Cannabis Consumer Safety

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Read the study here:  Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016 - PubMed 

Fungal Contaminants

Where Found: Ubiquitous in soil and air; contaminates cannabis through spores during drying or poor storage.


Health Effects: Pulmonary aspergillosis, invasive infections, and sepsis.


At-Risk Populations: Transplant patients, leukemia patients, and others with suppressed immunity.

Where Found: Soil and humid environments post-harvest


Health Effects: Produces ochratoxin A—linked to kidney and liver damage; respiratory infections possible.


At-Risk Populations: Individuals with chronic lung disease or immunocompromise.

Where Found: Grows in cultivation media like peat moss and coco coir.


Health Effects: Produces fumonisins and trichothecenes; may cause hepatotoxicity and neurotoxicity.


At-Risk Populations: Cancer patients; pregnant individuals.

Where Found: Thrives in humid cultivation environments.


Health Effects: Causes allergic sensitization and, occasionally, lung infections.


At-Risk Populations: Individuals with asthma or chronic respiratory conditions.

Where Found: Soil enriched with bird droppings and improperly stored cannabis.


Health Effects: Causes cryptococcal meningitis and pulmonary infections.


At-Risk Populations: HIV/AIDS patients; transplant recipients; potentially immunocompetent (healthy) individuals.


Clinical Case: A woman with no evidence of immunodeficiency developed C. neof

Where Found: Soil enriched with bird droppings and improperly stored cannabis.


Health Effects: Causes cryptococcal meningitis and pulmonary infections.


At-Risk Populations: HIV/AIDS patients; transplant recipients; potentially immunocompetent (healthy) individuals.


Clinical Case: A woman with no evidence of immunodeficiency developed C. neoformans meningitis after chronic cannabis use. Cultured cannabis from her dispensary tested positive for multiple Cryptococcus species.

Where Found: Found in decaying plant matter and humid post-harvest storage.


Health Effects: Causes mucormycosis, a rapidly fatal invasive infections involving lungs or brain.


At-Risk Populations: Individuals with HIV/AIDS, diabetes, and transplant recipients.

Bacterial Contaminates

Where Found: Soil; thrives in anaerobic post-harvest conditions.


Health Effects: Botulism; neurotoxin-induced paralysis.


At-Risk Populations: Immunosuppressed patients.

Where Found: Contaminated irrigation water, soil, and unclean post-harvest handling.


Health Effects: Gastroenteritis, dehydration, sepsis.


At-Risk Populations: Infants, elderly, immunocompromised individuals.

Where Found: Water and handling equipment.


Health Effects: Respiratory and bloodstream infections.


At-Risk Populations: Hospitalized patients and immunocompromised individuals.

Where Found: Soil and water; often introduced post-harvest.


Health Effects: Severe pneumonia, liver abscesses, sepsis.


At-Risk Populations: Diabetic, elderly, or immunocompromised patients.

Where Found: Irrigation systems, soil, and humid storage areas.


Health Effects: Causes UTIs, sepsis, and pneumonia; resistant strains common. 


At-Risk Populations: Burn victims, CF patients, and hospitalized individuals.

Improper Drying, Curing, or Storage Creates Microbial Risks

Even on the healthiest of plants, a diverse community of microorganisms exists. These include:


Epiphytes: Fungi and bacteria living on the surface of the flowers and leaves. Spores of molds like Penicillium and Aspergillus might already be present.


Endophytes: Microbes residing inside the plant tissues. Some can be latent pathogens, waiting for the right conditions.

Freshly harvested buds are full of moisture, a literal playground for microbes. If buds are not dried quickly and efficiently to the proper water content, the environment is ripe for microbial proliferation.


High water activity: microbes, especially molds, thrive when water activity is high, generally above .7 Aw. Slow drying keeps the Aw in the danger zone for too long.


Stagnant Air and Humidity: Poor airflow during drying exacerbates the problems, trapping moisture and creating humid microclimates within piles of drying plant material


Mycotoxin Production: Some of these molds are not just unsightly; they produce mycotoxins, toxic chemical compounds that can be harmful to human health. Even if the mold itself dies or is removed, these toxins can linger. Examples include aflatoxins(from Aspergillus), ochratoxins (from Aspergillus and Penicillium), and fumonisins (from Fusarium).

The consequences of these microbial contaminants can be significant:


  • Inhalation Hazards: Smoking or vaporizing cannabis contaminated with mold spores can introduce them directly into the lungs. This poses a particular risk to immunocompromised individuals (cancer patients, transplant recipients, those with HIV/AIDS, etc.) who are susceptible to opportunistic fungal infections like aspergillosis, cryptococcal meningitis, and mucormycosis.


  • Mycotoxin Exposure: Inhaling or ingesting mycotoxins can lead to various health issues, including liver damage, kidney damage, immune suppression, and potential carcinogenic effects.


  • Allergenic Reactions: Mold spores themselves can be allergens, triggering respiratory issues.

The good news is that these risks are largely preventable with proper post-harvest techniques.


  • Prompt and Adequate Drying: Ensuring harvested cannabis dries relatively quickly to a safe moisture level (water activity below 0.70 Aw) is generally recommended. This prevents prolonged periods of high Aw conducive to microbial growth.


  • Proper Airflow and Ventilation: Good air circulation during drying helps remove moisture and prevents humid pockets.


  • Controlled Curing: A slow, controlled curing process after initial drying helps stabilize moisture levels and further reduces the risk of mold growth while enhancing aroma and flavor. Unfortunately for financial reason, many commercial growers do not take the time to fully cure their products.


  • Appropriate Storage: Once dried and cured, storing cannabis in airtight containers in cool, dark, and low-humidity environments is crucial to maintain low water activity and prevent microbial resurgence.

Toxins in Cannabis

Produced By: Aspergillus flavus and Aspergillus parasiticus


Health Risks:


  • Aflatoxins are among the most potent naturally occurring liver carcinogens and are strongly associated with hepatocellular carcinoma, DNA damage, and immune suppression.


  • Chronic exposure, even in small quantities, can initiate hepatic tumorigenesis.


Why It Matters for C

Produced By: Aspergillus flavus and Aspergillus parasiticus


Health Risks:


  • Aflatoxins are among the most potent naturally occurring liver carcinogens and are strongly associated with hepatocellular carcinoma, DNA damage, and immune suppression.


  • Chronic exposure, even in small quantities, can initiate hepatic tumorigenesis.


Why It Matters for Cannabis Consumers:


  • Aflatoxins are heat-stable and resilient, surviving traditional       cannabis drying, curing, and even short-term storage.


  • Their inhalation through smoking or vaporizing contaminated cannabis introduces toxins directly into the lungs, bypassing hepatic first-pass metabolism.


  • These risks are especially high for immunocompromised individuals, who are both more likely to use cannabis for medical reasons and more vulnerable to toxin-induced immune suppression.


  • Studies have directly identified Aspergillus species producing aflatoxins on dispensary-grade cannabis.  

Produced By: Aspergillus and Penicillium species


Health Risks:


  • Ochratoxin A (OTA) is classified as a possible human carcinogen (Group 2B) by the IARC and is linked to nephrotoxicity, immunosuppression, and possibly urinary tract cancers.


  • OTA exposure is also associated with disruptions in cellular protein       synthesis and oxidative stress

Produced By: Aspergillus and Penicillium species


Health Risks:


  • Ochratoxin A (OTA) is classified as a possible human carcinogen (Group 2B) by the IARC and is linked to nephrotoxicity, immunosuppression, and possibly urinary tract cancers.


  • OTA exposure is also associated with disruptions in cellular protein       synthesis and oxidative stress.


Why It Matters for Cannabis Consumers:


  • OTA forms during improper drying and storage, particularly in high-humidity conditions, which are common in the cannabis supply chain when airflow or climate controls are inadequate.


  • OTA is odorless and invisible, and thus undetectable without specialized laboratory screening.


  • Despite its known risks, many state cannabis testing protocols do not mandate OTA screening, resulting in possible consumer exposure.

Produced By: Fusarium species


Health Risks:


  • Fumonisins are associated with neural tube defects, particularly spina bifida and anencephaly, making them a severe risk during pregnancy.


  • They are also linked to esophageal cancer, hepatic and renal toxicity, and neurotoxicity in animal models and human       epidemiological studies.


Why It Matters

Produced By: Fusarium species


Health Risks:


  • Fumonisins are associated with neural tube defects, particularly spina bifida and anencephaly, making them a severe risk during pregnancy.


  • They are also linked to esophageal cancer, hepatic and renal toxicity, and neurotoxicity in animal models and human       epidemiological studies.


Why It Matters for Cannabis Consumers:


  • Fusarium is commonly found in soil and growing media, particularly peat moss and coco coir, and can contaminate cannabis during cultivation.


  • These fungi are capable of translocating fumonisins into the flower tissue, where the toxins can remain post-harvest.


  • Unlike aflatoxins, fumonisins are rarely tested for in cannabis quality assurance protocols, unless explicitly mandated by state-level policy.


  • Cannabis users, especially those who are pregnant, immunocompromised, or       undergoing chemotherapy, are unlikely to be informed of this risk unless purchasing from producers that voluntarily test for fumonisins.

Timeline: Documented Microbial Concerns in Cannabis

2013

  • A study demonstrated that pesticide residues and microbial contaminants can transfer into cannabis smoke, reinforcing inhalation as a significant exposure route for toxins and microbes.


  • Clinical case reports began to surface during this period, including a case of early invasive pulmonary aspergillosis in a leukemia patient linked to cannabis use.

2015

  • The City of Denver issued multiple cannabis recalls for pesticide contamination; mold and microbial safety also began to receive attention. 

2016

Testing of California dispensary samples revealed yeast and mold counts exceeding 10,000 CFU/g, highlighting serious microbial contamination in products marketed to medical patients.


The CDC published an analysis showing cannabis users were 3.5× more likely than non-users to develop fungal infections, even after adjusting for age and immunocompromised status.

2017

  •  Despite the publication of microbiological safety standards (USP <1111>, <61>, and <62>) for herbal products, most state cannabis programs did not adopt these pharmaceutical-grade microbial testing protocols, creating inconsistent safety thresholds.


  • Canada issued multiple medical cannabis recalls for mold and pesticide contamination.


  • California dispensary audits revealed widespread pesticide and microbial contamination.


  • Clinical cases of cryptococcal meningitis and pulmonary mucormycosis were linked to cannabis use, even in patients without HIV or other obvious immune compromise. 

2018

  • Research confirmed that healthy cannabis flowers often host epiphytic fungi and bacteria, including Aspergillus, Penicillium, and Fusarium. 


  • California implemented comprehensive microbial and mycotoxin testing requirements under MAUCRSA. 


  • A CDC case series linked inhaled cannabis use with fungal infections in immunocompromised patients and identified significant contamination risks.

2019

  •  Oregon audits revealed that contaminated cannabis products were still passing lab tests, exposing weaknesses in enforcement and analytical reliability. 


  • Cannabis from dispensaries was found to contain Aspergillus, Cladosporium, Penicillium, and Fusarium species. 


  • Reports emphasized that fungal and bacterial contaminants could survive drying and curing and persist in “passing” products unless directly tested for toxins.

2020

  • Lab conflicts were documented regarding detection methods, standard plate counting vs. PCR, revealing that plate-based methods often missed viable mold fragments and mycotoxins.


  • A Los Angeles Times investigation found that cannabis products were passing total yeast and mold (TYM) testing but still contained undetected aflatoxins and ochratoxins, revealing flaws in over-reliance on CFU counts.

2021

  • Oregon issued multiple recalls for mold-contaminated cannabis.


  • Michigan regulators allowed mold-contaminated product to be sold, relying on weak microbial testing thresholds.

2022

  • A national analysis revealed inconsistencies in mycotoxin testing regulations across states, with only about 16 states requiring aflatoxin and ochratoxin screening.


  •  Peer-Reviewed Documentation of Testing Disparities: A national assessment by Jameson et al. confirmed that only 16–18 U.S. states required screening for key mycotoxins (aflatoxins B1, B2, G1, G2, and ochratoxin A), despite their known carcinogenicity. 


  • Holistic Industries reaches a $200,000 settlement with the Massachusetts Cannabis Control Commission after selling cannabis known to smell and taste moldy, which had passed qPCR microbial testing. CCC records note that Holistic chose PCR methods specifically to help product pass compliance testing.

2023

  • Whistleblowers in Massachusetts disclosed widespread lab shopping practices, where producers would submit samples to labs known for lenient standards to hide microbial contamination.


  • A CDC update reiterated that cannabis users, particularly the immunocompromised, remain at elevated risk for inhaled fungal infections.


  • A Los Angeles Times investigation uncovers dangerous levels of mold and banned pesticide residues in cannabis products purchased from licensed dispensaries. Some products had passed official testing but were later found contaminated upon independent retesting.


  • California’s Department of Cannabis Control (DCC) reported issuing 481 embargoes and 63 product recalls in 2023 alone, up from only 3 recalls per year in 2022 and 2021.


  • The Peer-review Blinded Assay Test (P-BAT) framework was published as a regulatory solution to counteract microbial under-reporting and lab shopping. It highlighted how labs often selectively fail to report microbial contamination in client samples. 


  • 2023 investigative report revealed that New York regulators allowed cannabis products with mold and microbial contamination to reach dispensary shelves, citing “testing challenges” and enforcement gaps.
     

2024

  • In response to mounting evidence, California lawmakers proposed new legislation requiring more stringent, standardized testing for aflatoxins, ochratoxins, and other microbial hazards.


  •  A national consumer survey revealed that 62% of cannabis users were concerned about product contamination, with many opting to grow at home due to safety concerns. 


  • The DEA Whitepaper (2024) and P-BAT research both recommended that microbial testing for cannabis be validated through state-run reference labs, citing rampant underreporting of Aspergillus, mycotoxins, and total microbial load.


  • MCR Labs sues eight competitor laboratories in Massachusetts, claiming they falsified microbial and pesticide results to help clients pass state compliance testing. The lawsuit claims this misled consumers and endangered public health, especially immunocompromised patients.


  • The CCC releases a Health & Safety Advisory identifying 32 dispensaries selling products that failed post-market microbial testing despite having previously passed.      Brands included Garcia Hand Picked and Strane. CCC confirms that plate count retesting revealed elevated yeast and mold, previously undetected via qPCR.

References/ Suggested Further Reading

1. McHardy, I., Romanelli, A., Harris, L. J., Opp, G., Gaudino, R., Torres, A., Polage, C. R., Tuscano, J. M., & Thompson, G. R., 3rd (2018). Infectious risks associated with medicinal Cannabis: Potential implications for immunocompromised patients?. The Journal of infection, 76(5), 500–501. https://doi.org/10.1016/j.jinf.2018.01.010

 2. Shapiro, B. B., MD, MPH, Hedrick, R., Vanle, B. C., Becker, C. A., Nguyen, C., Underhill, D. M., Morgan, M. A., Kopple, J. D., Danovitch, I., & IsHak, W. W. (2018). Cryptococcal meningitis in a daily cannabis smoker without evidence of immunodeficiency. BMJ case reports, 2018, bcr2017221435. https://doi.org/10.1136/bcr-2017-221435 

 3. Stone, T., Henkle, J., & Prakash, V. (2019). Pulmonary mucormycosis associated with medical marijuana use. Respiratory medicine case reports, 26, 176–179. https://doi.org/10.1016/j.rmcr.2019.01.008 

 4. Benedict, K., Thompson, G. R., & Jackson, B. R. (2020). Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016. Emerging Infectious Diseases, 26(6), 1308-1310. https://pmc.ncbi.nlm.nih.gov/articles/PMC7258471/

 5. Gwinn, K. D., Leung, M. C. K., Stephens, A. B., & Punja, Z. K. (2023). Fungal and mycotoxin contaminants in cannabis and hemp flowers: implications for consumer health and directions for further research. Frontiers in microbiology, 14, 1278189. https://doi.org/10.3389/fmicb.2023.1278189 

6. Boyar, K. (2022). Cannabis Microbial Testing: Methodologies and Considerations. In Recent Advances in the Science of Cannabis (1st ed., Vol. 1, pp. 131–160). CRC Press. https://doi.org/10.1201/9780429274893-6 

7. Sarma, N. D., Waye, A., ElSohly, M. A., Brown, P. N., Elzinga, S., Johnson, H. E., ... & Giancaspro, G. I. (2020). Cannabis inflorescence for medical purposes: USP considerations for quality attributes. Journal of Natural Products, 83(4), 1334–1351. https://doi.org/10.1021/acs.jnatprod.9b01200

8. Foundation of United Cannabis Standards . (2016, May 25). APHL guidance for state medical cannabis testing programs. FOCUS. https://www.focusstandards.org/aphl-guidance-state-medical-cannabis-testing-programs/  

9. Verweij, P. E., Kerremans, J. J., Voss, A., & Meis, J. F. (2000). Fungal contamination of tobacco and marijuana. JAMA : The Journal of the American Medical Association, 284(22), 2875-. https://doi.org/10.1001/jama.284.22.2869

10. Sullivan, N., Elzinga, S., Raber, J. C., & Bursian, S. J. (2013). Determination of Pesticide Residues in Cannabis Smoke. Journal of Toxicology, 2013(2013), 1–6. https://doi.org/10.1155/2013/378168 

11.Craven, C. B., Wawryk, N., Jiang, P., & Li, X.-F. (2019). Pesticides and trace elements in cannabis: Analytical and environmental challenges and opportunities. Journal of Environmental Sciences, 85, 82–93. https://doi.org/10.1016/j.jes.2019.04.028

12. Toth, J., & Rawson, J. (2024, January 19). Pesticides in cannabis - an explainer. Institute of Cannabis Science. https://cannsci.org/f/pesticides-in-cannabis---an-explainer?page_id=285&blogcategory=Pesticides 

13. Pinkhasova, D. V., Jameson, L. E., Conrow, K. D., Simeone, M. P., Davis, A. P., Wiegers, T. C., Mattingly, C. J., & Leung, M. C. K. (2021). Regulatory status of pesticide residues in cannabis: Implications to medical use in neurological diseases. Current Research in Toxicology, 2, 140–148. https://doi.org/10.1016/j.crtox.2021.02.007  

14. Pruyn, S. A., Wang, Q., Wu, C. G., & Taylor, C. L. (2022). Quality Standards in State Programs Permitting Cannabis for Medical Uses. Cannabis and Cannabinoid Research, 7(6), 728–735. https://doi.org/10.1089/can.2021.0164

15. Seltenrich, N. (2019). Cannabis Contaminants: Regulating Solvents, Microbes, and Metals in Legal Weed. Environmental Health Perspectives, 127(8), 82001-. https://doi.org/10.1289/EHP5785 

16. St. John, P., Greene, S., & Elebee, L. I. (2024, December 19). Search your stash: 538 cannabis pesticide tests show what’s In your weed. Los Angeles Times. https://www.latimes.com/california/story/2024-12-19/we-tested-cannabis-products-for-pesticides-how-dirty-is-your-weed  

17. Casacchia, C. (2025, February 6). CA issued 63 cannabis recalls, 500 product embargoes in 2024. MJBizDaily. https://mjbizdaily.com/california-issued-63-cannabis-recalls-nearly-500-product-embargoes-in-2024/#:~:text=Recalls%20up%20amid%20pesticide%20outbreak,and%20nearly%2025%2C000%20individual%20units.  

18. Jameson, L. E., Conrow, K. D., Pinkhasova, D. V., Boulanger, H. L., Ha, H., Jourabchian, N., Johnson, S. A., Simeone, M. P., Afia, I. A., Cahill, T. M., Orser, C. S., & Leung, M. C. K. (2022). Comparison of State-Level Regulations for Cannabis Contaminants and Implications for Public Health. Environmental health perspectives, 130(9), 97001. https://doi.org/10.1289/EHP11206 

19. Robertson, S. (2025, March 6). Burning questions plague cannabis testing industry. The Shoestring. https://theshoestring.org/2025/03/06/burning-questions-plague-cannabis-testing-industry/ 

 20. St. John, P. (2024, December 19). Cannabis conundrum: Legal doesn’t mean clean; illicit isn’t always dirty. Los Angeles Times. https://www.latimes.com/california/story/2024-12-19/legal-and-illegal-cannabis-products-pose-hidden-health-risks 

21. Procter, S., Baird, G.L. & Iannuccilli, J. Peer-review Blinded Assay Test (P-BAT): a framework for trustless laboratory quality assurance for state-regulated cannabis markets. J Cannabis Res 7, 4 (2025). https://doi.org/10.1186/s42238-025-00261-3 

22. Racino, B. (2023, September 20). NY’s testing failures expose legal weed consumers to unsafe cannabis; a “serious health threat.” Syracuse. https://www.syracuse.com/marijuana/2023/09/nys-testing-failures-expose-legal-weed-consumers-to-unsafe-cannabis-a-serious-health-threat.html  

23. Business Wire / Royal Queen Seeds. (2025). New survey shows many Americans concerned about unsafe cannabis. https://www.businesswire.com/news/home/20250410575085/en/New-Survey-Shows-Many-Americans-Concerned-About-Unsafe-Cannabis 

 24. Diggama Consulting. (2024, March 13). White Paper: Soultions to Cannabinoid Inflation. Drug Enforcement Administration. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwig7crJxaSNAxUuJEQIHTOaMVUQFnoECB0QAQ&url=https%3A%2F%2Fdownloads.regulations.gov%2FDEA-2024-0059-35496%2Fattachment_1.pdf&usg=AOvVaw1q2j2VEIkDll5LktMJXpnm&opi=89978449

25. Szyper-Kravitz, M., Lang, R., Manor, Y., & Lahav, M. (2001). Early invasive pulmonary aspergillosis in a leukemia patient linked to aspergillus contaminated marijuana smoking. Leukemia & lymphoma, 42(6), 1433–1437. https://doi.org/10.3109/10428190109097776  

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