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For nearly a century, Cannabis has been stigmatized and criminalized across the globe, but in recent years, there has been a growing interest in Cannabis due to the therapeutic potential of phytocannabinoids. With this emerging interest in Cannabis, concerns have arisen about the possible contaminations of hemp with pesticides, heavy metals, microbial pathogens, and carcinogenic compounds during the cultivation, manufacturing, and packaging processes. This is of particular concern for those turning to Cannabis for medicinal purposes, especially those with compromised immune systems. This review aims to provide types of contaminants and examples of Cannabis contamination using case studies that elucidate the medical consequences consumers risk when using adulterated Cannabis products. Thus, it is imperative to develop universal standards for cultivation and testing of products to protect those who consume Cannabis.
Cannabis is associated with various types of microbes including molds that have been shown to harm immunocompromised patients, as well as bacteria and viruses that have the potential of causing harm to humans. A recent metagenomics study on 15 medicinal Cannabis plants shows that Cannabis is associated with a wide range of epiphytic and endophytic microbial communities including several toxigenic bacterial and fungal species (Mckernan et al., 2016). While most of the microbes found to be in association with Cannabis are likely beneficial to the plant in some way or phytopathogens, several bacterial species have been identified that could be opportunistic pathogens in humans (Mckernan et al., 2016). While there are currently no reports of bacterial infection caused by contaminated Cannabis, several examples of fungal contamination, namely Aspergillus sp., are found in the literature and pose a threat to human health (Mckernan et al., 2016). In this section, the authors will introduce some of the possible human pathogenic microbial species and their relevant case studies.
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Bacterial contamination is less of a direct health threat to Cannabis users than fungus and molds, but there have been potentially pathogenic species identified in a few recent studies (Mckernan et al., 2016; Mcpartland and Mckernan, 2017; Sandler et al., 2019). A study of five Cannabis cultivars had shown that most species of bacteria were identified from samples of endorhiza-, rhizosphere-, and bulk soil-associated microbiomes more so than from other regions of the plant. These bacteria contaminate include various species of Pseudomonas, Cellvibrio, Oxalobacteraceae, Xanthomonadaceae, Actinomycetales, and Sphingobacteriales in the examined microbiomes (Winston et al., 2014). Another study shows a variety of potential human pathogens, including Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, Ralstonia pickettii, Salmonella enterica, Stenotrophomonas maltophilia, and Clostridium botulinum, in the flowers of medicinal Cannabis plants grown at indoor facilities in Massachusetts, Maine and Rhode Island (Mckernan et al., 2016). Endophytic bacterial taxa have also been identified that may provide fungal resistance and other fitness-related traits to Cannabis through secondary metabolite production, some of which could be used in growth promotion and/or in biological control designed experiments (Scott et al., 2018). Although some bacteria have been shown to be beneficial to cultivation, the possible pathogenic species that have been associated with Cannabis are of greater concern, specifically the risk these species pose to consumers.
While dozens of bacterial species found to be present in Cannabis plants, E.coli, Salmonella, and Clostridium are a few common potential human pathogenic species shown to be associated with Cannabis (Mckernan et al., 2016). Escherichia coli infection has potential to cause a wide range of diseases depending on the strain encountered, including meningitis in infants, enteritis, and diarrhea (Kim, 2016; Crofts et al., 2018; Valilis et al., 2018). Exposure to Salmonella can cause bacterial infection with symptoms including diarrhea, vomiting, fever, and enteritis (Daley et al., 2013). Clostridium can cause botulism, a rare disease with symptoms including cranial nerve palsies and flaccid paralysis of voluntary muscles, with potential progression to respiratory illness and death (Sobel, 2005).
Cannabis can contain fungal pathogens that cause serious and often fatal infections in persons with immunocompromising conditions, such as cancer, transplant, or infection with HIV (1). In these patients, some reasons for using cannabis include pain and nausea relief and appetite stimulation. The frequency of fungal infections associated with cannabis is unknown but is a growing concern as more states legalize its medicinal and recreational use.
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