Michigan faces health risks from tainted medical marijuana
The recalls of six batches of medical marijuana available on the state’s regulated market since January have prompted industry and health expert concerns about continuing to let caregivers grow and create pot products to meet a shortage in the licensed market.
More than 50 pounds of medical marijuana product were recalled in January from provisioning centers in Detroit, Lansing, Jackson, Kalamazoo and Ypsilanti for issues such as chemical residue, E. coli, arsenic, cadmium and Salmonella. The majority of the 43 products failing the testing were caregiver grown, the state has said.
Despite the recalls, the state Medical Marihuana Licensing Board approved a resolution in mid-January allowing licensed facilities to purchase medical marijuana from caregivers through March 31 in an effort to meet an industry shortage while newly licensed growers prepare their first harvests. The state's testing of caregiver products sold at provisioning centers lasted two weeks, from early to mid-January.
The potential for contaminated product to slip through the licensed system for lack of testing could pose a risk to patients, in particular those with compromised immune systems, said Jamie Alan, an assistant professor in Michigan State University’s Department of Pharmacology and Toxicology.
"If it's not tested, you don’t know what’s in it," Alan said. "But the alternative is that they’re in pain. It's probably a somewhat small risk, but you can’t guarantee that.”
While licensed facilities want the state’s 350,000 patients to have access to medical marijuana, “we also want people to be able to know what they're ingesting.” said Joe Neller of Green Peak Innovation in Dimondale, which grows marijuana. “There’s no way to know how contaminated that product that patients have been consuming has been.”
Over the next two months, patients searching for medical marijuana from a licensed provisioning center can buy from a small supply of tested product or sign a release and purchase untested, caregiver-supplied marijuana, said David Harns, a spokesman for the state Department of Licensing and Regulatory Affairs.
Patients also have the option of bringing their untested marijuana to a licensed safety compliance facility for testing, Harns said.
“The products will not be required to have met state testing standards, so patients need to understand that fact and assume the potential risk that the products may present,” he said in a statement.
The batches recalled in the past month largely consisted of marijuana flower, as well as other products such as marijuana concentrate, patches and tinctures. Marijuana flower can be used in a variety of ways; marijuana tinctures are consumed on their own or added to a food or beverage, while concentrate is usually inhaled as a vapor.
As the grace period for untested product continues through March, licensed growers and processors will be required to continue testing their own product, giving caregivers and unlicensed sellers a market edge over licensed facilities.
The resolution penalizes “certain licensed facilities by selective enforcement” and fails to provide patients access to safe medical marijuana, the Michigan Coalition of Independent Cannabis Testing Laboratories said in a statement.
“Under this new ruling, Michigan's most vulnerable patients are buying purported medical cannabis products that could legitimately harm them,” the group said in a statement.
The coalition, made up of more than a dozen licensed testers, growers and processors, proposed the state instead test caregiver marijuana prior to sale and put restrictions on caregiver product based on failure rates for chemical residue, heavy metals and residual solvents.
Because most users will be buying from regulated provisioning centers in the future, the Michigan Cannabis Industry Association is not overly concerned by the short-term use of untested product, said association spokesman Josh Hovey.
Many caregivers had tested their product voluntarily prior to the state's regulatory framework requiring as much for licensed facilities, Hovey noted. "This is especially true for those that were serving pediatric patients and patients with autoimmune deficiencies," he said.
While not ideal, the state’s decision to allow caregiver product to be used on the regulated market through March was the appropriate response to the shortage, said Jamie Lowell, a board member of MILegalize and representative for the medical marijuana group, Americans for Safe Access.
“I agree that people should not be consuming things with contaminants in them, but just because a couple things showed up in this testing, you cannot label all caregiver product as being bad for consumers,” Lowell said.
Caution urged amid recalls
Medical marijuana batches in Lansing Jan. 11 tested above state limits for chemicals, such as the mite-killing insecticide Spiromesifin, Salmonella and E. coli. Some items tested at more than double the state limit for Spiromesifin, while others tested positive for Salmonella and E. coli, which the state has ruled should not be detected at all.
Some kinds of E. coli can cause diarrhea, urinary tract infections, pneumonia and other illnesses, according to the Centers for Disease Control and Prevention. A Salmonella infection can result in diarrhea, fever, abdominal cramps and, in severe cases, hospitalization and death, according to federal health officials.
The state contaminant limits for the marijuana products seem reasonable, especially given the historical context of a marijuana-linked Salmonella outbreak in the Midwest in the 1980s, MSU's Alan said.
“With the chemical it’s hard to say,” Alan said, noting there’s little research of the impact of Spiromesifen on humans.
“With the bacteria, certainly if you’re immuno-compromised or have any serious illnesses, they pose a significant concern.”
The infection risk to the immuno-compromised — a population likely to consume medical marijuana product — is a real concern when it comes to the continued use of untested product, said Dr. Preeti Malani, the University of Michigan’s chief health officer and a professor of medicine in the division of infectious diseases.
A 2017 nationwide poll of people between the ages of 50 and 80 found 6 percent of those polled used medical marijuana and 31 percent said marijuana definitely provided pain relief. The survey, called the National Poll on Healthy Aging and conducted by a UM team Malani directed, should be a wake-up call to physicians, especially those dealing with immuno-compromised populations like the elderly, she said.
“It’s one more piece of the safety puzzle that we might not have thought of,” Malani said.
Little official research on cannabis, the expected increase in use with the state’s legalization and a disconnect between physicians and the varying preparations of the drug have created a complicated and cloudy relationship between the medical community and medical marijuana, Malani said.
“Regardless of the morality issue, or whether or not you think it’s the right or wrong thing, we need to study this as a public health concern,” she said.
Though linked solely to medical marijuana, the January recalls and extended caregiver product use through March raise concerns about the future of the recreational market, said Scott Greenlee, president for Healthy and Productive Michigan, the ballot committee that opposed November’s legalization ballot proposal.
The obstacle-laden path to a regulated medical marijuana market could be a “precursor” for the recreational market, Greenlee said. And the recalls of home-grown products pose questions about the home-grow operations allowed under the recreational law.
“That whole piece of this is going to turn into the wild, wild west I think fairly quickly, and there’s going to be a lot of issues,” Greenlee said.