Cannabis-Infused Edible Products in Colorado: Food Safety and Public Health Implications

Alice E. White, MS; Christine Van Tubbergen, MPH; Brianna Raymes, MPH; Alexandra Elyse Contreras, MPH; Elaine J. Scallan Walter, PhD

Disclosures

Am J Public Health. 2020;110(6):790-795. 

In This Article

Abstract and Introduction

Abstract

Cannabis-infused "edibles" are a popular means of cannabis use, and the variety of edible food products available to consumers continues to grow. Although there has been much discussion on dose standardization, childproof packaging, and the prevention of overconsumption, the important topic of food safety has received less attention.

We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated foodborne illness outbreaks and other contamination events.

It is important for public health agencies, particularly environmental health and enteric disease programs, to be familiar with the cannabis industry, including regulatory partners, signs and symptoms of cannabis ingestion, the scope of edible products sold and consumed, and the food safety risks unique to cannabis products.

Introduction

On January 1, 2014, Colorado became the first state in the nation to allow sales of "recreational" (nonmedical) cannabis, having legalized medical cannabis in 2012. Medical cannabis is now legal in 30 states across the United States, with recreational cannabis legal in eight states.[1] Cannabis use has been linked to a broad set of health effects, including respiratory infections, vascular disease, mental illness, and motor vehicle injuries.[2] Therefore, in states where medical or recreational cannabis is now legal, many public health departments are monitoring the public health impact of cannabis legalization. Assessing the public health impact of increased cannabis use is further complicated by the new and evolving landscape of cannabis products available to consumers. Methods of cannabis use include smoking cannabis flower, vaping or "dabbing" with concentrated oils, topical application of lotions and salves, sublingual application of tinctures or drops, and ingesting cannabis-infused food products and beverages, referred to as "edibles."[3,4]

Edibles are a popular means of cannabis use.[5] Edibles are especially popular among those who use cannabis for medical purposes and older adult cannabis users who value the discretion they offer in addition to perceived lower rates of toxin exposure and other health risks when compared with smoking cannabis flower.[3,6,7] In Colorado, as of November 2019, there were 289 state-licensed retail marijuana product manufacturers and 222 licensed medical marijuana–infused product manufacturers.[8] There are currently no restrictions on types of edible products in Colorado. We reviewed available Web sites from a list of licensed manufacturers and retailers in Colorado to describe the range and frequency of products. The most frequently advertised products were candies (e.g., sour gummies, toffee) and beverages (e.g., sodas, juices), followed by baked goods and pastries; chocolates and cooking oils and sauces (e.g., olive oil, hot sauces); savory snacks (e.g., jerky); capsules and pills; sublingual drops, sprays, and oils; and syringes with oil to add to beverages.

In Colorado and elsewhere, public health and regulatory interventions on edibles have focused on dose standardization, childproof packaging, and the prevention of overconsumption. Less emphasis has been placed on the food safety risks associated with edibles or gaps in public health training or capacity to detect and investigate edible-associated public health incidents.[9,10] Without federal regulatory oversight, the responsibility for regulatory inspection and enforcement has fallen to state and local agencies. However, in Colorado, the Denver Department of Public Health and Environment (DDPHE) is the only agency that routinely inspects infused product manufacturers consistently with other types of food facilities. Additionally, there are limited guidelines for conducting surveillance for microbial contamination or unintentional consumption of cannabis-infused food products. Given the popularity of edibles, the growing variety of cannabis-infused edible food products available to consumers, and the lack of regulation and surveillance, food safety requires more focused attention.[3] We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated public health investigations.

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