In the death of a 27-year-old woman working at a cannabis facility in Massachusetts in 2022, what went wrong and what preventative measures can be put into place?
These are the questions answered in a comprehensive report published Thursday by the Massachusetts Fatality Assessment and Control Evaluation (FACE) Program, a partnership between the Massachusetts Department of Public Health and the National Institute for Occupational Safety and Health (NIOSH).
In addition to the report, the state’s health department published a “bulletin for healthcare providers” and the Centers for Disease Control and Prevention published an article in its Morbidity and Mortality Weekly Report (MMWR) that provides “measures for protecting cannabis industry employees from occupational hazards.”
These unprecedented publications mirror the unprecedented nature of the woman’s death: “the first death attributed to occupational asthma in a U.S. cannabis production worker,” in the words of the CDC.
The backstory, as detailed in the health department’s bulletin: in May 2021, Lorna McMurrey, who had “no history of asthma,” began working for Trulieve, one of the largest cannabis companies in the U.S. A few months into the job, “she reportedly experienced work-related cough,” as well as labored breathing and dyspnea, and nasal congestion that “worsened throughout the workday.” She took a Covid-19 test, required by Trulieve, but was negative, and a “chest X-ray was normal.” When she moved to a role in which she directly worked with cannabis flower, her “symptoms became worse.” In November, “she became acutely dyspneic at work and was transported by ambulance to an emergency department.” When she left, she was given” an albuterol inhaler, a five-day course of prednisone and cetirizine.” She used the inhaler, but then, in January, “she became acutely dyspneic at work and ultimately stopped breathing and lost consciousness. She was transported to a hospital, where she remained on life support until she died three days later.”
Along the way, even though she told the doctor that “she was concerned that she was allergic to something at work,” there was little discussion about it. The Massachusetts Department of Health bulletin urges healthcare providers to “ask your patients about the type of work they do and the conditions at their workplace,” among other new recommendations.
The FACE report about the investigation noted that “occupational injuries and fatalities are often the result of one or more contributing factors or key events in a larger sequence of events that ultimately result in the injury or fatality.”
In this case, the investigators flagged three “unrecognized hazards as key contributing factors in this incident,” including: “failure to recognize ground cannabis as a potential occupational respiratory hazard;” “failure to adequately control the spread of airborne cannabis dust;” and a “lack of a comprehensive safety and health program and overall safety training.”
The report includes six recommendations, four of which are directed at employers.
Employers should: “assess and control hazardous materials in the workplace, including asthmagens;” “ensure that all workers are properly trained about hazardous materials in the workplace;” “develop and implement a comprehensive safety and health program that addresses hazard recognition, avoidance of unsafe conditions, and proper use of equipment;” and “implement a medical surveillance program to monitor the health of their workers.”
One recommendation was directed at equipment manufacturers, which is that they “should adopt and implement the concept of Prevention through Design (PtD) to identify potential hazards associated with equipment and then eliminate these hazards through design changes.”
And finally, one recommendation was directed at regulators, which is that they “should consider how they can further support the health and safety of cannabis industry workers.”
Trulieve and OSHA came to an “agreement” in December 2022 that included a fine of $14,500. This summer, Trulieve announced that it will close all of its operations in Massachusetts by the end of 2023, in an effort to “preserve cash and improve financial performance.”