The Hawaii Department of Health (DOH) along with licensed medical cannabis dispensaries and private independent laboratories, have had to carefully navigate through initial and new statutes and regulations for legal, operational and technical guidance — while walking a tightrope with federal laws that consider marijuana an illegal, dangerous substance with no proven medicinal value.

Along the way, we’ve learned from the insights and shortcomings of other states. For example, California, which does not have restrictions on pesticide use or set limits on pesticide residues on medical cannabis, has seen patients’ health compromised by cannabis products. According to a peer-reviewed study in The Journal of Toxicology, smoking medical cannabis with high levels of pesticides can cause serious damage to kidneys, the liver and other organs.

These cases underscore the importance of the department’s foundational principles of patient safety, product safety and public safety. These cases have also been a wake-up call to remain vigilant. Instead of speeding things up, we are proceeding with caution. Launching an unsafe program for those with debilitating health conditions would be irresponsible.

We realize the medical cannabis dispensaries and the testing laboratories are making significant investments to prepare for the new program. Obtaining a return on their investment is important and we wish them success; however, there is much more at stake. With this program still in its infancy, we do not want to have cases of preventable harm and unnecessary liability and litigation.

A recent report card from Americans for Safe Access (ASA) served as validation we are doing things the right way. The report ranked Hawaii’s program fifth-highest in the nation and noted: “Hawaii is on track to become one of the best programs in the country … ”

There are three phases involved in the approval for each medical cannabis production center of a dispensary. Statewide, of the eight dispensary licensees, Maui Wellness is the first to meet the requirements for all three phases for its two production centers. This occurred in late May.

In addition, there are three inspections required for all retail sites. Aloha Green on Oahu and Maui Wellness have met two of the three requirements to open a retail location. Both completed their second inspection in May. The third inspections will coincide with products being ready for sale.

Private independent laboratories are another integral component of the program. The Hawaii DOH’s State Laboratories Division is working with private labs to ensure they have proven capabilities to properly test and evaluate medical cannabis products. The first lab is expected to operate this summer.

All products must undergo a battery of tests at the private laboratories. Medical cannabis products are tested for their potency to ensure their quality. The labs also test for the presence of heavy metals such as arsenic, mercury and lead, and pesticides which can impact the health of patients. Moisture content is evaluated to test for conditions conducive to the development of mold or harmful bacteria.

And while Hawaii island and Kauai may not have on-island laboratories ready to conduct the tests right away, the Legislature this year amended the statute to allow for interisland transportation of medical cannabis samples for testing purposes only, and this is now pending before the governor. We are preparing protocols with the Attorney General’s Office to implement this.

As we continue to make progress, we are confident we will successfully address new dilemmas to create a medical cannabis dispensary system that is effective, efficient and safe for Hawaii’s patients and public.

Virginia Pressler, M.D., is director of the Hawaii Department of Health.