HONOLULU, Hawaii (HawaiiNewsNow) - A lack of proper controls over Hawaii’s medical marijuana dispensaries is putting patients’ health in danger, a doctor and state Department of Health whistleblower told Hawaii News Now during a months-long investigation.
Medical cannabis is prescribed to provide relief for some of the most crippling conditions, and is supposed to be a safe alternative to addictive prescription painkillers.
But an HNN investigation revealed many of the vaping cartridges being sold in Oahu’s dispensaries would be banned in other states for failing to meet safety standards.
And some patients are reporting symptoms that doctors believe are directly linked to chemicals the state Department of Health doesn’t require testing for.
Dr. Clifton Otto is one of two board-certified cannabis physicians in the state, and has grave concerns about the state’s oversight of the program.
“At least a third of my patients are coming to me with concerns about the cartridges,” he said.
And he’s not talking about the ones bought on the black market. The vape pen refills his patents use are being purchased at Hawaii’s state-regulated marijuana shops.
Otto says they’re at the center of dozens of complaints.
“Not all of them experience the burning or the strange taste. But the majority of them do," he said.
For the past two years, Otto has repeatedly asked the Department of Health to investigate what chemicals dispensaries are using to make their liquid THC.
“Sometimes I get responses that, ‘We received your email. We’ll look into it,’” he said. “Sometimes, I receive nothing back at all.”
With no real answers, he brought his concerns to Hawaii News Now.
And he isn’t the only one worried about the safety of patients.
Peter Oshiro has been with the Health Department for more than three decades and currently heads up the Food Safety Branch. He says he was first brought in to help regulate the dispensaries in 2016.
He spoke to HNN about his concerns with dispensaries without getting departmental approval.
When asked if he was worried about retaliation from his workplace, he said, “Absolutely not."
“I’m a civil servant. I am so comfortable because everything I’m telling you is the truth. It’s the God’s honest truth,” he said.
It was Otto’s concerns that prompted HNN to conduct tests of its own on the THC oil being sold at Oahu’s three dispensaries.
Several months ago, this reporter accompanied a cannabis card holder who randomly purchased nine samples. Most were purchased at Aloha Green because it had the biggest stock.
HNN then had the cartridges blind tested at a state-certified lab to find out what chemicals the cannabis oil contained.
Results showed nearly half had ethanol at levels exceeding 5,000 parts per million ― concentrations so high the cartridges would be illegal in states like California, Colorado and Washington.
Cure Oahu was the only dispensary to meet those states’ safety standards in each of its two products HNN had tested.
Lab results showed THC oil from a cartridge purchased at Noa Botanicals contained 10 times the ethanol allowed in Colorado.
The results alone are cause for concern, but are doubly worrisome given that Hawaii doesn’t require dispensaries to test for ethanol at all.
That’s in sharp contract to other states.
Heather Krug, scientist in charge of Colorado’s State Marijuana Laboratory and Sciences Program, said there’s evidence that ethanol can lead to rapid intoxication and other unwanted side effects.
There’s little known about the long-term effects of ethanol inhalation.
In Colorado, ethanol limits for vape cartridges are capped at 1,000 ppm to protect patients.
“Ethanol is a type of alcohol found in alcoholic beverages. It’s used to extract the THC from the marijuana plant," Krug said.
"The 5,000 to 10,000 ppm range can cause irritation to the eyes, lungs, nose and throat.”
Some of those same symptoms have been reported by dozens of patients who see Otto, the Hawaii doctor. And he said there’s another concern, too.
“The other issue of course is not only what is in the oil but what is in the devices being used to vaporize the oil," Otto said.
Additional testing showed lead in parts of an Aloha Green cartridge, specifically sections of the casing that come in direct contact with the medication.
HNN took all of the lab results to the state Department of Health, where officials said the agency’s inspectors know exactly how each dispensary is making its THC oils.
“How they’re manufacturing, processing, labeling, packaging. Every single aspect,” said Michele Nakata, supervisor for the Medical Cannabis Dispensary Licensing Section.
Officials did acknowledge they were unaware how so much ethanol was ending up in the final product or why one of the cartridges was contaminated with lead.
When asked if there should be lead in any of the containers used to deliver medicine, Nakata responded: “No, it should not be.”
Nevertheless, the department says it stands behind vape pens marketed in Hawaii’s dispensaries.
“They are as safe as we know. You know, based on current information,” said Nakata.
Oshiro, the longtime Health Department program manager who’s blowing the whistle on practices he believes are putting public health at risk, disagrees.
“They (Hawaii’s Department of Health) have no clue how to regulate this industry. And the sad fact is they don’t want to learn," Oshiro said, adding that one of his biggest concerns is that the state’s cannabis program isn’t using properly trained people.
It’s been an ongoing problem that he says got worse last year when the state reestablished its Food and Drug Branch and tasked it with overseeing the dispensaries.
In an email seven months ago, state Director of Health, Bruce Anderson acknowledged, “They are short-staffed and the staff that are there need more training. They would certainly agree. However, I believe it’s time for them to step-up."
Oshiro said of the situation, “We don’t even inspect facilities with people who are qualified to inspect a doughnut shop. It’s frightening.”
In the meantime, it seems there’s an inter-departmental dispute over some of the rules, like whether it’s OK for dispensaries to reprocess marijuana contaminated with mold and yeast.
The Department of Health said it’s not prohibited as long as the final product meets its safety standards. State lawmakers, meanwhile, are debating a bill that would approve of the practice Oshiro says has been going on for years.
“They clearly don’t have any studies about long-term effects of mold and yeast colonies that are destroyed to the point where you cannot detect,” said Oshiro.
“But all the byproducts, all the dead cells everything else left behind, is now going to be allowed to be concentrated put in a vape pen and inhaled into people’s lungs.”
HNN showed him the lab results on ethanol testing.
His response: “It’s kind of like another ‘wow.’ What’s kind of disconcerting about the test results is the spikiness. It seems to be very uncontrolled.”
HNN asked Nakata why the Health Department hasn’t required the dispensaries to remediate the ethanol out of its THC oils.
She said that if there was evidence of a “major public health emergency and we were having people show up with symptoms and illness then absolutely we can implement emergency rules.”
“That hasn’t been happening,” she added.
But Otto, the doctor, strongly disputes that.
Nine months ago, he wrote to Anderson and Nakata informing them about side effects many of his patients are experiencing.
“I see patients every day when I’m doing certifications. Patients who have stopped using these cartridges,” said Otto. “They’re not safe for patient use. They’re not safe to be used as medicine.”
HNN reached out to all the dispensaries involved in our investigation. To be clear, they are all in compliance with guidelines laid out by the state Department of Health.
The CEO of Noa Botanicals said its “products are safe" and that they will continue to “abide by the rules” set forth by Health Department.
Meantime, Aloha Green provided its own lab tests disputing some of the ethanol levels. The results they provided still showed ethanol concentrations in their products were above 5,000 ppm.
As for the lead in their cartridge, a spokesman said they are “concerned about our finding” saying they’re the “best cartridges China makes.”
Aloha Green also provided a certificate they say is from the cartridge manufacturer that shows it passed heavy metal testing.
The dispensary now says it’s working with another manufacturer to develop a state-of-the-art cartridge that’s set to launch next month.
Cure Oahu was the only dispensary that didn’t have very high ethanol levels in its products.