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BACKGROUND: In November 2012, Colorado voters legalized the use and sale of recreational marijuana effective January 2014. Following this, many public health questions have arisen, including how to investigate foodborne outbreaks associated with marijuana-containing foods and beverages (edibles). Initial efforts in Colorado focused on regulation and potency and less on safety of edibles from a foodborne illness perspective. As of March 1, Colorado Department of Revenue (DOR) regulations require retail marijuana product manufacturing facilities to provide food safety training to staff, “comply with all kitchen-related health and safety standards of the relevant local jurisdiction and, to the extent applicable, with all Colorado Department of Public Health and Environment health and safety regulations applicable to retail food establishments”, and meet general sanitary requirements. However, all aspects of edible production are regulated by DOR which has little environmental health expertise and is not a traditional public health partner. Further, no routine inspection of edible production will occur. Little information exists on how best to identify and respond to foodborne illness related to edibles.
METHODS: To better understand the edible industry and define what resources are needed for effective foodborne illness response, we researched statutes and regulations and reached out to stakeholders including the state public health lab, DOR, environmental health colleagues and local public health agencies.
RESULTS: We identified three predominant issues—epidemiologic surveillance, lab surveillance and identifying and meeting potential partners before an outbreak occurs. We have developed and added questions about edibles to routine enteric disease questionnaires and created a supplemental questionnaire for use during an outbreak. We have requested a list of edibles being produced for retail sale from DOR to better characterize foodborne illness risk. We are clarifying what bacterial testing will be performed on edibles prior to sale and how public health will be notified of a positive result. Additionally, we created a “who-to-call” document to facilitate communication among agencies when an outbreak is suspected.
CONCLUSIONS: Ongoing areas of concern are lack of routine facility inspections, no limits on type of edibles produced, challenges in creating new partnerships, and reluctance from traditional partners due to differing federal and state laws. Given the novelty of recreational marijuana legalization, no best practices exist for recognizing and responding to foodborne illness associated with edibles. We seek to further explore ideas that would help Colorado, Washington, and other states create effective practices related to foodborne illness and marijuana edibles.