ISSUE NO. 20-2025

FatalFacts U.S. DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION OSHA.GOV • 1-800-321-OSHA (6742)

Occupational Allergies and Asthma in the Cannabis Cultivation and Production Industry DESCRIPTION OF INCIDENT

A 27-year-old flower technician, who made “pre-rolls” (ground cannabis cigarettes) in an indoor cannabis cultivation and processing facility, experienced a severe asthma exacerbation at work that resulted in cardiac arrest.

FINDINGS The employee had started her employment with the asthma preceding her death. During the subsequent facility counting final products, a position in which OSHA inspection, interviews with her co-workers she did not directly handle cannabis. Her co-workers found that four of the ten flower technicians also had reported that she was coughing when she transferred evidence of work-related allergy and/or asthma. to the flower technician position. She then developed additional work-related symptoms including, runny nose, shortness of breath, and wheezing.

Approximately 5.5 months after starting employment in the facility and 5 weeks after beginning work as a flower technician, she required ambulance transport from work to the emergency department for worsening shortness of breath with wheezing. Her breathing

Photo: Adobe Stock improved with treatment en route. Per the emergency department record, she was told that she may have been developing asthma. She told the healthcare provider that she had been experiencing a cough and runny nose for more than a month and thought that LUNG HAZARDS IN THE she might be allergic to something at work. However, she was returned to work as a flower technician CANNABIS INDUSTRY 7,8 without any work restrictions. y Allergens: cannabis plant; fungi including mold; pollen Her employer tried to keep her farther away from the y Irritant/inflammatory agents: volatile grinder and allowed her to voluntarily use her own organic compounds (VOCs); endotoxins; respirator (N95 filtering facepiece). Two months later terpenes; pesticides; cleaning agents; she experienced a severe asthma exacerbation at disinfectants; ozone work. This resulted in cardiac arrest with brain injury y Agents that are both allergens and irritants: from lack of oxygen and care was withdrawn. Her organic dust; bacteria illness progressed rapidly with little evidence of severe

WORK-RELATED ALLERGIES Prevention5,6 Symptoms and signs can include any of the following that To reduce the incidence of occupational allergies and occur primarily on workdays or become worse at work: asthma in this industry, a multifaceted approach is recommended. Upper airway y Conduct medical screening and surveillance y Irritation of the eyes, y Congestion in the nose à Workers experiencing any work-related allergy nose and/or throat y Sneezing and/or asthma symptoms noted above should be seen promptly by a healthcare provider with Asthma expertise in occupational allergy and asthma y Cough y Shortness of breath à Jobs with exposure to known allergens, such y Chest tightness y Wheezing as cannabis, should have written surveillance programs that periodically assess employees for Skin Conditions allergy signs and symptoms and perform medical y Itchiness, rash, and/or hives tests as recommended by an appropriate Symptoms can start in workers who have never occupational health professional with expertise had them before or worsen with work exposures in occupational allergy in employees who have pre-existing allergies and/ à Identify jobs causing symptoms in employees so or asthma. Occupational allergy symptoms have that exposures can be assessed and controlled wide individual variation reflecting involvement of y Assess hazards in jobs that cause symptoms in the immune system. Workers who experience any of workers to identify the causative agents involved5,7 the above symptoms and/or signs should tell their y Implement exposure control with engineering controls, employer and healthcare provider as soon as possible. administrative controls including work practices, and Reducing or completely stopping exposure as soon personal protective equipment (PPE) as applicable5,7 as work-related allergies are detected is important y Provide medical management to prevent the symptoms from getting worse and à For example, complete cessation of exposure with reduce the risk of symptoms continuing even after the applicable benefits, rather than exposure reduction exposure terminates. and/or respirator use, may be appropriate for Work-Related Allergies in the Cannabis Industry workers with occupational allergies This Fatal Facts focuses on the first known y Worker training and education should cover occupational asthma fatality in the expanding cannabis à Identified job hazards industry. Employees are at increased risk due to à Use of engineering controls, such as local exhaust the magnitude of exposure to cannabis dust as well ventilation, at point of operation as limited awareness regarding this hazard. Work- à Work practices that minimize exposures such as related allergies and asthma have been reported in HEPA vacuuming rather than dry sweeping other publications. In data from four U.S. state-based à Proper use/care of PPE surveillance systems, thirty work-related asthma à Signs and symptoms of occupational allergy and cases, including a second fatality, were identified the need for prompt employer notification and among workers exposed to cannabis.1 Disabling medical evaluation if symptoms occur asthma has also been reported. An earlier, more detailed review of the Washington State cases in the à Procedures for employees to notify their preceding publication reported that an employee in employer about potential signs and symptoms of the legalized cannabis industry had severe persistent occupational allergy work-exacerbated asthma and had not returned to Additionally, employers may also collaborate with work after five years. 2 In a study of current cannabis academia on preventive efforts and risk factors for workers, 71% reported allergic and/or respiratory occupational allergy in this emerging industry. In symptoms. 3 Although not in the cannabis cultivation particular, information that may support development and production industry, anaphylaxis has been of diagnostic tests for cannabis sensitization would be reported in a police detective who had work-related useful for future preventive efforts. cannabis contact.4

APPLICABLE OSHA STANDARDS ADDITIONAL PREVENTION AND RESOURCES INFORMATION FOR EMPLOYERS y The OSH Act General Duty Clause, Section 5(a)(1), y BOX. Measures for protecting cannabis industry requires employers to provide its employees with employees from occupational hazards — United a workplace free from recognized hazards that are States, 2023 available at www.cdc.gov/mmwr/ causing or likely to cause death or serious physical harm volumes/72/wr/mm7246a2.htm?s_cid=mm7246a2_w y 29 CFR 1910.132 – Personal Protective y OSHA Denver Region. Local Emphasis Program for Equipment osha.gov/laws-regs/regulations/ Cannabis Industries. CPL 24-04 (EP). July, 2024 standardnumber/1910/1910.132 and osha.gov/ y OSHA On-Site consultation Program: osha.gov/ personal-protective-equipment consultation y 29 CFR 1910.134 – Respiratory Protection osha.gov/ laws-regs/regulations/standardnumber/1910/1910.134 and osha.gov/respiratory-protection KNOW YOUR RIGHTS y 29 CFR 1910.1200 – Hazard Communication osha.gov/ Workers have the right to: laws-regs/regulations/standardnumber/1910/1910.1200 and osha.gov/hazcom y Safe working conditions. y 29 CFR 1904 – Recordkeeping and Reporting y Training and information about workplace Occupational Injuries and Illnesses osha.gov/ hazards, how to prevent them, and the OSHA laws-regs/regulations/standardnumber/1904 and standards that apply to their workplace. osha.‌gov/recordkeeping y Review records of work-related injuries and illnesses. There are 22 OSHA-approved State Plans covering both y File a complaint with OSHA if they believe their private sector and state and local government workers workplace is unsafe or their employer is not and seven State Plans covering only state and local following OSHA’s rules. government workers. State Plans are required to have y Report an injury or speak up about health and standards and enforcement programs that are at least safety concerns without retaliation. If a worker as effective as OSHA’s and may have different or more has been retaliated against, they must file a stringent requirements. complaint with OSHA as soon as possible, but ADDITIONAL INFORMATION FOR no later than 30 days.

WORKERS AND HEALTHCARE For additional information, see osha.gov/workers. PROVIDERS y NIOSH - About Work-related Asthma y OSHA Safety and Health Topics - Occupational OSHA Standards and Regulations: Asthma osha.gov/laws-regs y OSHA FactSheet on Work-Related Asthma OSHA Publications: osha.gov/publications ADDITIONAL INFORMATION FOR OSHA-Approved State Plans: HEALTHCARE PROVIDERS osha.gov/stateplans y Weaver VM, Hua JT, Fitzsimmons KM, et al. No Cost On-Site Consultation Services: Fatal Occupational Asthma in Cannabis Production — osha.gov/consultation Massachusetts, 2022. Available at www.cdc.gov/mmwr/ volumes/72/wr/mm7246a2.htm?s_cid=mm7246a2_w Training Resources: osha.gov/training y Sack C, Simpson C, Pacheco K. The emerging Compliance Assistance Services: spectrum of respiratory diseases in the U.S. cannabis osha.gov/employers industry. Available at www.ncbi.nlm.nih.gov/pmc/ articles/PMC10449032/pdf/nihms-1923988.pdf

REFERENCES 1 Pacheco M, Fitzsimmons K, Reeb-Whitaker C, Rosenman K, 5 Weaver VM, Hua JT, Fitzsimmons KM, Laing JR, Farah W, Hart A, Flattery J, Weinberg JL, Reilly MJ, Yiu S, Sack C, Todorov D, Harrison Braegger TJ, Reid M, Weissman DN. Fatal Occupational Asthma in R, Dodd KE, Sparer-Fine E. Work-related asthma in the cannabis Cannabis Production - Massachusetts, 2022. MMWR Morb Mortal industry: Findings from California, Massachusetts, Michigan Wkly Rep. 2023 Nov 17;72(46):1257-1261. doi: 10.15585/mmwr. and Washington. J Occup Environ Med. 2025 Jun 3. doi: 10.1097/ mm7246a2. PMID: 37971937; PMCID: PMC10684356. JOM.0000000000003461. Epub ahead of print. PMID: 40561210. 6 NIOSH [2022]. Evaluation of potential hazards during harvesting 2 Reeb-Whitaker C, LaSee CR, Bonauto DK. Surveillance of work- and trimming cannabis at an indoor cultivation facility. By Grant related asthma including the emergence of a cannabis-associated MP, Wiegand DM, Green BJ, Lemons AR. Cincinnati, OH: U.S. case series in Washington State. J Asthma. 2022 Aug;59(8):1537- Department of Health and Human Services, Centers for Disease 1547. doi: 10.1080/02770903.2021.1955379. Epub 2021 Aug 16. Control and Prevention, National Institute for Occupational Safety PMID: 34288786. and Health, Health Hazard Evaluation Report 2019-0152-3381, 3 Sack C, Ghodsian N, Jansen K, Silvey B, Simpson CD. Allergic https://www.cdc.gov/niosh/hhe/reports/pdfs/2019-0152-3381.pdf. and Respiratory Symptoms in Employees of Indoor Cannabis 7 Couch JR, Grimes GR, Green BJ, Wiegand DM, King B, Methner MM. Grow Facilities. Ann Work Expo Health. 2020 Aug 6;64(7):754- Review of NIOSH Cannabis-Related Health Hazard Evaluations and 764. doi: 10.1093/annweh/wxaa050. PMID: 32459852; PMCID: Research. Ann Work Expo Health. 2020 Aug 6;64(7):693-704. doi: PMC7407609. 10.1093/annweh/wxaa013. PMID: 32053725; PMCID: PMC7416426. 4 Engler DB, Malick AA,Saraf SK, Dargel LA. Severe marijuana 8 Sack C, Simpson C, Pacheco K. The Emerging Spectrum of allergy controlled with omalizumab. J Allergy Clin Immunol. Respiratory Diseases in the U.S. Cannabis Industry. Semin Respir 2013;131(2);AB215. Crit Care Med. 2023 Jun;44(3):405-414. doi: 10.1055/s-0043-1766116. Epub 2023 Apr 4. PMID: 37015286; PMCID: PMC10449032.

Note: The described case was selected as an example of improper work practices that likely contributed to a workplace fatality. The incident prevention recommendations do not necessarily reflect the outcome of any legal aspects of this case. OSHA encourages your company or organization to duplicate and share this information. This Fatal Facts is not an OSHA standard or regulation, and it creates no new legal obligations. The recommendations contained herein are advisory in nature and are intended to assist employers in providing safe and healthful workplaces. The Occupational Safety and Health Act of 1970 (OSH Act) requires employers to comply with safety and health standards promulgated by OSHA or by an OSHA-approved state plan. The requirements of OSHA-approved state plans can be reviewed by selecting the state’s website at: osha.gov/stateplans. The OSH Act’s General Duty Clause, Section 5(a)(1), requires employers to provide employees with a workplace free from recognized hazards likely to cause death or serious physical harm.

DTSEM FF-4489 09/2025