More than 10 years ago, Arizonans voted to approve the implementation of the Arizona Medical Marijuana Program. In 2020, the program expanded with the passing of Prop 207, allowing for the adult recreational use of marijuana. There are now many dispensaries and adult-use facilities statewide, where adults above the age of 21 can purchase marijuana for personal use. These products are subject to laboratory testing.

Several times this year, as recently as yesterday, marijuana-related products have been voluntarily recalled because of suspected contamination.

What is the process from suspected contamination to recall? 

If a product has been distributed publicly, the Arizona State Health Laboratory Compliance Team checks the product for a wide range of potential contaminants (found in table 3.1). Specific products are tested for contaminants relevant to them. For example, inhalable products (i.e., marijuana that can be inhaled) is tested for the Aspergillus fungus, but edible products are not.

The Arizona State Health Laboratory’s Compliance Team conducts inspections and audits on marijuana products for sale across the state. These inspections are scheduled with laboratories on an annual basis, but if a complaint is received another unannounced inspection will be conducted as well. 

If inspectors find any discrepancies between test results from a product and equipment documentation, they look into it. If a product is suspected to be contaminated, ADHS scientists start to determine the cause. This begins with checking the equipment logs: all laboratory instruments keep an internal log of any failed tests.  

Once it is determined a recall is required, based on the program’s process, a member of the ADHS Licensing team reaches out to the marijuana facility to determine if any of the product was sold to the public or if the facility has any remaining  product that needs to be quarantined. 

The ADHS team will then have the facility answer a questionnaire including the name of the product, when it was harvested, and what products were used to grow it. Typically, the facility will then have their original sample sent to two different laboratories for repeat testing. If the tests are negative for the suspected contaminants, the product can be sold and no recall is necessary.

So far, marijuana sold in Arizona has had recalls for Aspergillus and Salmonella contamination. 

Aspergillus is a very common fungus that commonly affects those with weakened immune systems, weakened lungs, or who are allergic to the fungus. Those affected may experience headache, cough, wheezing, shortness of breath, or fever. 

Salmonella is a more well-known pathogen that can cause diarrhea, fever, and can sometimes result in more severe symptoms such as bloody stools or dehydration from vomiting and diarrhea. 

When conducting a recall, ADHS includes a brief explanation of how the contaminated product was discovered, the cultivator’s name, the name of the product, the type of product, and the batch number. Consumers can find that information on the product’s label. Other information, such as names of dispensaries selling the product, are not included because it may not be a comprehensive list and could give consumers a false sense of security.

If you have a product that has been recalled, it’s important that no one consumes the product. You should either dispose of it, try to return it, or hold on to it to see if the product is retested and the recall is updated. 

Sometimes, ADHS will initiate a recall in an abundance of caution to prevent the public from consuming products initially testing positive for contamination, only to have repeat laboratory testing show the product was not contaminated. In those instances, ADHS will issue an update on the product recall notifying the public. 

So far, ADHS has not received notification of any confirmed illnesses from the consumption of a contaminated marijuana product. We issue  recalls out of an abundance of caution and in an effort to protect the public from illness. Learn more about the Marijuana program in Arizona on our website or sign up to receive these emails to stay up-to-date on a variety of public health topics, including marijuana.

The Medical Marijuana Program staff completed the work efficiently and with great attitudes. It could not have been done without assistance from the entire Division of Public Health Licensing. Everyone who contributed did an incredible job being flexible and getting behind the effort.

You can see some of the recommendations at the end of the report.  We expect to address many of them in our ongoing Rulemaking.  The info in the Annual Report is just a sub-set of all of the data we have about the program…and you can see the full array of data and information including our summary monthly reports on our hub website.

The Dispensary Collaborative had a great turnout, with almost 150 dispensary agents, board members, and medical directors. The all-day meeting covered dispensary inspection results, patient and dispensary agent educational resources offered by the Arizona Poison Control, the administrative rules process, financial audit requirements (including the difference between profit and non-profit entities), and our computerized Point of Sale system that’s used by dispensaries to verify the status of cards and record marijuana transactions. 

Overall, the input and suggestions that we received from the dispensaries was constructive and will be helpful as we continue to move forward with building a solid relationship with our dispensary stakeholders.

This week we posted new draft rules (and an Online Survey to get public comment) to comply with the Judge’s Order.  We’re also using this opportunity to refine the regulations- basically to close some loopholes we’ve found in physician certifications and delivery by dispensaries among other things.  Here’s a summary of some of the modifications to our current rules that we’re proposing: 

• Adding a process by which dispensary registration certificate holders, who don’t earn their approval to operate within 1 year due to individual circumstances, may renew their dispensary registration certificate;
• Removing the prohibition of an individual who was a principal officer or board member of a dispensary that failed to get an approval to operate within 1 year from being a principal officer or board member of a new dispensary;
• Revising the method of selecting future dispensaries to match the method we used in 2012… removing the allocation on the basis of locations with the highest number of qualifying patient residents;
• Clarifying what is required of a dispensary to be considered open, operating, and available to dispense;
• Clarifying the policies and procedures for inventory control and the transportation of marijuana to a dispensary’s cultivation site or to other dispensaries, and delivering to qualifying patients and designated caregivers;
• Clarifying that a dispensary agent delivering marijuana for a dispensary is required to have a registry identification card issued under the registration certificate;
• Clarifying where a dispensary may dispense medical marijuana to a qualifying patient or designated caregiver;
• Clarifying where a dispensary agent may transport medical marijuana, plants, or paraphernalia;
• Clarifying what a trip plan needs to include;
• Limiting dispensary donations by patients and caregivers to 2.5 ounces of useable marijuana every 2 weeks;
• Adding seniors, veterans, and folks that receive Supplemental Security Income or Social Security Disability Insurance benefits to the list of folks that qualify for discounts on patient registration cards; and
• Amending the meaning of “25 miles” to by road rather than as the crow flies. 

This is “regular” rulemaking, so we’ll be holding oral proceedings during the formal rulemaking period.  We think we’ll be able to work through the process and establish the modified rules by early 2015.

In other news, we completed our review of the latest petitions to add debilitating medical conditions to the official list this week.  As you recall, the AZ Medical Marijuana Act charges us to periodically accept petitions to add new medical conditions to the list that qualifies folks for a card.  Last summer we accepted petitions from the public to add new medical conditions for PTSD, depression and migraines. We also received a lot of informal comments regarding adding PTSD; depression & migraines and heard in person testimony from dozens of folks at our public hearing in October. 

We also contracted with the U of A College of Public Health to do an evidence review of published scientific studies.  You can see the UA’s analyses for depression; migraine headaches and PTSD on our petition website.  Our ADHS Medical Advisory Committee reviewed and analyzed the data, as in past submission periods, and provided me with recommendations earlier this week. 

Our literature review found limited scientific evidence to support permanently adding the petitioned conditions to the statutory list of qualifying debilitating conditions identified in the Act.  I didn’t approve the petitions because of the lack of published data regarding the risks and benefits of using Cannabis to treat or provide relief for the petitioned conditions.  We’ll be accepting petitions again January 27 – 31, 2014.

Perhaps the most striking thing in the report is that 25 doctors have signed about 70% (about 25,000) of the 36,000 or so certifications in Year 2… and a handful of doctors wrote more than 2,000 certifications. That doesn’t necessarily mean that these doc’s aren’t acting in the best interests of their patients- but it does give us some insight into which ones we should be focusing on to ensure that they’re meeting our certification expectations. The report goes into more detail if you’re interested.

You can see some of the recommendations at the end of the report. Of course… the info in the Annual Report is just a sub-set of all of the data we have about the program… and you can see the full array of data and information including our summary monthly reports on our hub website.

Now that we’ve completed the overhaul of our medical, skilled nursing, assisted living and behavioral health rules (18 Articles in all)- we’ve turned our attention toward amending our medical marijuana rules.  We began that process this week by scoping out modifications to the rules for renewing dispensary certificates.  We’re also planning to make some modifications to the “25-mile rule” (measuring by road rather than “as the crow flies”), eliminating the former “year 2” selection criteria for dispensaries by focusing on vacant CHAAs rather than patient density, and removing the lifetime disqualification for those applicants that receive a dispensary registration certificate but don’t execute.

Once we have an initial “straw-man” draft, we’ll solicit public comment and have oral proceedings just like we did for the original rules in 2011.  We think we’ll be able to work through the process and establish the modified rules by the Fall of 2014.

The major difference is that the definition of “Useable Marijuana” in AMMA includes “… dried flowers of the marijuana plant, and any mixture or preparation thereof…” without specifically addressing the “resins” and “extracts” identified in the Criminal Code.