Public Accounts Committee on June 9th, 2016

[Dr. Cyd Courchesne]

I can't really speculate on things before I got there. I can only say what I observed when I got there, and the way forward as the deputy has indicated.

[Michel Doiron]

If I may, Mr. Chair, I guess we were relying on our partners to make some of these decisions, and when Dr. Courchesne arrived we started looking at how we were documenting those decisions. The OAG did raise that in their audit, that we had not properly documented some of the decisions. I think there was a reliance on Medavie Blue Cross to provide us...and they're a great partner, they are incredible.

We decided that the department had to take that responsibility on, not a third party, to ensure that the decisions were correct, but more importantly, from a government perspective, that we were documenting those decisions and following through with them.

[Paul Lefebvre, Liberal, Sudbury, ON]

Has mental health now become more of a priority within the review committee? Or is it just one of the other—

[Gen Walter Natynczyk]

Sir, mental health exactly, along with physical health, is always a priority, so it is centre of mind constantly.

[The Chair, Conservative, Kevin Sorenson]

We'll now go back to Monsieur Poilievre, please, for five minutes.

[Pierre Poilievre, Conservative, Carleton, ON]

It says in paragraph 4.63 that 29% of the approximately 600 veterans authorized to utilize marijuana for medical purposes had obtained this authorization from one physician. Why is it that such an enormous number of veterans went through a single physician to obtain the authorization for marijuana use?

[Gen Walter Natynczyk]

Sir, we can only speculate that our veterans are networked with each other. Again, they have had a common experience in operations, be they in Afghanistan, in Bosnia, Rwanda, Somalia, or operations prior to that, so they are networked, and they are dispersed from coast to coast to coast in the country, some in remote areas, some in larger areas, and when a soldier, sailor, air man or woman hears that something is working for somebody else, they will share that.

[Pierre Poilievre, Conservative, Carleton, ON]

The fact that they are dispersed would seem to be a reason why they wouldn't be going to the same doctor.

[Gen Walter Natynczyk]

But the other challenge that we have is that there are physicians in the country who will not prescribe—

[Pierre Poilievre, Conservative, Carleton, ON]

That's the point.

[Gen Walter Natynczyk]

—and therefore that's one of the challenges. At the same time—

[Pierre Poilievre, Conservative, Carleton, ON]

I'm sorry, I don't mean to interrupt you, but we're very tight on time.

Building on your point, we found that 53% of the approximately 1,400 authorized to use marijuana for medical purposes had obtained this authorization from four physicians. You've said that a lot of physicians won't prescribe it. There's probably a reason they won't prescribe, and I don't think it's because they're engaging in moralism, as some had suggested earlier. It's probably because they have some questions as to whether or not marijuana is the right treatment for the person who is sitting before them in the doctor's office.

I've been to the operational stress injury clinic here in Ottawa, and they specifically say that in order to treat post-traumatic stress, you have to confront the underlying trauma that caused it. This is very difficult and painful because people who come back from theatre are experiencing extraordinarily painful memories, and they have to relive those to treat the stress symptoms they are enduring.

My worry is that marijuana is being used as a numbing treatment rather than as a real treatment for the underlying cause of post-traumatic stress, which could be why so few doctors are prepared to prescribe it.

The other worry I have is that the quantities in question are a maximum of 10 grams a day. According to the Government of Canada, one gram produces two joints. So with 10 grams, that's 20 joints a day. That's like smoking a pack of cigarettes, with every single cigarette being filled 100% with marijuana. I have a hard time believing that this is medically sound, based on Health Canada's.... Mr. Harvey found earlier today that compared to Health Canada's observations on marijuana consumption, the amounts here are four, five, six times higher than those highlighted on the Health Canada website. Do you share any of these concerns about the possible excessive prescription of this solution for our veterans?

[Gen Walter Natynczyk]

Sir, you're absolutely correct in your concerns, and we share all of them, and this is the reason our minister has asked for this review: to try to get as much of the real information across the board from the best researchers in the country and to hear the perspectives from our veterans as well. The challenge for many of our physicians across the country is that there is a lack of evidence on the medical use of marijuana. It is still very much an experimental treatment, but some veterans find it to be very beneficial so they can undergo treatment, vocational rehabilitation, and so on. However, given all the concerns, it's precisely why we're doing this review: to provide recommendations to our minister on how to move forward on this important issue.

[Pierre Poilievre, Conservative, Carleton, ON]

Will that review look into the psychological benefits versus the psychological drawbacks of abundant marijuana use among veterans suffering from post- traumatic stress?

[Gen Walter Natynczyk]

If I could ask Dr. Courchesne to just briefly mention her meeting with some of Canada's top medical experts on this topic.

[Dr. Cyd Courchesne]

Yes. The policy review is including an extensive literature review, and we're working with Health Canada. They've been very gracious in sharing the literature review that they're doing on that. Certainly that will be factored into our policy review.

[The Chair, Conservative, Kevin Sorenson]

We'll now move to Ms. Zahid.

[Salma Zahid, Liberal, Scarborough Centre, ON]

We appreciate the department's progressive initiative on giving access to veterans who require marijuana for medical purposes, for their health issues. There are several concerns expressed in this report regarding the amount prescribed for the eligible veterans, including intervention during excessive drug usage, high-risk veterans, and containing the costs associated with it. It seems that this program was begun without a sound policy on how it should be implemented and administered. Can you discuss the department's policy with regard to medical marijuana? Why did you feel it should be created?

[Gen Walter Natynczyk]

In 2001, Health Canada indicated that marijuana for medical use should be accessible to all Canadians, and veterans are obviously are a part of our nation. In 2007, a senior official in the department approved, for compassionate reasons, marijuana for medical use by one individual who was in an end-of-life situation. We expanded it in 2008, and the department approved it for a small number of people. At the time, it was covered by Health Canada regulations that prescribed which physicians could authorize, under what circumstances, and to what limit. All of that changed in 2014, and at that point the department had to expand its guidelines.

I'm just going to ask Michel Doiron to elaborate on that.

[Michel Doiron]

The deputy's correct. At that point, we had a limited number of individuals coming to us. After the liberalization of the guidelines, a treating physician could authorize the use of marijuana, and we started getting a lot of demands. It's not a drug like other drugs. We had agreed to pay in 2008—though in 2007 there was one case we paid for. We were already paying.

Then we had to react to this growth. We looked at what the beneficiaries were asking for, what had been approved in that short period. We had put a cap on this in June 2014, because we wanted to make sure we understood what was going on. We capped it at 10 grams because 80% of our veterans were asking for that or less.

[Salma Zahid, Liberal, Scarborough Centre, ON]

You prescribed an amount of 10 grams per day, doubling the amount identified by external health professionals, and tripling the amount that Health Canada recommends. How was this amount of 10 grams determined?

[Michel Doiron]

We went to what was being requested and what we had been paying for since the act came into force. It was based on our going out and trying to assess the evidence. To be honest, for medical purposes, the evidence is clearer now, but at that point 2014, it was sketchy at best.

[Salma Zahid, Liberal, Scarborough Centre, ON]

Between 2014 and 2016, the evidence started coming in. Why did you not go back and do further research? Why did you not prescribe the amount based on the evidence available?

[Gen Walter Natynczyk]

I want to avoid the use of the word “prescribe”. It's “authority”. It's the authority a physician gives his or her patient to have access to an amount of marijuana. It has to do with the relationship between the physician and the patient. In 2014, the department, in trying to capture most of the authorities, set the limit at 10 grams. Clearly, that is higher than what Health Canada said. That's precisely why we're doing this review now, in order to provide advice to the minister on how to move forward on this very important issue.

[The Chair, Conservative, Kevin Sorenson]

Mr. Godin.