For over a year, Utah has not been testing medical marijuana for several pathogens in the plants that could be harmful to patients, particularly those with compromised immune systems.
Last April, the Utah Department of Agriculture and Food suspended the requirement for pathogen-specific testing — for things like salmonella, E.coli and certain molds, which are sometimes found in the plants — citing supply chain issues and a problem getting pipette tips that are used to draw samples and put them on the testing medium.
State officials said they are still testing cannabis samples for contamination more generally, conducting tests that measure what is called “total aerobic count” and “total yeast and mold.” But those tests have far more lenient standards and cannot distinguish between the presence of common, harmless microbes that are all around us and potentially dangerous pathogens.
For example, when the state was still running pathogen-specific tests on cannabis flower or processed products, samples were rejected if any trace of E.coli, salmonella or several types of mold were detected. Period.
A sample of flower would only fail the total aerobic count test if there are more than 100,000 “colony-forming units” per gram — each unit being a cluster of growth when the sample is put on a petri dish. Without additional analysis, there is no way for labs to know what is growing on the tray. Processed oils and liquids have lower thresholds for microbes and mold.
That means a flower sample could fail for having too much harmless bacteria but would pass even if it has 99,999 units of a potentially dangerous pathogen.
In short: There is no way the state can say with certainty that products on dispensary shelves are free of pathogens like E.coli, salmonella or mold.
That presents a problem.
Numerous studies have linked those pathogens to illnesses, and in some instances, serious illnesses. E.coli and salmonella, two of the pathogens for which the state has suspended testing, can cause severe diarrhea, stomach cramps and vomiting.
Aspergillus can be more problematic. Reactions can be mild, nothing more than allergic reactions or sinus infections. But it can become more severe, forming fungal balls in the lungs that cause patients to cough up blood. It can also enter the bloodstream, spreading to the kidneys, heart or brain and can be fatal.
Several years ago, doctors at the University of California, Davis noticed some patients were developing rare, severe lung ailments and suspected it might be caused by cannabis use. They found dangerous bacteria and mold on plants being sold in several parts of the state. While they couldn’t conclusively link the two, it was enough for them to warn immunocompromised patients to use caution.
As one would expect, all of these conditions can be much more dangerous to those with compromised immune systems, a fairly common trait for those who are taking medical marijuana.
According to the most recent data, more than 52,000 Utahns have state-issued medical cannabis cards. Some of those patients have the following qualifying conditions: 1,559 have cancer; 674 have multiple sclerosis; 589 have Crohn’s Disease; 216 have HIV or AIDS; 88 have a terminal illness and 64 are in hospice; 32 have amyotrophic lateral sclerosis (Lou Gehrig’s Disease). All of those ailments either directly impact a person’s immune system or often involve treatments that suppress immunity.
Dr. Brandon Forsyth, director of the state medical cannabis program, said Utah cannabis producers have “an excellent track record” when it comes to product safety. Between January 2020, when the state began testing, and April 2021, when the pathogen tests were suspended, just three out of roughly 600 samples failed, with all three testing positive for Aspergillus.
There have been no pathogen-related outbreaks in Utah, he said, but the state discourages the use of smokable cannabis flower, in part because of the risk of pathogens.
Other states have not fared as well as Utah. In Colorado, which has the same testing standards as Utah, roughly 15% of cannabis flower failed the microbial testing in 2020 — both for pathogens and for the total yeast and mold. And the detection of pathogens has prompted product recalls in Nevada, California, Michigan, Oklahoma, Ohio, New Mexico and Colorado.
Because marijuana is still illegal at the federal level, there are no national testing standards, meaning states have been left to cobble together their own requirements. As of 2020, an overwhelming majority of states required specific testing for salmonella. About half, including Utah, required products to test negative for Aspergillus.
But Kevin McKernan, founder and chief science officer for Medicinal Genomics, a cannabis research company, said relying on aerobic counts or yeast-and-mold tests “is just a tarot card” that provides no useful information about patient risk.
“These are legacy tests that are really obsolete,” McKernan said. “I think the industry should be testing for clinical concerns and that directs us toward specific species where documented harm exists in the clinical literature.”
It begs the question: After a year of suspended testing, is the pipette tip shortage still an issue?
I talked with officials at a couple of labs in the state that used pipettes who said that tips were indeed in very short supply, but those issues have been since resolved and they have not been experiencing shortages.
Forsyth said the state recently received a large shipment of tips and said it hopes to resume testing within a couple of months. The state, as a policy, discourages patients from using smokable flower, in part because of the higher risk of pathogens. Patients should consult with their doctor and if they have complaints about a product should register a complaint with the Utah Medical Cannabis Program at: https://medicalcannabis.utah.gov/production/
“Ultimately, it is not possible for regulators to fully protect patients against the risks associated with the use of cannabis products or any other consumer product,” Forsyth wrote in an email. “The laws in place are meant to decrease these risks and minimize the potential for harm, not to remove personal responsibility from patients for their own safety.”