Health Committee on Dec. 9th, 2013

[Peggi DeGroote]

This also goes back to the question by Mr. Lizon about appropriate care. If we look at the number of hours that a family physician spends learning about pain while in medical school, it's about three hours in total. Our veterinarians have about 15 hours of pain education. Even though you were told last week that dentists get the same medical training on pharmacological information and that that ought to be good enough, if we look at the number of three hours, it's not at a good standard.

I will suggest that if a family physician doesn't have confidence in what they're doing—through no fault of their own, because we can say that they're not getting good education to begin with—they perhaps don't know even how to do things. My big concern right now for people suffering from pain is that the physicians then will decide not to write prescriptions for opioids, so that people can't even manage their pain. There is a program out of the University of Toronto called the ECHO program, which comes from the University of New Mexico. It is about training front-line family physician workers in pain and addiction. I know this is going forward in Ontario, because we will be one of the hubs for it. I think that kind of thing will help to manage and give confidence to the doctors who are seeing the patients.

Honestly, in lots of cases and through no fault of their own, the doctors don't know what to do.

[The Chair, Conservative, Ben Lobb]

Thank you, Ms. DeGroote.

Mr. Wilks, you have five minutes.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you very much, Mr. Chair.

Each one of you here today has used the words “awareness”, “best practices”, “data collection”, “science”, and “reasoning”. I will bring up a term that is widely used: “medical marijuana”. I don't believe there is any awareness of it. I don't believe there are any best practices for it. I don't believe there's been any data collection whatsoever. There's been very little science done on it. There's very little reasoning as to why we're doing it, especially when we have synthetic models of Marinol, nabiximol, and dronabinol, which provide opportunities for those who are affected by some significant diseases and can aid them.

Seeing that a doctor can prescribe medical marijuana without it going through a pharmacy, I'm curious to hear your perspective, given the addiction issues you've seen, on two things. One, do you believe that marijuana can be an addictive drug; and two, from the perspective of medical marijuana, what needs to be done to ensure that that it is safely prescribed to those who fall under the prescription of a medical doctor?

I'll start with whoever wants to start. You have about one minute each.

Dr. Buckley, you seem to be quite enthralled. Go ahead.

[Dr. Norman Buckley]

No, I'm going to watch this one go by.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Dr. Bromley.

[Dr. Lisa Bromley]

Of course marijuana is an addictive drug. No one can debate that. We need clinical practice guidelines on physicians using it safely. The best I know of are by Dr. Mel Kahan from Toronto, who is planning to release a paper in Canadian Family Physician to guide physicians on how best to prescribe it safely given that it will be a matter of a clinical judgment now. Generally, physicians are quite unprepared to face this as an issue.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Ms. DeGroote.

[Peggi DeGroote]

I think it's difficult for family physicians to have so many different treatment modalities in their medical bag with the limited time they have. I know that we have some patients, especially who have MS, where it has been the miracle drug for them. They're no longer in wheelchairs and they can really get out and function, and that's wonderful.

It's tough. I'm not a doctor. The doctor's have to make that clinical decision, and we give them full authority to do that, because that's what they're good at.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Dr. Buckley, I'll put you on the spot now.

[Dr. Norman Buckley]

I'm with Dr. Bromley. There are a variety of things that are addictive, and marijuana is probably one of them. Addiction is an interaction between a substance and a person. Some people are addicted to a variety of things, and that's a very complex story.

As far as clinical use goes, I'm entirely in agreement that we know precious little about it. We don't prescribe marijuana. We give them permission to use it with a “get out of jail free” card that we sign. This keeps them from getting busted unless they fail to adhere to certain rules about how much they can have and what they can have with it. My clinical choice is to use the commercially available preparations first.

The other challenge is that smoking itself is bad for you. I don't care what you're smoking—oregano, marijuana, or tobacco—smoking is bad for you. We also know precious little about the different strains. I have a patient who comes in with a book on different genetic strains of marijuana. He knows more about marijuana and genetics than I do about people. So it is a very difficult medical situation.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thanks.

My three years of undercover drug work taught me quite a lot about THC, or Delta 9-Tetrahydrocannabinol. There are only two plants—indica and sativa—but there are hundreds of strains that can react differently to each person in this room and outside of this room. It's a challenging thing. In my opinion, the road is winding and unclear.

[The Chair, Conservative, Ben Lobb]

Well put, Mr. Wilks.

Ms. Mathyssen, are you going to...?

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Yes, I have a quick question.

I want to thank all of the presenters here today. I enjoyed listening to what you had to say.

It seems to me that you're talking about having to pay close attention to the reality of human beings. Whatever recommendations we make, compassion very much has to be a part of them. We have to consider the circumstances of individuals and what they're going through. I say that because there was great concern about having methadone clinics in my riding. Of course, the law-and-order types were dead against it until they discovered the people going there were people for whom we should have compassion. A number of veterans who had come back from peacekeeping with injuries and had been prescribed drugs that were difficult to overcome were going to the methadone clinic. So it's clear to me that we need to do a lot more looking.

The Lazarus project and the work at Inverness were mentioned. I'm wondering to what degree the Canadian health care field, the professionals, have engaged in similar efforts. Have we looked at these projects? What about the projects that would guide us compassionately with regard to the circumstances of the human being?

Is there anyone who could tackle that?

[Dr. Norman Buckley]

Looking at the clock, I'll rely on the chair to restrict this little excursion.

The Canadian Centre on Substance Abuse has initiated a national strategy that is not unlike the things you've described. They've brought together people from law enforcement, the pharmaceutical industry, addiction practice, pain practice, public health, nursing, first nations health, social work, coroners' offices, and a variety of other fields. What you describe when you refer to the Inverness project and Project Lazarus is integrated community strategies where everybody who's involved gets together to work towards a common goal, which is the compassionate care of people who require care. It integrates all of the necessary information into a treatment plan. The CCSA is working on that at a national level. Other groups have worked on it at local levels. At the end of the day, these templates need to be rolled out locally. In Hamilton, we've initiated a group that is working towards this at the local level, but it's necessary to do it in a variety of situations across the country.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Dr. Buckley.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Thank you to all of our witnesses here today.

If you have more questions, I'm sure Ms. DeGroote and Ms. Bromley would stick around for a few minutes to answer them.

I think that's it for today. We'll see you on Wednesday.

We have a new gavel here for the meeting, so the meeting is adjourned.