Pesticides in Cannabis: The Need for Evidence to Inform Policy and Protect Patients

Drawing from an interdisciplinary synthesis of microbiology, chemistry, osteopathic medicine, psychology, environmental health, and regulatory policy, this commentary highlights the increasingly pertinent issue of pesticide residues in state-legal cannabis products and clinical implications for medical cannabis patients. This commentary uses peer-reviewed and gray literature along with state cannabis regulations to highlight the toxicological gap that pesticide action levels are not based on human health risk and are not cannabis-specific; instead, they are derived from analytical detection limits and noncannabis crop assumptions. Medical cannabis patients may also have a higher exposure risk than other people who use cannabis for adult-use (nonmedical) purposes. For example, medical patients may have complex medical co-morbidities and use cannabis products more frequently than those who use products for nonmedical purposes. Medical patients have expressed concern about pesticides and their increased risk in several settings (e.g., online, public testimony, clinical). Further research is warranted to better quantify vulnerable patient populations including risks of pesticide exposures for specific qualifying health conditions. Given the increased prevalence of cannabis use across the United States, it would be beneficial for health care providers to be equipped with this knowledge for their patients who use cannabis and feel comfortable recommending different products and safer routes of administration (e.g., noncombustible). To work toward health-based pesticide testing thresholds, prioritizing differential risks from route of administration, product type, and real-world dosing behaviors is essential. Policymakers aiming to adopt health-based pesticide testing criteria will benefit from supporting additional research to set these standards.