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

Bioaerosol Exposures and Respiratory Diseases in Cannabis Workers

PURPOSE OF REVIEW

This review investigates occupational inhalation hazards associated with biologically derived airborne particles (bioaerosols) generated in indoor cannabis cultivation and manufacturing facilities.

RECENT FINDINGS

Indoor cannabis production is growing across the US as are recent reports of respiratory diseases among cannabis workers, including occupational asthma morbidity and mortality. More information is needed to understand how bioaerosol exposure in cannabis facilities impacts worker health and occupational disease risk. Preliminary studies demonstrate a significant fraction of airborne particles in cannabis facilities are comprised of fungal spores, bacteria, and plant material, which may also contain hazardous microbial metabolites and allergens. These bioaerosols may pose pathogenic, allergenic, toxigenic, and pro-inflammatory risks to workers. The absence of multi-level, holistic bioaerosol research in cannabis work environments necessitates further characterization of the potential respiratory hazards and effective risk prevention methods to safeguard occupational health as the cannabis industry continues to expand across the US and beyond.

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.

Cannabis Cultivation Facilities: A Review of Their Air Quality Impacts from the Occupational to Community Scale

This review addresses knowledge gaps in cannabis cultivation facility (CCF) air emissions by synthesizing the peer-reviewed and gray literature. Focus areas include compounds emitted, air quality indoors and outdoors, odor assessment, and the potential health effects of emitted compounds. Studies suggest that β-myrcene is a tracer candidate for CCF biogenic volatile organic compounds (BVOCs). Furthermore, β-myrcene, d-limonene, terpinolene, and α-pinene are often reported in air samples collected in and around CCF facilities. The BVOC emission strength per dry weight of plant is higher than most conventional agriculture crops. Nevertheless, reported total CCF BVOC emissions are lower compared with VOCs from other industries. Common descriptors of odors coming from CCFs include "skunky", "herbal", and "pungent". However, there are few peer-reviewed studies addressing the odor impacts of CCFs outdoors. Atmospheric modeling has been limited to back trajectory models of tracers and ozone impact assessment. Health effects of CCFs are mostly related to odor annoyance or occupational hazards. We identify 16 opportunities for future studies, including an emissions database by strain and stage of life (growing cycle) and odor-related setback guidelines. Exploration and implementation of key suggestions presented in this work may help regulators and the industry reduce the environmental footprint of CCF facilities.

Surveillance of work-related asthma including the emergence of a cannabis-associated case series in Washington State

OBJECTIVE

We conducted surveillance for work-related asthma (WRA) in Washington State to identify the industry sectors and asthma exposures most commonly affecting injured workers and in need of prevention activities.

METHODS

Using workers' compensation data as the primary data source, valid cases were classified as work-aggravated asthma (WAA) or new onset asthma that includes occupational asthma (OA) and reactive airways dysfunction syndrome (RADS). The source of exposure that caused the worker's asthma, their industry and occupation were determined.

RESULTS

There were 784 valid work-related asthma cases identified for the period 2009-2016, WAA (n = 529) was most common followed by occupational asthma (n = 127) and RADS (n = 12). The Health Care and Social Assistance industry had the highest number of cases (n = 170) with 82% classified as WAA. The highest overall proportions of new onset asthma are occurring in Agriculture, Forestry, Fishing and Hunting (33% of work related asthma cases), Manufacturing (31%) and Construction (30%). The leading substances associated with new onset asthma across all industries include hop plant dust, wood and cedar dust, mineral and inorganic dust, mold, and cleaning materials. We describe ten cases of cannabis-associated asthma including seven from workers in the legalized cannabis industry, four of whom had OA.

CONCLUSION

State-based work-related asthma surveillance is critical in identifying the workers and exposures associated with this occupational disease, including the detection of a case-series in the cannabis industry.

Occupational Allergies to Cannabis

Within the last decade there has been a significant expansion in access to cannabis for medicinal and adult nonmedical use in the United States and abroad. This has resulted in a rapidly growing and diverse workforce that is involved with the growth, cultivation, handling, and dispensing of the cannabis plant and its products. The objective of this review was to educate physicians on the complexities associated with the health effects of cannabis exposure, the nature of these exposures, and the future practical challenges of managing these in the context of allergic disease. We will detail the biological hazards related to typical modern cannabis industry operations that may potentially drive allergic sensitization in workers. We will highlight the limitations that have hindered the development of objective diagnostic measures that are essential in separating "true" cannabis allergies from nonspecific reactions/irritations that "mimic" allergy-like symptoms. Finally, we will discuss recent advances in the basic and translational scientific research that will aid the development of diagnostic tools and therapeutic standards to serve optimal management of cannabis allergies across the occupational spectrum.

Cannabis: An Emerging Occupational Allergen?

Cannabis is the most commonly used psychoactive drug. In recent years, Cannabis access has expanded for both medicinal and non-medicinal has grown. This is also marked with an increasing number of individuals gaining employment in this emerging industry. In this article, we briefly discuss the health hazards associated with Cannabis exposure with an emphasis on the potential for allergic reactions in workers who handle and process Cannabis plant.

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.