersensitivity reactions to cannabis in laboratory personnel. Int Arch Allergy Immunol 2011; 156 (04) 423-426
- 51 Silvers WS, Bernard T. Spectrum and prevalence of reactions to marijuana in a Colorado allergy practice. Ann Allergy Asthma Immunol 2017; 119 (06) 570-571
- 52 Decuyper II, Van Gasse A, Faber MA. et al. Occupational cannabis exposure and allergy risks. Occup Environ Med 2019; 76 (02) 78-82
- 53 Mayoral M, Calderón H, Cano R, Lombardero M. Allergic rhinoconjunctivitis caused by Cannabis sativa pollen. J Investig Allergol Clin Immunol 2008; 18 (01) 73-74
- 54 Engler DB, Malick AA, Saraf SK, Dargel LA. Severe marijuana allergy controlled with omalizumab. J Allergy Clin Immunol 2013; 131 (02) AB215
- 55 Majmudar V, Azam NAM, Finch T. Contact urticaria to Cannabis sativa. Contact Dermat 2006; 54 (02) 127-127
- 56 Williams C, Thompstone J, Wilkinson M. Work-related contact urticaria to Cannabis sativa. Contact Dermat 2008; 58 (01) 62-63
- 57 Rojas Pérez-Ezquerra P, Sánchez-Morillas L, Davila-Ferandez G. et al. Contact urticaria to Cannabis sativa due to a lipid transfer protein (LTP). Allergol Immunopathol (Madr) 2015; 43 (02) 231-233
- 58 Reeb-Whitaker C, LaSee CR, Bonauto DK. Surveillance of work-related asthma including the emergence of a cannabis-associated case series in Washington State. Journal of Asthma 2022; 59 (08) 1537-1547
- 59 OSHA. Cultivation facility worker died after inhaling ground cannabis dust. Accessed October 24, 2022, at: https://www.boston.com/news/local-news/2022/10/06/osha-trulieve-worker-asthma-death-cannabis/
- 60 Llamas R, Hart DR, Schneider NS. Allergic bronchopulmonary aspergillosis associated with smoking moldy marihuana. Chest 1978; 73 (06) 871-872
- 61 Kagen SL, Kurup VP, Sohnle PG, Fink JN. Marijuana smoking and fungal sensitization. J Allergy Clin Immunol 1983; 71 (04) 389-393
- 62 Gargani Y, Bishop P, Denning DW. Too many mouldy joints - marijuana and chronic pulmonary aspergillosis. Mediterr J Hematol Infect Dis 2011; 3 (01) e2011005
- 63 Stanojevic S, Kaminsky DA, Miller MR. et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J 2022; 60 (01) 2101499
- 64 WAC 296–20–370: Accessed February 12, 2023, at: https://app.leg.wa.gov/wac/default.aspx?cite=296-20-370
- 65 Pal I, Sinha BabuA, Halder I, Kumar S. Nasal smear eosinophils and allergic rhinitis. Ear Nose Throat J 2017; 96 (10-11): E17-E22
- 66 Tarlo SM, Balmes J, Balkissoon R. et al. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement. Chest 2008; 134 (3, suppl): 1S-41S
- 67 Hierarchy of Controls | NIOSH | CDC. Accessed February 8, 2023, at: https://www.cdc.gov/niosh/topics/hierarchy/default.html
- 68 Gardner M, Reed S, Davidson M. Assessment of worker exposure to occupational organic dust in a hemp processing facility. Ann Work Expo Health 2020; 64 (07) 745-753