HEALTH AND SAFETY OF CALIFORNIA CANNABIS...

HEALTH AND SAFETY OF CALIFORNIA CANNABIS

WORKERS

Marc B Schenker, MD MPHDistinguished Professor Emeritus

Public Health Sciences and MedicineWestern Center for Ag Health and Safety

University of California at Davis

Cannabis Industry Occupational Hazards: Presentation Outline

Background‒ Cannabis Industry and Workers in California

Occupational Hazards and Health Effects‒ Respiratory and Dermal Exposure

‒ Explosions and Fires

‒ Repetitive Strain

‒ Physical Hazards

‒ Workplace Violence

Conclusions 2019 North American Cannabis Summit 2

Background

Cannabis Industry and Workers in California

2019 North American Cannabis Summit 3

California Regional Production


About 8 million pounds in North Coast and North Mountains

About 3 million pounds in the Central Valley

About 2 million pounds in the Central and South Coastal regions with most California population

Source: ERA Economics

Presenter

Presentation Notes

Emerald Triangle is Humboldt, Trinity and Mendocino counties

CalCannabis: Types of Cultivation Sites


1. Outdoor Cultivation

Without the use of light deprivation and/or artificial lighting in the canopy area

2. Indoor Cultivation

Artificial light at a rate greater than 25 watts per square ft.

3. Mixed-light Cultivation

Light deprivation and/or artificial lighting below a rate of 25 watts per square ft.

4. Nursery Cultivation

Clones, immature plants, seeds

Cannabis Production

Planting, Cultivation, Harvesting


Presenter

Presentation Notes

Nursery, Hoop houses, green netting, harvesting

Post-processing (1)


Hand trimming

DestemmingDrying Hand trimming

Trimming table in a farmTrimming table in a

processing plant

Post-processing (2)


California Cannabis Workers


Estimated *FTE workers: Outdoor 127,000

Indoor 40,000

Mixed light-greenhouse 30,000

TOTAL ~197,000

Cultivators: full-time workers, traditionally young, white, male

Trimmers / processors: part time - seasonal.

* FTE = full-time equivalent with 2,000 hrs/year.

Source: ERA Economics

Presenter

Presentation Notes

Small farms employ mean of 3 full time and 4 part-time employees Medium farms 8 full time and 4 part-time Large farms, automated often 3 full time and a few part-time employees.

Cannabis Farm and Processing Locations

Major production has been in small, remote, rural locations, esp. in Northern California

No registry and illegal status further compound challenge of obtaining representative health data

No large studies of worker populations, as in other production ag

Much of health risk conclusions based on limited data, inference from other ag health data


Trimmigrants


Traditionally immigrants, foreign vacationers, college students, young working professionals. With more industrial production, changing to labor contractors in processing facilities, often with older female workers.

California Cannabis Industry Licensing and Regulation

Bureau of Cannabis Control Testing laboratories

Cal Cannabis Cultivation, CDFA Any cultivation activity

• Manufactured Cannabis Safety Branch Extraction, infusion, packaging

Dept. Pesticide Regulation Pesticide handling, residue

California EPA Environmental impacts

California OSHA Workplace safety and health


Methods

Literature Review‒ Media, academic and industry research, official aggregate data

Site Visits & Key Interviews‒ 3 outdoor growing facilities‒ 2 indoor growing facilities‒ 1 extraction facility‒ 1 distribution facility (for cannabis extraction equipment)

‒ 1 processing plant (under construction)


Cannabis Industry Occupational Hazards Respiratory & Dermal Exposures

‒ Allergens‒ Chemical exposures‒ Microbiological exposures

Musculoskeletal Disorders (Ergonomic Risks)

Physical Hazards‒ Electrical Hazards‒ Cuts, abrasions, etc.‒ Compressed gas explosion, fire

Workplace Violence‒ Robbery, assault 2019 North American Cannabis Summit 14

Respiratory Health Hazards in Agriculture


Schenker, et al. AJRCCM, Nov 1998

Respiratory Hazards in Agriculture

EXPOSURE EXAMPLES

Organic dusts‒ Vegetable Grain, hay, cotton ‒ Animal Hair, feathers, skin, dander‒ Microbial Bacterial and fungal antigens, endotoxin

Gases H2S, NH3, CH4, CO2, NO2

Chemicals Paraquat, solvents, fuels, exhausts

Inorganic dust Silica, silicates, asbestos2019 North American Cannabis Summit 16

Agricultural Associated Airway Disorders

Upper Airway Responses‒ Nasal to larynx (inflammatory responses from organic dusts, gases and

pesticides)

Asthma and Asthma-like syndrome‒ (allergic v non-allergic, similar symptoms; reversible)‒ May eventually lead to Chronic Obstructive Airway Disease

Gas Inhalation ‒ (discussed after biological exposures)

2019 North American Cannabis Summit 17Schenker, AJRCCM Suppl: Nov ‘98

Odds Ratios* for Respiratory Symptoms by Percent Time at Dusty Job, CA farmers


00.20.40.60.8

11.21.41.61.8

2

Odd

s Ra

tio

PersistentWheeze

ChronicBronchitis

ChronicCough

Asthma

0% 1-49% >49%

*Logistic regression, adjusted for age, smoking status, gender and other variables

Schenker, JOEM, 2006

Age-Adjusted Prevalences for Chronic Conditions: NHIS


02468

101214161820

Asthma COPD CV Dis HBP

FarmerBlue CollarWhite Collar

Brackbill, AJE, 1994

Occupational Asthma

Exposure to workplace airborne irritants, allergens ‒ organic dusts examples include hay, mites, animal dander, endotoxin, gases (ammonia) and pesticides

Asthma symptoms of chest tightness, chronic cough, wheeze and/or shortness of breath.

Airway inflammation

Worsen existing asthma

Without treatment becomes chronic


Examples of Agents in Agriculture Causing Occupational Asthma Plant-derived

‒ Cereals‒ Grain dust mites‒ Soya bean dust‒ Coffee dust

Animal-derived‒ Cow dander, urine

Arthropod-derived Other

‒ NH3, NO2 (high concentrations)‒ Pesticides (?)


Agricultural Respiratory Disease: Asthma-like Syndrome Acute non-allergic airway response from inhalation of agents in

ag environment. Symptoms of chest tightness, wheeze and/or dyspnea. May be cross-shift decline in FEV1 (<10%). Airway inflammation; PMNs, cytokines. Transient increase in airway responsiveness. Dose-related effects. Self-limited inflammatory event.


Agricultural Lung Disease: Alveolar and Interstitial Disorders

Interstitial (non-airway) tissue affected

Organic Dust Toxic Syndrome (ODTS)

Farmer’s Hypersensitivity Pneumonitis

(Farmer’s Lung)

Interstitial Fibrosis


Organic Dust Toxic Syndrome (ODTS) Exposure to moldy dust - containing endotoxins,

fungi, mycotoxins, bacteria – example cotton dust

Acute inflammatory condition of airways and alveoli.

Symptoms: fever, flu-like, coughing, aching, headache, lethargy

Systemic symptoms peak 4-8 hrs. after exposure.

Not due to hypersensitivity.

Self-limited, excellent prognosis.


Hypersensitivity Pneumonitis

Sensitization to repeated inhalation of dusts containing fungal spores

Causes inflamed alveoli in the lungs which may scar

Symptoms: allergic reaction ‒ Acute : flu-like fever, chills, joint pain, headache , cough – occur

within 9 hours of exposure‒ Chronic : bronchitis, cough,

shortness of breath fatigue, weight loss, can lead toirreversible lung damage


Agricultural Lung Disease: Infections

Bacteria……………………….

Mycobacteria…………………

Fungi……………....................

Viruses………………………...

Parasites………………………

Anthrax, brucellosis, leptospirosis, pasturellosis, psittacosis, Q fever, streptoccal.

M. Tuberculosis, M. Bovis

Aspergillosis, coccidiodomycosis, cryptococcis, histoplasmosis,

Hantavirus, swine influenza

Ascariasis, dirofilariasis, echinococcosis, paragonimiasis


Cannabis Production:Respiratory and Dermal Exposures Allergens…………....................

Chemical Exposures…………..

Microbiological Exposures……

C. sativa, THC (delta-9-tetrahyrocannabinol)

Pesticides, Rodenticides, Fungicides, Insecticides, Corrosive materials in plant amendments

Endotoxins, Bacteria, Fungi (including mold), predatory mites


Known Respiratory Hazards in the Cannabis Industry (1)

OSHA - no indoor or outdoor occupational microbe air contamination rules

Endotoxin– fragmented (dead) Gram neg bacteria‒ *Outdoor facility tested in WA - airborne concentrations lower than European

recommended limits (90 EU/m3)‒ **Indoor hemp processing plant – 1,900 EU/m3 – high, health effects likely –

similar in other greenhouse crops

Microbial ‒ *Outdoor facility found bacteria which cause respiratory health effects (asthma,

ODTS, HP, chronic bronchitis). Levels below those found in animal feeding operations.

2019 North American Cannabis Summit 28*Couch et al (2017) ** Dutkiewicz et al (2001)

Presenter

Presentation Notes

Microbial – Actinobacteria ~50% (Gram +ve) and Gram –ve = ~ 40% of remaining bacteria are knowing to cause many of the respiratory health effects (asthma, ODTS, HP, chronic bronchitis). No set exposure limits, levels generally below those found in indoor animal feeding operations. REFS: *Couch J et al, Evaluation of Potential Hazards during Harvesting and Processing Cannabis at an Outdoor Organic Farm. NIOSH HHE report 2015-0111-3271, April 2017 ** Dutkiewicz et al, Exposure to airborne microorganisms and endotoxin in herb processing plants. (2001) Ann Agric. Environ Med 8(2) :201-11 Thilsing T. et al Dust, endotoxin, fungi and bacteria exposure as determined by work task, season, and type of plant in a flower greenhouse Ann Occup Hyg (2015) 59 (2): 142-157 Martyny, JW et al. Report: Health Effects Associated with Indoor Marijuana Grow Operations. Press Release September 10, 2012 National Jewish Health, Denver CO. Journal Article: Potential exposures associated with indoor marijuana growing operations. J Occup Environ Hyg. (2013); 10 (11): 622-39 doi: 10.1080/15459624.2013.831986.

Known Respiratory Hazards in the Cannabis Industry (2)

*Outdoor facility – only relative abundance collected in one facility

• Predominantly Botrytis cinerea - grey mold in Cannabis sativa

**Indoor facilities may have total concentrations ≥ (1 x 105) spores per m3 air – likely harmful with prolonged exposure

2019 North American Cannabis Summit 29*Couch et al (2017); **Martyny et al (2012)

Presenter

Presentation Notes

Fungal - mostly Basidiomycota phyla in outdoor samples and Ascomycota Phyla in greenhouse The most common species was Botrytis cinerea – in the Ascomycota * REFS: *Couch J et al, Evaluation of Potential Hazards during Harvesting and Processing Cannabis at an Outdoor Organic Farm. NIOSH HHE report 2015-0111-3271, April 2017 **Martyny, JW et al. Report: Health Effects Associated with Indoor Marijuana Grow Operations. Press Release September 10, 2012 National Jewish Health, Denver CO. Journal Article: Potential exposures associated with indoor marijuana growing operations. J Occup Environ Hyg. (2013); 10 (11): 622-39 doi: 10.1080/15459624.2013.831986.

Indoor Conditions


• Potential for greater exposure to pesticides and concentrated chemicals than outdoors

• High humidity levels – promote mold growth

• Poor ventilation practices

Dermal Exposures: Effects

Dermatological exposures to ‒ THC (delta-9-tetrahyrocannabinol) commonly found on all surfaces

where cannabis cultivated or processed‒ Fungi‒ Cannabis sativa vegetation‒ Corrosive materials in plant amendments

Symptoms: ‒ irritation or burns to skin‒ allergic dermatitis

• Hives, itching, swollen eyes2019 North American Cannabis Summit 31

Presenter

Presentation Notes

THC toxicity unlikely, but not well described in research literature as yet. Topicals are non-psychoactive, so they are often popular among patients who want the therapeutic effects of cannabis but not the “high”. This non-psychoactivity is because the cannabinoids in these topicals bind to CB2 receptors near the skin, activating the endocannabinoid system, and are never absorbed into the bloodstream. Because human skin has a low absorption rate for these cannabinoids, coverage and dose need to be large enough to overcome this barrier (Challapalli & Stinchcomb, 2002). This is why most cannabis topicals suggest applying “liberally” to the affected location. However, CBN (cannabinol) which is mildly psychoactive and CBD (cannabidiol) which is not psychoactive and has calming properties are more permeable to the skin than THC and are more likely to stimulate the CB2 cannabinoid receptors, making them the popular choice for the manufacture of cannabis topicals (Jorge et al., 2011). Since CBD contents are much higher in commercial hemp than in marijuana, hemp is a more viable and less toxic source of CBD for use in topicals. A 2007 study completed by an international research group detailed how “enhanced activation of the endocannabinoid system” helps regulate immune responses in the skin, meaning topicals may be useful in treatment of skin allergies (Gaffal et al., 2013). Topical applications of cannabinoids also benefit the skin thanks to their anti-inflammatory, antibacterial, and immunity-modulating properties. Burns, rashes, eczema, psoriasis, and skin infections can all be relieved with the analgesic and antibacterial properties exhibited by cannabinoids when used in topicals (Hebrew Univ. of Jerusalem, 2016). Challapalli PV, Stinchcomb AL. In vitro experiment optimization for measuring tetrahydrocannabinol skin permeation. Int J Pharm. 2002;241:329–39. Gaffal E, Cron M, Glodde N, Tuting T. Anti-inflammatory activity of topical THC in DNFB-mediated mouse allergic contact dermatitis independent of CB1 and CB2 receptors. Allergy 2013; 68: 994–1000. The Hebrew University of Jerusalem. (2007, August 17). Cannabis May Help Alleviate Allergic Skin Disease. ScienceDaily. Retrieved April 7, 2016 from www.sciencedaily.com/releases/2007/08/070816094649.htm Majmudar, V., Azam, N. A., & Finch, T. (2006). Contact urticaria to Cannabis sativa. Contact Dermatitis, 54(2), 127. doi:10.1111/j.0105-1873.2006.0560h.x Williams, C., Thompstone, J., & Wilkinson, M. (2008). Work-related contact urticaria to Cannabis sativa. Contact Dermatitis, 58(1), 62-63. doi:10.1111/j.1600-0536.2007.01169.x

Explosion hazard with compressed gases


Commercial extraction with liquefied gas under high pressure.- CO2 - Butane, propane- Dichloromethane, naptha, benzene, methanol, ethanol, etc.

75% of production may go into extraction in some areasGases also used for controlling plant growth

Use of compressed gases in home extraction sites


Explosions are common with home extraction, most often from butane explosions and fires

Explosions are Frequent with Cannabis Oil Extraction


Presenter

Presentation Notes

Explosions stemming from the use of butane gas to extract THC from marijuana are getting more common – and so are calls to the state Department of Toxic Substances Control Emergency Response Unit to help clean up the mess afterward. Experts link the increase in extraction to the manufacturing of hash oil, a particularly potent form of marijuana. Its use is increasing as vaporizing, or vaping, and medical marijuana become more common.

Ergonomic Health Hazards

Ergonomics is the process of designing or arranging workplaces, products and systems so that people can work more efficiently and safely.

Ergonomic injuries may be referred to as Repetitive Stress Injuries (RSIs), Repetitive Motion Injuries (RMIs), Musculoskeletal Disorders (MSDs), Cumulative Trauma Disorders (CTDs).


Musculoskeletal Disorders

Repetitive stress, Inadequate hand tools‒ Trimming

Prolonged static postures‒ Sitting long hours ‒ Work stations not organized

ergonomically

Forceful exertions

Prolonged physical contact with hard work surfaces


Presenter

Presentation Notes

10-15 hours Results of one survey: Back pain, discomfort in their hands, wrists, and figures, and knee pain

Ergonomics of Cannabis Trimming


Trimming Table at a Farm

Trimming Table at a Processing Plant

Repetitive Hand Motion in Trimming

• Evaluation of Potential Hazards during Harvesting and Processing Cannabis at an Outdoor Organic Farm

• 4 employees

• The peak level cutting force estimates were low.

• More experienced workers were faster, more efficient.


NIOSH HHE: Harvesting and Processing Cannabis at an Organic Farm: Findings

Employees did not report any work-related symptoms

Employees were concerned about repetitive hand motions from trimming cannabis

Some hand trimming activities required a lot of hand motions, but not a lot of force.


Trimming Ergonomics: Repetitive Stress Injury Risk?

“After a few weeks your hands are calloused, your lower

back crippled, your wrists ache, and all the days merge

into a green haze.”


Sera Higgs. Matador Network,July 20, 2016

Physical Hazards

Heat Illness – outdoor and greenhouse exposures

Electrical Hazards‒ Explosion, fire, exposed

equipment

Unsafe work environment‒ Ladders + heights‒ Safe footing + work space ‒ Plant support entanglement ‒ Lifting heavy materials‒ Entrapment


Presenter

Presentation Notes

Common electrical hazards include: temporary wiring (e.g., extension cords), missing breakers, blocked electrical panels, improperly wired units, electricity use in high humidity and watering areas, improper repairs, unguarded fans, overloaded circuits, inadequate wiring, lack of training and general electrical safety (MOHSWG, 2017). In the cannabis industry, confined spaces include, but are not limited to, water tanks, cold storage areas, and manholes (MOHSWG, 2017). Marijuana Occupational Health and Safety Work Group. (2017). Guide to Worker Safety and Health in the Marijuana Industry. Colorado Department of Public Health & Environment. Retrieved from https://drive.google.com/file/d/0B0tmPQ67k3NVb1IydUQxSkZRS1U/view

Workplace Violence

Armed Robbery‒ Limited access to formal banking institutions – large amounts of

cash on-site at workplace‒ Isolation

Sexual Assault‒ Sex trafficking

Lack of reporting due to illegal status and isolation‒ Precarious work status – immigrants without papers


Summary: Health and Safety

Little data exists on actual risks

Concern or limited data for:‒ Diverse respiratory hazards‒ Dermatitis‒ Allergic reactions‒ Repetitive stress injuries‒ Physical injury: cuts, strains, etc.‒ Explosion, fire‒ Infection: bacterial, fungal‒ Personal safety, esp for women


Summary and Recommendations

• Diverse occupational health and safety hazards exist for workers in cannabis growing and processing.

• Research is needed to better characterize exposures and health hazards.

• Resources should exist for this effort, in addition to product licensing, environmental and other regulatory efforts.

• The cannabis workplace should be a “safe and healthful workplace that is free from serious recognized hazards”. This is commonly known as the General Duty Clause of the OSH Act

• Education and outreach programs are needed


UC Davis Cannabis Study Team

Occupational medicine Marc Schenker, MD

Epidemiology Diane Mitchell, PhD

Toxicology Kent Pinkerton, PhD

Ergonomics Farzaneh Khorsandi, PhD

Industrial hygiene Debbie Bennett, PhD

Agricultural economics Dan Sumner, PhD


Thank You!Marc Schenker, MD MPHDistinguished Professor EmeritusPublic Health Sciences and MedicineWestern Center for Ag Health and SafetyUniversity of California at [email protected]://agcenter.ucdavis.edu

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