Public Accounts Committee on June 9th, 2016

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Thank you, Mr. Chair.

I would like to clarify my position in this debate.

As a parliamentarian, my purpose is to find potential solutions to see to it that our veterans are treated well. The fact that I am questioning the costs should not be interpreted as a minimization of their situation. The costs are one element, but it is very important for me that we find the best solution for veterans.

I want to know today if the whole exercise is aimed at finding the best solution. If marijuana is the solution, we have to know whether we are dealing with communicating vessels, as Ms. Mendes mentioned earlier, and if it means that another category of medication and its costs will be reduced and be transferred there. I think you don't have the answer, but that you will provide it later. Those are my thoughts.

My question is for the Auditor General.

Based on your audit, can you reassure us by telling us that the Department of Veterans Affairs is in control of the situation and will take the necessary means to ensure the effectiveness of its programs, while also ensuring that the budgets are not a money pit in the ground?

[Michael Ferguson]

As we noted in the audit, there were a number of issues with the program. Obviously, in order for the program to work effectively, certain problems need to be ironed out. That was the case for all aspects of the program that we looked at. The department will have to make a few improvements for the program to be effective.

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

My next question is for the department representatives.

You have accepted the recommendations and stated that your intentions are good, but are you able to say to us today, June 9, 2016, whether you have the necessary means to achieve your ends?

I don't want you to take this the wrong way, but would just like to ask you, in my own words, whether you have enough staff and data available to you to better manage public funds within your department. The goal is to make the most of those taxpayer dollars so that veterans can enjoy a good quality of life and the best medicines available on the market, while at the same time living within our means.

[Gen Walter Natynczyk]

Thank you very much for your question.

The well-being of our veterans is also our goal. It is truly a priority for us. To answer your question, I'm confident that our managers and our department's leadership and planning will be able to remedy the shortcomings identified in the audit report. As I've said before, I greatly appreciate the Auditor General's help and have noted the issues he pointed out. With the support of our doctors, our pharmacists, and our measures, we will make sure those weaknesses are corrected.

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Thank you very much, Mr. Chair. That brings me to the end of my questions. I have a bit of time left, but I am offering it to my colleague.

[The Chair, Conservative, Kevin Sorenson]

You do have a couple more minutes, but I want to get something here.

As you know, we'll be issuing a report on the study we're doing. Just so I understand this correctly, although we've seen this explosion in the use and quantity of medical marijuana, we have anecdotal evidence that the use of other pain relief, other medication, has diminished. That's all anecdotal.

There is no evidence, as far as data are concerned, that says, yes, the number of medications has diminished, the number of those using these medications has diminished and so has the cost. There's no evidence for that. It's more anecdotal. You have the veterans saying that they have all this medicine they don't have to take anymore. Is that correct?

[Gen Walter Natynczyk]

Mr. Chair, we actually do have evidence, as you indicated, that the use and cost of marijuana for medical purposes has increased exponentially. We also have evidence that the use of opioids and other antidepressants has gone down.

[The Chair, Conservative, Kevin Sorenson]

Proportionally?

[Gen Walter Natynczyk]

What we are lacking is the causal relationship. We are lacking causal evidence that one went up and the other went down.

[The Chair, Conservative, Kevin Sorenson]

Given the excessive jump in the use of medical marijuana, doubling in cost over the next year to $25 million, how much of a decrease has there been in the use of other medications? Is it just miniscule? It may not be exactly proportional, but is it close, or what type of evidence do you have there?

[Michel Doiron]

It is not one for one, and that's in regard to a causal effect. We've seen a very big increase in marijuana usage and cost, but the relationship is not one for one. We have seen a decrease in the use of other medications. We're trying to analyze that decrease, and why, but it is not directly proportional—far from it actually. That's what we're trying to analyze.

[The Chair, Conservative, Kevin Sorenson]

So, it's far from proportional.

[Michel Doiron]

Yes. Now, we've only started to see that decrease. That's why we are studying it to see what will materialize, what will it look like. We are tracking that and working with our partners at Medavie Blue Cross in tracking the use of opioids, tranquillizers, antidepressants, and some of the pain medications. At present, it is not directly proportional.

[The Chair, Conservative, Kevin Sorenson]

Mrs. Mendès.

[Alexandra Mendes, Liberal, Brossard—Saint-Lambert, QC]

Thank you very much, Mr. Chair.

I would like to thank the witnesses for the clarifications they provided.

It's important to continue with this study and to later confirm the benefits of using marijuana to treat certain illnesses and chronic pain—as that's what it's often used for—our veterans have to deal with.

I would like us to return to the title of the Auditor General's report. It alludes not only to marijuana as a treatment, but also to all of the other medications veterans need.

Will the study or research being carried out on the program in its entirety be able to show whether there is a difference in terms of savings between the use of marijuana for medical purposes and the use of other medications? Could this be included as part of the study as a whole?

[Michel Doiron]

Thank you very much for your question.

That's what we are planning to do. I can't predict what the results of our studies will be. The further these studies progress, the more evidence we'll have on the cost of the marijuana and on the increase or decrease in the cost of other medications. In addition to developing a clear policy on marijuana, we want to know what is being used. Some veterans have told us they no longer need to use medication x, y or z. And others tell us their doctors are prescribing lower doses than they used to.

It's the causal link that we're trying to analyze.

[Alexandra Mendes, Liberal, Brossard—Saint-Lambert, QC]

From what I know about the issue, it would apply more to pain medication.

[Michel Doiron]

Yes, to a large extent, but it also applies to antidepressants, tranquillizers, and opioids. This is what we are in the process of analyzing. It's too early in the study to draw any conclusions. We are going to develop a policy on marijuana. We will be conducting public research, in addition to our research with the Canadian Institute for Military and Veteran Health Research and other organizations. We want the policy to be flexible enough to meet the needs of our veterans. Our core mandate is to ensure the well-being of our veterans, and I am pleased that the committee mentioned that.

There will be further studies; more people will start using marijuana for x, y or z reason, and the information will be made available. We will review our results on a regular basis with those aspects in mind, in order to make sure that our policy continues to meet the needs of our veterans, not only in terms of effectiveness and efficiency, but also in terms of their health and well-being.

[Alexandra Mendes, Liberal, Brossard—Saint-Lambert, QC]

Right now, our objective for the medium and long term is for your department to know that we will be following your progress in the next few years with interest. We will come back to review it, but always keeping the best interests of our veterans in mind.

I find it extremely difficult to assess your estimates. It might strike you as odd that I would make such a remark, but I look at your estimates and see that you are anticipating a few increases, but nothing major from one fiscal year to the next.

How can you predict what the medical needs will be? I imagine you would rely on data from previous years, but aren't future needs very difficult to predict?

[Michel Doiron]

I will give a general answer and leave it to Dr. Courchesne to get into the technical specifics.

It is difficult to make predictions, but I believe that it is critical to understand that, for us, whether it's one veteran or a thousand veterans who come to us in need, our mandate is to ensure that they receive the care they require.

[Alexandra Mendes, Liberal, Brossard—Saint-Lambert, QC]

Exactly—and that's why I'm asking you the question. You don't know exactly what the needs will be, but in principle, you don't have the right to refuse to respond to those needs.

[Michel Doiron]

That's right.

Our budgets are based on yearly estimates from past years and from a consistent military tempo. If Canada decides to deploy troops in a conflict, we will have to review our estimates.

We must have realistic estimates. We base our forecasts on previous years, on the community of serving members, on the veterans' community, and on the number of members who leave the Canadian Armed Forces each year. There is a very well-established percentage of those members who become our clients. It's part of our data. We regularly work with Treasury Board and the finance department, and we will make adjustments in a given year and at year's end, as needed.

[Alexandra Mendes, Liberal, Brossard—Saint-Lambert, QC]

Thank you so much.

[The Chair, Conservative, Kevin Sorenson]

Thank you very much, Ms. Mendès.

Thank you to our guests for appearing before our committee today. I think you've attracted a lot of interesting questions. Above all else, I think we want accountability and transparency, and we want to know that one department, say Veterans Affairs, isn't working against the best recommendations of Health Canada. When we have an Auditor General's report, our job is to go through it.

Let me just say that because of the number of questions that we've fielded today, if you leave here and all of a sudden think that something was missed or maybe that you didn't have enough time to complete an answer or to provide a little more information, please submit that answer to our clerk, who will see that each one of us is copied on some of that.

We're going to suspend. I'll ask the committee to stick around for a moment. We have one small item of committee business. It wasn't on the agenda, but I think we have agreement to go to it briefly.

We will suspend and come back here in about two minutes, because our time has almost run out.

We thank the individuals who appeared today. Thank you.

[Proceedings continue in camera]