Cannabis Industry Worker Health and Safety: Time for Action

It is a critical time for characterizing occupational health in the cannabis cultivation industry. At the time of publication, medical use of cannabis is legal in 37 states and the District of Columbia, and recreational adult use is legal in 19 states and the District of Columbia.¹ Momentum towards legalization at the federal level is growing, with the October 6, 2022 Statement from President Biden on Marijuana Reform pardoning Federal offenses of simple marijuana possession and initiating review of federal scheduling.² Cannabis industry experts using an econometric model estimate 321,000 full-time equivalent (FTE) cannabis jobs in the United States at the beginning of 2021, despite staffing issues and turnover created by the COVID-19 pandemic.³ California is the largest of these, with 57,970 FTE jobs. Given that most cannabis is still sold on the illegal market – only about 20% of the cannabis grown in California is produced legally⁴ – this is likely to be a significant undercount of the true number of cannabis workers. While the market share of illicit cannabis varies by state,⁵ the proportion of workers who are unaccounted for in estimates based on legal industry revenues is likely to be similarly large. Among the uncounted are undocumented seasonal workers and victims of labor trafficking; the relative scale of these populations is unknown.^6,7

Despite the size and rapid growth of the legal industry, the workplace health and safety risks faced by cannabis workers remain largely uncharacterized. Cannabis cultivation workers may have similar exposures to other agricultural workers (e.g., organic dust, pesticides, ergonomic factors) as well as distinct exposures including the cannabis plant.⁸ Within indoor and mixed light (greenhouse or tent) conditions, exposure to high levels of fungal spores, bacteria and endotoxin are likely allergic and respiratory hazards.^9,10 The cannabis plant itself is also allergenic.¹¹ While difficulty accessing workers due to legal concerns and stigmatization will continue to be a problem, moves toward a regulated industry will provide opportunities for health research both in terms of access to workers and loosening restrictions around cannabis research funding which has been hampered by its federally illegal status. As the landscape of the cannabis industry changes, there is an urgent need to identify the health and safety needs of cannabis workers and lay plans for unified and coordinated research and advocacy efforts.

The University of California, Davis Western Center for Agricultural Health and Safety convened a virtual meeting “Cannabis Industry: Setting Priorities for Occupational Health” on July 22, 2021, with the goal of identifying the most critically needed research, policy, and training actions to prevent occupational illness and injury among cannabis workers. Participants came from a variety of backgrounds, with 45 regulators, cannabis businesspeople, labor representatives, and researchers in attendance. Four themes arose during the meeting presentations and discussions: legality, workplace hazards, health effects, and training and education. The following are brief synopses of these themes:

• Legality: Criminalization of cannabis work prevents workers from seeking assistance with health and exposure issues. Workers coming from illegal to licensed workplaces are less aware of their rights and the protections they should be afforded than workers who started out in the legal industry. Even in licensed businesses there are numerous health and safety hazards to address, and workers at unlicensed workplaces are likely to have less protection and training.

• Workplace hazards: Priority hazards for immediate intervention are unsafe use of trimming machines,¹² pesticide exposures, practices leading to allergen exposure, wildfires, and psychosocial stressors such as isolation. Factors related to these hazards are differences between licensed and illicit grows and how the remote location of some farms may affect safety due to inaccessibility to inspections and emergency services.

• Health effects: The health effects of most immediate concern are respiratory disease, injuries from workplace violence, chemical exposures, and physical exposures such as electrical hazards. Difficulties with epidemiologic study design including access to workers and trust issues, and the probable inadequacy of existing administrative datasets (e.g., workers’ compensation claims) to research health effects are important related issues.

• Training and education: The most critically needed topics in training are workplace violence prevention, pesticide use, machine use, machine maintenance, and respiratory and allergic sensitization. All of these have a lack of formal training in workplaces and a lack of appropriate educational materials. Fitting training materials to the unique culture of the cannabis industry using social media, and making materials specific to cannabis work are important; materials for non-English-speakers are needed.

From these discussions, we have identified policy changes, research topics, and training needs that are crucial to advance the health and safety of cannabis cultivation workers.

Policy

The comprehensive Cannabis Administration and Opportunity Act introduced in US Congress in 2022 includes many components relevant to worker health including federal legalization, creating a federal regulatory structure, ensuring access to banking, and expanding funding for research including worker health and safety.^13,14 Access to banking services would allow licensed cannabis businesses to invest in capital improvements and training for worker health and safety as well as eliminate the hazard of dealing in large amounts of cash; lack of money to invest is often cited by businesses as a barrier to implementing health and safety programs.^15–17 Expanding access to cannabis materials for research and ensuring funding for cannabis worker health research are essential to understanding worker health effects.

The legal market is highly taxed and regulated by inconsistent state and local laws, and many illegal businesses will not make the transition due to the expenses of licensing and complying with regulations. This results in a large parallel illegal market that produces significantly cheaper products. Unification and simplification of cannabis regulation at the state and local level would help businesses transition to the legal market where they are better able to utilize existing health and safety resources. In addition, these policy changes could help advance diversity and equity in the cannabis industry which would provide opportunities and enhance protections for the most vulnerable worker groups including undocumented workers.⁷

Research

Cannabis industry occupational health and safety research must be advanced. At present, many hazards in cannabis cultivation are inferred from other agricultural workplaces due to lack of cannabis-specific evidence. In many cases, these inferences are valid: cannabis is an agricultural product and hazards such as respirable dust, machinery, exposure to chemicals, and the growing concern of wildfire smoke exposure¹⁸ are similar in all farming workplaces. However, it is clear the industry does have unique hazards, worker characteristics, and cultural needs. Cannabis workers are demographically distinct and subject to hazards such as extreme geographic isolation, increased risk of workplace violence, and exposure to the cannabis plant. It is not possible to contextualize basic research on exposures and health outcomes without more data on the cannabis workforce; it is currently impossible to generate robust estimates of the number of cannabis workers or a deeper understanding of vulnerable subgroups of workers. Cannabis workers tend to also be cannabis users, and in the case of respiratory effects it is difficult to disentangle which symptoms may be due to occupational exposure vs. consumption. Large cohort studies will be important in understanding this and other health outcomes. While California cannabis taxes are used to fund in-state research activities,¹⁹ increasing federal funding for cannabis industry worker health research through NIOSH or other agencies will help enable a unified approach to research across many US states and occupational health subject areas.

Training

A lack of training among business owners and workers is a problem throughout the industry.^16,17,20 Workers report having little or no training and those transitioning from the illegal to legal industry workplaces are particularly unaware of their rights. Business owners can be reluctant to give workers time away from their tasks to complete safety training. The recreational cannabis laws in California and Nevada have requirements for worker and supervisor training courses, and the United Food and Commercial Workers Union has created the only cannabis-specific 30-hour training course in California¹⁶; however, due to backlogs in licensing and lack of resources at regulatory agencies, this requirement is not well enforced. Other health and safety training courses have been developed,²⁰ and feedback from cannabis workers has shown a high level of interest and engagement in education. Workers have shown interest in non-traditional formats such as videos or social media, and described success with finding health information online but concern that not all information was correct or reliable. In the absence of policy-directed training requirements, easily available and accessible educational materials and outreach to workers and businesses to distribute materials will be essential. In addition, multilingual materials and those for lower literacy workers must be developed.

The cannabis cultivation industry is booming, and worker health and safety must not be left behind. Expanding legalization provides new opportunities for research and advocacy, and increased public interest in cannabis is highlighting worker issues associated with the illegal industry that have been previously more hidden. There are concrete policy, research, and training needs that can best be addressed with a coordinated approach by agricultural health experts and cannabis industry stakeholders, and the time to start is now.

Disclosure statement

The authors declare no conflict of interest relating to the material presented in this article. Its contents, including any opinions and/or conclusions expressed, are solely those of the authors

Additional information

Funding

This project was supported in part by the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (CDC-NIOSH) Cooperative Agreement # U54 OH007550 with the Western Center for Agricultural Health and Safety.