Patients’ Perceptions of Cannabis Contamination in Florida’s Medical Program
Insights into Florida’s Medical Cannabis Program through Social Media Analysis
Department of Agricultural Education and Communication, University of Florida, Gainesville, FL, USA
Department of Epidemiology, University of Florida, Gainesville, FL, USA
Associate Provost and Dean of the Graduate School, University of Florida, Gainesville, FL, USA
Director of the Mid-Columbia Agricultural Research and Extension Center, Oregon State University, Hood River, OR, USA
Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
Correspondence to: Gabriel Spandau, gspan96@ufl.eduAbstract
Introduction
As medical cannabis becomes more accessible, product quality must be evaluated. Researchers identified a social media community where Florida medical cannabis patients discuss personal experiences. The objective of this study was to analyze posts in this community to understand patient experience with products purchased from Florida medical dispensaries they believed to be contamination, perceptions of product quality, and desired changes to the Florida program.
Methods
Social networking theory acted as the underlying framework, and we employed a qualitative case study design to identify mentions of possible contamination and understand patient perceptions of contamination and the Florida medical cannabis program from the Reddit community FLMedicalTrees. The lead researcher conducted a social media analysis of posts identified as containing discussions relevant to product contamination. Constant comparison methods were used to code data, arrive at themes, and maintain validity and reliability of interpretation of coded themes.
Results
Of 300 post mentions of contamination, 98 posts were identified as relevant following review. Key results were as follows: (1) multiple mentions of possible contamination of products from medical cannabis dispensaries reported by Florida program patients; (2) patients sought second opinions when concerned about possible contamination and shared personal experiences as well as advice on what concerned patients should do if they believe they have contaminated products; (3) some patients expressed feelings of anxiety and worry about health, safety, and quality control, while others that described possible product contamination did not express concern; and (4) patients wanted changes regarding vertical integration, company accountability, state oversight, and home grow law.
Conclusions
Medical cannabis patients and providers could benefit from education on responding to possible contamination within medical cannabis products. Policymakers should consider these findings when setting regulations around contamination testing thresholds, dispensary oversight, and other regulations that directly impact patient safety, like allowing patients to see products before purchase.
Introduction
Florida implemented legislation creating a compassionate use medical cannabis program in 2014, which was later converted to a medical cannabis program model that is currently operating today [1]. Florida offers a variety of medical cannabis products to qualifying medical cannabis patients. Doctors in Florida may prescribe patients medical cannabis for conditions such as cancer, glaucoma, multiple sclerosis, chronic pain, or any of the state’s twelve health-related issues approved for medical cannabis use [2]. Florida has guidelines for the packaging, labeling, storage, transportation, and oversight of all medical cannabis products sold in state dispensaries [3, 4]. The Florida Department of Health’s Office of Medical Marijuana Use (OMMU) is the governing body, serves as a watchdog for licensed medical cannabis companies, and can perform random unannounced compliance inspections at any Florida Medical Marijuana Treatment Center (MMTC) [5, 6]. MMTCs are required to be vertically integrated, meaning they must operate the plant production facility, extraction laboratory, and dispensary themselves to comply with state law [7].
Prior research has indicated cannabis products can be contaminated in several ways [8–10]. In California, Raber et al. [9] tested medical cannabis concentrates sold to patients and found around 80% of the products sent in for testing had some variety of contamination. Pesticides and multiple chemical solvents, which can be toxic to humans, especially those who have illnesses or compromised immune systems, were found in small quantities within the concentrates [9]. Pesticides can contaminate cannabis during the growing process and chemical solvents used in extraction processes can leave residuals behind in the final product if not purged correctly. Purging a concentrate is the act of removing all residual solvents from the concentrate [11].
As the public experiences new medical advances, the internet has become a place and tool for health communication and engagement. Prior researchers have explored how the Internet is utilized for health communication [12–14]. For example, Pang et al. [13] found that people conducted exploratory online searches for health information because they wanted to find out more about new health issues, evaluated inconsistent information, or were curious about a relative’s health. A survey of participants’ online health communication behaviors found participants (n = 7,934) typically used the internet to read medical information and determine if it was necessary to seek a doctor’s attention [12]. Wong et al. [14] showed social media can be a useful tool in patient education and collaboration between patients and health care providers or other patients, but the validity of information obtained from social media needs to be considered.
As Florida’s medical cannabis program is only a decade old and in its relative infancy, it is important to examine what is working well and what may need to be changed to improve health and safety and ultimately the overall system’s policy and regulatory procedures. Even though OMMU regulating product quality standards are in place, some Florida medical cannabis patients have documented that they have received contaminated products from dispensaries and shared their accounts through online forums and different social media accounts [15, 16]. Patient reports of contamination have ranged from finding small hairs in a gram of cannabis concentrate to mold growing out of the cannabis flower. Patients’ contamination descriptions such as the aforementioned can be found on the subreddit titled FLMedicalTrees [15]. This online community is located on the social media site Reddit and is a place where Florida medical cannabis patients share their experiences related to the state’s medical cannabis program.
Therefore, the following study explored patients’ experiences with cannabis contamination via a content analysis of relevant social media posts. The purpose was to better understand medical cannabis patients’ experiences with potentially contaminated medical cannabis products within the Florida medical cannabis program. The authors conducted a qualitative content analysis of social media posts related to medical cannabis product contamination posted on the subreddit FLMedicalTrees. The following research questions (RQs) guided the study:
- RQ1: What were medical patients’ experiences with contaminated products?
- RQ2: What type of information did patients seek and share about medical cannabis contaminants?
- RQ3: What were medical patients’ perceptions of the current state of the medical cannabis program in Florida?
- RQ4: What changes did medical patients suggest should be made to improve Florida’s medical cannabis program?
Methods
Theoretical Framework
Social network theory (SNT) guided the study [17]. SNT is rooted in mathematics and sociology and began in the 1950s when sociologists applied it as a mapping tool to examine humans and their patterns and interactions within larger social networks [18, 19]. SNT is a media effects theory that examines individuals, organizations, or communities and how they form networks for knowledge sharing, behavior, or attitude change, and how the network itself affects a larger social system [20–22]. People or groups within the network are referred to as nodes. Each node makes different connections with other nodes to share information. The nodes can be analyzed for closeness, interconnection to other nodes, or node position, and how different factors affect the flow of information [23]. While most studies have used SNT in a quantitative way to measure interconnection in social networks and distance between nodes, this study used it as a qualitative lens to conceptualize the information-sharing qualities of an online health engagement community. For this study, the social network examined was the online Reddit community FLmedicaltrees. Users of the network represented the nodes, and the connections between the nodes occurred as posts and conversations within the community. The interactions between the nodes are what researchers coded in this study.
The coded interactions include post headings, images, and comments. The posts serve as a conversation starter in this community and spur interaction between different nodes or community members. The original poster interacts with those who comment on the post and commenters interact with each other as well as the original poster, creating a web or network for information. By using SNT as a lens for this study, researchers were able to gain a better understanding of how the community interacted and how a post about contamination could reach other members of the community.
Study Design
The research followed a qualitative case study design [24] and applied content analysis methods [25] in a social media context [26, 27] to examine the phenomenon [28] of medical patients’ lived experiences with contamination in the Florida medical cannabis industry. To try to understand how participants viewed contamination of certain medical cannabis products, we used internet-based content analysis methods to examine the Reddit data [25]. We found multiple meanings, codes, categories, and themes through social media post analysis. The lead researcher conducted the study as part of their larger dissertation and recognized his views and prior experiences working in the cannabis industry may have potentially influenced data collection, analysis, and interpretation. The study received University of Florida Institutional Review Board approval for human subjects research and followed all required guidelines and agreed-upon procedures (IRB202201376).
Reddit Context
During the lead researcher’s previous employment in the Florida medical cannabis industry, he was introduced to the subreddit FLMedicalTrees. The channel is well-known among people who work in the medical cannabis industry. Through the subreddit, medical cannabis industry workers could find out what patients were saying about products they helped grow or extract, hear about patient experiences in the dispensary they worked in, see what products competing dispensaries sold, and keep up with major happenings in the Florida medical cannabis market. Through this personal experience, the lead researcher determined FLMedicalTrees would be an ideal research context for this study. FLMedicalTrees is a subreddit that was created in August 2017 and has 71.5 thousand members. FLMedicalTrees members are assumed to be Florida medical cannabis patients. The fifth stated rule of the community is that all posts must be related to the Florida medical cannabis program (Fig. 1). Social media sites/communities of this size and population/level of participation are not overly abundant. Major social media sites, such as those platforms operated by Meta, Facebook, and Instagram, do not permit any kind of cannabis content, and X (formerly known as Twitter) does not have a similar structure of groups or communities by which contributors are organized on a given topic or interest. These limitations on restricted cannabis content, and few organized communities that have broad, population-level reach or traffic, leave few of the mainstream social media site options to explore. The goal of this study was to conduct a case study on medical cannabis patients’ experience in Florida and that is why this community was selected for review and analysis. In this subreddit, members can post anything related to the Florida medical cannabis program including but not limited to new products, new dispensaries, product sales, products that worked or did not provide the desired health outcomes, and products that may be contaminated.
Data Collection and Analysis
Data were collected through qualitative content analysis methods of posts ranging approximately from 2020 to 2022 [25]. The lead researcher collected posts from FLmedicaltrees using specific keywords related to contaminates that could be found in medical cannabis products (mold, fiber, hair, contaminate). The keywords were searched using the built-in Reddit search tool. He initially identified more than 300 posts containing search hits for one or more of the keywords of interest. The lead researcher then narrowed down the sample to only include posts relevant to the study’s contamination RQs (n = 98). Relevant posts were collected in July 2022, digitally printed, saved as a PDF, and stored in a folder on Microsoft Teams. The first three authors then collaborated to develop and verify a coding framework that included deductive and inductive codes [25]. To develop this coding frame, a combination of concept-driven and data-driven strategies was used. Deductive codes are typically based on theory or the research problem, and inductive codes emerge based on observed patterns in the data [29]. Deductive codes, based on our research problem, included contamination concern, seeking information, and providing information. With the deductive codes and RQs in mind, the first two authors each reviewed 20 different relevant posts to consider the common sentiment and themes regularly discussed. Inductive codes generated from this process included similar experience, regulation need, and lack of contamination concern. Once the frame was developed, the three lead researchers separately coded five posts each, and compared codes. Multiple rounds of discussion and comparison were conducted until clear definitions of each code were defined, and the three lead researchers found consensus in their codes when separately coding multiple posts and comparing. The lead researcher then went through each post and coded using the created frames. The lead researcher served as the primary coder, and through constant comparison methods, the second and third co-researchers reviewed 20% of the coded posts and confirmed coding accuracy [30]. Post images were coded for context and post headings and comments were coded using the researcher-developed coding frame. The lead researcher coded the posts by hand without the use of qualitative coding software. Qualitative coding software was not used because the data analysis required a certain amount of content knowledge and understanding of nuances in images and language used within the community. After all posts were coded, the research team went back through the codes and collapsed similar codes into categories. Collapsing codes into categories was the process of going back through each individual frame and grouping the codes into similar categories within each frame. For example, a category that came out of the frame seeking information was “seeking advice on contamination.” Categories were then combined into major themes that answered the RQs [29].
Results
The results of this study included four themes. Table 1 presents the RQs and the coinciding thematic result derived from the coded data. The themes pulled from this data analysis may not represent the broader Florida medical cannabis patient population.
| Research question (RQ) | Theme |
|---|---|
| 1. What were medical patients’ experiences with contaminated products? | Patients experienced multiple forms of contamination through different products from medical cannabis dispensaries |
| 2. What type of information did patients seek and share about medical cannabis contaminants? | Patients sought second opinions about potential contaminants, advice on safety of a possibly contaminated product, and how to return the product to dispensaries |
| Patients shared personal stories, similar experiences of contamination, and advice for those concerned about product quality or returning a product | |
| 3. What were medical patients’ perceptions toward the current state of the medical cannabis program in Florida? | Some patients expressed feelings of anxiety and concern about health, safety, and quality control, while others had a lack of concern |
| 4. What changes do patients recommend should be made to Florida’s medical cannabis program? | Patients want changes regarding vertical integration, company accountability, state oversight, and home grow law |
The themes are presented in the below sub-sections with supporting Reddit posts and interview quotes. Within each thematic result, the below figures represent initial posts Reddit users made. The lead researcher provided selected comments listed underneath each figure coded for that theme. The selected comments are not displayed in chronological order. However, the researcher chose them to provide a thick rich description of the results [31].
Theme One (RQ1)
Patients have experienced multiple forms of contamination through different products from medical cannabis dispensaries. Patients’ initial posts in FLMedicalTrees showed a variety of contaminated products that they purchased from medical cannabis dispensaries. Patients posted what appeared to be photos they took on their own devices. The photos included cannabis concentrates, flower, capsules, edibles, and vape cartridges with different forms of what patients believed to be contamination. For instance, Figure 2 shows a screen capture of a Reddit user’s image post and comment about potential plastic zip tie contamination.
Observations of other shared posts indicated possible contaminants included small hairs in vape cartridges, white strands coming out of cannabis flower, black dots present in cannabis concentrates, white dots or hairs on flower, fluffy white spider weblike formation on a brownie, fluffy white spider weblike formation on flower, and dark blackish material in oral capsules (Fig. 3). The comments shown in Figure 3 indicate that the original poster in Figure 2 did not experience an isolated incident or seemingly overreact. They received confirmation from other Reddit users about their concerns as a form of validation through others sharing their opinions about the possible contamination or experience.
Theme Two (RQ2)
Patients sought second opinions on potential contaminants, advice on the safety of a possibly contaminated product, and recommendations on returning products to dispensaries. Patients shared personal stories, similar experiences of contamination, and advice for those concerned about product quality or returning a product.
The majority of patients’ posts were in search of second opinions to confirm whether or not products were contaminated, and several community members provided warnings to others about contamination. The FLMedicalTrees subReddit community appeared to serve as a way for patients to better understand and learn about contaminated products and batches of products they should avoid in dispensaries.
Figure 4 shows a Reddit user’s post and comment seeking second opinions on a possibly contaminated medical cannabis concentrate product. The original poster of Figure 4 was concerned about the black line they claimed was growing in their cannabis concentrate and commenters on the post provided second opinions and similar personal experiences. Patients discussed and debated possible contamination in some posts, while in other posts, declared it was undoubtedly a contaminated product. A Reddit user’s post and comment sought second opinions on the black ball in the center-right of the pictured vape cartridge (Fig. 5).
Another example is demonstrated by the post below (Fig. 6), where the original poster is seeking a second opinion on the discoloration of the purchased flower and stem. Most comments on the post were confident it was some form of contamination. Commenters thought the brown-grayish color could be mold, fungus, or Botrytis (a type of fungal bud rot).
Patients posted to seek second opinions on what they believed to be contamination across multiple cannabis products. Through the comments, patients discuss instances of what they believe to be contamination that are similar to what is described or shown in the original posts, stories of contamination, or quality issues in their medical cannabis products. Commenters throughout many of these posts also advise original posters to return their products, and not to consume anything that may be contaminated.
Theme Three (RQ3)
Some patients expressed anxiety and concern about health, safety, and quality control, while others lacked concern. Seeing other users’ possibly contaminated medication seemed to cause worry and anxiety among members of the community. Many users recommended their fellow patients who posted about products they believed to be contaminated should report the product to the state and seek medical attention if they felt adverse effects. They often also expressed disgust or disappointment in the quality of medication sold to patients. Figure 7 shows a screen capture of a Reddit user’s post that expressed concern and worry about what they believed to be mold on the dispensary flower they consumed. The original poster of Figure 7 and commenters who replied to the post expressed concern over the quality of the pictured product:
Be strong 💪 call them asap
If you are feeling like you have a medical emergency call 911
You need to report them to the department of health this is supposed to be medicine not mold
Ewww omg 😱nasty af 🤮
Other commenters on Figure 7 felt there was no need for the original poster to be concerned:
You’ll be ok. Prob breathe in way worse shit on a day-to-day basis
.-. You’re fine like 100% fine, I’ve seen people take the mold off the bud and smoke it like it never existed. They are fine, you’re even better.
No you don’t need medical attention so much of what we smoked throughout life before med had mold and we didn’t know ... You do need a discount and a refund
Members of the community would sometimes become concerned for their own safety and the quality of their own products as well as the initial posters’ safety and medication quality as demonstrated by Figure 8 and selection of coinciding comments.
Figure 8 shows a screen capture of a Reddit user’s post that expressed concern and worry regarding what they believe to be mold on the dispensary flower they purchased. Commenters expressed a range of frustration with Florida’s medical cannabis quality control:
I just spent the last hour meticulously going over my oz with a loupe. Best I can tell 0 mold. Same batch number as the OP.
It’s so sad that mold inspection has become standard procedure as soon as I get a product home.
I feel sorry for all the folks that bought an oz or two. It would suck to know my flower was grown next to that.
I’m really liking my ounce too.. Damn I hope I don’t run into any mold. :\
This is so sad, patients should not have to worry if the medication they are consuming is safe especially for the price...This is nothing more than poor quality control in the grow houses caused by inadequate ventilation and or human error.
Patients using this online Reddit community have strong debates about possible contamination across numerous posts. Though some lack concern about what some believe is contamination, many commenters feel the possible contamination could be of true health concern. Some commenters appeared to become concerned for their health and safety based on what the original poster showed and claimed.
Theme Four (RQ4)
Patients recommend changes regarding vertical integration, company accountability, state oversight, and home grow law. Throughout posts on Reddit, community members’ comments on reviewed posts regularly discussed the quality of the medication in question and made statements that insinuated it could be the fault of vertical integration. Reddit comments related to desired changes to the Florida medical cannabis market are listed below. Figure 9 is a screen capture of a Reddit user’s post that warns community members of possible contamination in a product that seems to have occurred multiple times. The comments that follow are about patients’ desires for the ability to grow at home and how they felt the lack of a home grow policy could be linked to profit. Figure 9. One commenter felt some corporations came into Florida with little experience in growing cannabis yet purchased one of the few available commercial licenses and took advantage of medical patients:
We need to be allowed to grow our own medical marijuana at home. These companies are obviously groping in the dark figuring everything out as they go along. We shouldn’t have to pad the pockets of dispensary investors when we can grow it ourselves and not have to sit there and inspect every jar and hope they give refunds for mold-contaminated product. The system is obviously not protecting patients from receiving cannabis with mold, bugs, plastic, etc. like it was supposed to. These companies are about profits above all.
In response to the previous comment, another Reddit user felt passing a home grow law was unrealistic without the connections or funds:
You are absolutely right, but we would need some billionaire patient to out bribe the dispensaries currently filling our politicians pockets!):
Commenters throughout this post also continually expressed quality control issues and a lack of care from dispensaries:
Compassionate care’ is just marketing. Nobody actually cares lol.
I was told I should have looked at the medicine, which they double bagged and stapled shut then put into a plastic bag. I opened it on the way home and saw 10%.. then saw reggie weed.. never going back to LHS I’ll tell you that much. Apparently their description is just a copy/paste from Leafly.com which another user pointed out. This hurt to smoke.
I’m about to start buying off the street again.
They are selling product with mold. This is a health concern. They are making top dollar on bad product that should have been thrown into the trash due to contaminants. Plain and simple.
Vertical integration was another topic of discussion among patients as they seemed to feel it played a large role in the quality control issues many Reddit posters experienced. Figure 10 displays a screen capture of a Reddit user’s post that let other users know about the possible contaminant of a batch of flower, which led to a discussion about vertical integration. Some of the comments on this post included the following:
Another reason to get rid of VI
Another reason to get rid of VI, The EXACT same words the manager at One Plant said to me `when I returned it, lol
Seriously though, this is the 3rd post I’ve seen of this. It’s harmful and not safe medicine. Yet seems they’ll continue to sell a moldy product in a strictly medical program... ? Not limited to this single distributor I’m thankful these cash grab company’s are shaming Florida’s program with examples similar to this. It gives me hope that there will be more of a incentive to cut them out entirely and let us all grow our own
Lets not forget they’ve all done it to us. We deserve better packaging and quality assurance. This is getting ridiculous.
More examples of patients’ desire for the current home grow law to change can be seen in Figure 11. It shows a screen capture of a Reddit user’s post that informed other users about a possible contaminant and led to further discussion about home grow. A selection of comments responding to the Figure 11 post included the following:
How much of this will we have to put up with before our political overlords grant us lowly patients the right to cultivate our own medicine? That’s the question we all need to be asking often and asking loudly.
Homegrow would be so awesome.
I’d be happy with just 2 plants
Sadly the only two reasons we don’t have the ability to grow our own is greed and ignorant anti cannabis legislators who can’t let go of the past
All kidding aside, that sucks. Been a cruel, cruel summer for mold. Seems like dang near every dispensary has had a mold issue. Either VI has to go, our let us grow our own.
These comments demonstrate the frustration and concern community members expressed on posts discussing or displaying medication that was possibly contaminated. Patients felt medical cannabis companies demonstrated poor quality control due to the lack of competition in the market that only allowed vertically integrated companies to participate. Patients also felt home grow policy needed to be adjusted to allow patients to grow medical cannabis at home. Patients believed that dispensaries’ poor-quality control demonstrated the need for patient home grow.
Discussion
Medical cannabis patients who participated in the social media community of interest reported experiences with possible contaminants across almost every variety of medical cannabis product in the state of Florida. These possible contaminants ranged from items that could be seen directly with the eye, like hairs, thick white mold, thin cobweb-like mold, black balls inside what should be yellow/gold extracts, and plastic. Other possible contamination that patients discussed and possibly experienced included chemical solvents left behind in their cannabis concentrates, strange smells and tastes that they attributed to possible pesticides or fertilizers, and mold or fungal spores that may not have developed enough to be seen but are still present and harmful. This assortment of possible contamination and patient concern demonstrated that these experiences were not exclusive to a singular product or dispensary. While these experiences and concerns do not represent the entire Florida medical cannabis patient population, findings of possible contamination by patients were supported by other literature. Raber et al. [9] found most of the medical cannabis concentrate samples sent to the research team for testing had pesticide or chemical solvent contamination; though products tested in this study originated from California and were collected from December 2012 to February 2013, about 8 to 9 years before the social media posts represented in this study.
Patients regularly sought and shared second opinions, personal stories, and similar experiences related to possible contamination issues in their medical cannabis products. Second opinions ranged from advice on whether to consume the product, the type of contamination that may be present, who was at fault, and what action the original poster should take. Patients who shared personal stories discussed dispensary experience dealing with product returns, instances of feeling ill due to unintentional consumption of a possibly contaminated medical cannabis product and financial hardships related to the cost of medical cannabis products and state policies. Similar contamination experiences were discussed on most reviewed posts and helped confirm the perspective of the original poster as they may have been seeking a second opinion through their original post. Similar experiences discussed included patients having purchased the same product and batch number and having the same concern, or patients that purchased the same type of product or went to the same store and had a similar experience of possible contamination. Patients shared much information about numerous personal topics and advice on their medication’s safety. This demonstrates that the online space fostered a community for the participating patients and that they felt comfortable sharing a certain amount of personal information in this online space. This aligns with Pang et al. [13] and Wong et al. [14] findings as we observed patients using the internet to obtain health information related to their medical cannabis products and possible contamination through patient collaboration on social media.
Patients had a mixture of feelings toward the current state of the Florida medical cannabis program. Many patients were anxious and concerned about their health and safety due to what they believed to be quality control issues within the program. It seemed that some patients became worried about the state of their medication when seeing other patients post about possible contamination in their products. Those who expressed the strongest concern were patients who felt they had a similar experience or who had purchased a product from the same batch. Patients regularly discussed what they believed to be a lack of quality control in the industry and the possible negative health outcomes that could result from a lack of quality control measures. Other patients did not sympathize with the original posters and felt that they were complaining. These patients felt everyone should be grateful for the opportunity to use cannabis as a medication without repercussion from law enforcement and the new ease of access that dispensaries provide patients, regardless of the possible contamination. The patients who did not have concern for possible health or safety issues claimed cannabis users have experienced much worse with illegal cannabis and have not experienced health problems. Regardless, most patients were concerned about health and safety issues. Patients with a lack of concern for health or safety may be using the medical cannabis program in Florida to acquire cannabis legally and conveniently as cannabis is not recreational in Florida and is still illegal to purchase or sell outside the medical cannabis program. This may explain their lack of concern as they do not have to worry about underlying health conditions that could be affected by consuming contaminated products. When considering the theoretical framework used to guide this study, SNT [17], those individuals who lacked concern in this community are outliers and these nodes may have less interconnection to the larger community.
The main changes patients recommended for the medical cannabis program within FLMedicalTrees were the desire to eliminate the requirement for commercial vertical integration and allow patients to grow their cannabis at home. Removal of vertical integration was regularly mentioned on posts related to possible mold in cannabis flower, as well as the need for dispensaries to be more accountable and for improved laboratory testing of products, but these changes were not mentioned as frequently as home grow or vertical integration. Some patients felt vertical integration was the cause of poor quality control and a lack of care. These patients also thought allowing smaller businesses into the market that could not afford vertical integration, would result in increased competition and an increased need to produce quality products. Home grow was a regular topic across the posts reviewed for this study and patients felt the home grow restriction only existed to allow dispensaries to gain more profit. Patients felt that being able to grow at home is important and, when reviewing other states that have a medical cannabis program, found approximately 50% allowed patients to grow their cannabis [32].
Limitations
This study’s purpose was not to quantify contamination rates or gauge the extent of contamination problems in terms of the proportion of products that could be estimated as having contaminants. Another limitation of this study included the use of public access data. The use of public access data can make it difficult to verify the truth of the information, so a large sample of posts was used to mitigate this limitation. Also, the lead researcher conducted all the coding and his personal biases or possible shifts in views during the coding process may have influenced the results. However, constant comparison of codes between the lead researcher, second, and third authors was used to maintain validity and reliability and lessen bias.
Conclusions and Recommendations
Future research should explore the perspectives and experiences of dispensaries regarding contamination. Interviewing dispensary employees who work directly with patients and the product could provide additional insight into how prevalent contaminants are identified before sale. We also recommend that the large Florida medical cannabis patient population be surveyed to better understand how many of the concerns and desires expressed by the patient community on Reddit represent the larger Florida medical cannabis patient population. The survey should include items about patients’ contamination experiences, trust in medication and social media information, and changes to the current medical cannabis program policies and structure. While the FLmedicaltrees Reddit community appeared to be a valuable resource for medical cannabis patients in Florida, the information presented by some community members did not always appear to come from verified, credible, or trustworthy sources. The research team recommends the state’s Department of Health and the University of Florida produce educational curricula and materials in a variety of formats related to medical cannabis contaminants, identification, and safety concerns related to consuming contaminants. Land grant universities and health departments in other states should also consider similar educational steps for their medical cannabis patients. Researchers may also want to explore the cannabis events happening across the state as they have recently been the partial target of state regulation. Researchers should explore why patients attend these events, what is the draw for vendors at these events, and how event organizers perceive their role in the cannabis community. Identification of other online communities like FLmedicaltrees may also be beneficial for researchers, policymakers, and educators. We recommend community experience, knowledge, and desire comparison research to determine the prevalence of certain issues and identification of policies that are beneficial to patients from a consumer safety perspective. Educators should attempt to reach these communities by regularly posting about common issues regularly discussed within the community to develop trust, and policymakers should review these communities to better understand and serve the community for which they create policy.
Considering broader medical cannabis trends like continued research on health effects, increased use, and new and growing medical cannabis programs throughout the country [32–34], these findings have implications for policy creation and evaluation, as well as education. With the increased use of medical cannabis occurring as medical programs become more widespread [32], communities like FLmedicaltrees can be a valuable resource for patients to learn, share information, and support each other. These open-access communities also provide educators and researchers with a look at real-time patient experiences which they can use to develop effective communication and trainings to meet their needs. While clinical trials and research examine medical cannabis health outcomes for patients dealing with a variety of issues [34], it is also important researchers continue to evaluate cannabis product contamination from a patient safety and education perspective. Understanding patient knowledge levels of medical cannabis and contaminants can be useful in developing education and obtaining reliable survey data related to contamination.
This research can aid in understanding medical cannabis product contamination, developing patient safety and testing policies, and future cannabis contamination knowledge and education research. An example of a recent patient safety effort that emerged from reports of high product contamination and recalls in California was a patient guide for cannabis safety called “What’s in Your Cannabis? A Patient and Consumer Guide to Navigating Cannabis Safety” [35], produced by the Americans for Safe Access, a nonprofit patient advocacy organization.
Acknowledgments
I would like to thank Carlton Bone for his consistent support and aid in finding and utilizing different Reddit tools to allow for a better understanding of the community being studied.
Statement of Ethics
This study protocol was approved by the University of Florida’s Internal Review Board, Approval No. 202201376. Written informed consent was not required for this study as it is based on publicly available data, from the online Reddit community FLmedicaltrees.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
This study was not supported by any sponsor or funder.
Data Availability Statement
The data that support the findings of this study are openly available in “figshare” at http://doi.org/10.6084/m9.figshare.27931893. Further inquiries can be directed to the corresponding author.