Public Safety Committee on May 5th, 2016

[Paul Frewen]

Thanks.

In response to both, I think these interventions indeed could be a mental preparation for the difficult types of workspaces we're finding trauma and PTSD to come from. This could be done up front and throughout and encouraged as a well-being practice.

I'm sensitive also to the point around language. Indeed, it might be the same sorts of things, but we can call it mental training or cognitive preparation. A focus on mind and cognition and mental training more than the emotional fluffy stuff can sit well and be more acceptable. That would be the up-front preparation.

We have seen an openness to these types of practices as well. Both men and women in different types of jobs have experienced the trauma, they've struggled, and these types of interventions do more and more make sense to people.

Also, speaking to that as well, the technology focus that I was leaning toward at the end there can also aid the person who might be a little more sceptical of meditation and mindfulness. If you show them their EEG, if you show them their heart rate, if you show them how to regulate their condition, it really puts the power and the control back into their own hands, as opposed to being reliant on a medical model only.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Do you see a role for the federal government to play in sharing things like yours—which would have to translated into French, being mindful of that—as a best practice, if we were to put together something on PTSD and OSI?

[Paul Frewen]

Absolutely. Right here, these practices themselves don't require so much the therapist or the clinician. We do want to provide the instruction and ensure that everything we suggest is evidence based. These practices, of course, are ancient history and are increasingly being validated in the current conventions of randomized controlled trials that we heard about earlier, and indeed have actually been shown to have direct effects on the brain and body through the neuroimaging approaches that were also referenced earlier.

There is a good evidence base for these approaches and there have actually been no contraindications for them. There's really no research to suggest that meditation practice is going to lead to worse outcomes.

It has to be done right. Sometimes while sitting quietly with your emotions, difficult things are going to come up, for sure. We need the right education around how to address symptom occurrences that come during meditation. The same would occur, for example, while sitting quietly and reading a book or watching TV. It's really not that any of these practices are going to lead to harm, and quite likely they are going to lead to some benefit.

I would think that, yes, it would be quite reasonable to recommend it.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

I want to turn to Dr. Aiken for a moment, because you've done a lot of work on the treatment side of it.

Do you use this type of work in treatment and also, I think more importantly, in prevention?

[Dr. Alice Aiken]

I'll speak about the research that's been done. There are many good Internet-based treatment protocols out there. In fact, Dr. Merali and I were just talking. We're on a research team together that has developed a website for men's mental health specifically. It was funded by Movember.

There are a lot of good Internet-based treatments out there. What I would always ask is—and I know Dr. Frewen would as well—what research has been done specifically on outcomes for that specific website? What kinds of responses are they getting? In particular, what kinds of responses are they getting from a population—I think somebody else said it—that is typically more male and macho? I would ask specifically what kind of work is being done on that.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Can you answer that in my remaining one minute?

[Paul Frewen]

Yes, thanks. Indeed, we're currently using this particular website with a number of populations, men and women of various trauma types. We've so far only published on it, actually, an open sort of web use, but in that case persons varied. We grouped them based on their PTSD symptomatology. We found that persons with PTSD indeed were responding very favourably to the intervention. With regard to their feedback, essentially, they would use it because they felt this made sense to them as an intervention for PTSD. We're taking those initial findings essentially as a proof of concept to the now more rigorous approaches that were spoken to before in terms of randomized controlled trials.

[The Chair, Liberal, Rob Oliphant]

Thank you.

Mr. Miller.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Thank you very much, Mr. Chairman.

I'd like to thank Mr. Frewen, Mr. Merali, and Ms. Aiken for being here. You gave great presentations.

Ms. Aiken, I'd like to also thank you and your husband for your service to Canada. Thank you for that.

Mr. Merali, I found one interesting comment in your presentation that I just want to make sure I understand correctly. You mentioned medical marijuana, and in the context it sounded like you had a worry about the higher use of medical marijuana, in that it's already happening and is probably going to increase. It sounded to me as though you had a concern with that. Could you clarify? I just want to be clear that I heard you.

[Dr. Zul Merali]

I was not necessarily expressing a concern. I was reflecting that the projections indicate that the costs are going to keep on escalating to a level of $30 million or something. The question, again, was why we're not investing instead of—not instead of, but we should also be supporting parallel efforts to try to find more definitive solutions to this.

As we have seen, there are many, many modalities of treatments. How effective, really, are they? We want to stem the flow and make people feel better and more fully engaged. Why don't we figure this thing out, just as we do for other illnesses, and find more permanent solutions, other than through trial and error? Let's try this, this will make you feel better, that will make you feel a bit better, but you're still not cured. I think we need to get to the bottom of that. That is what I was trying to get to.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

To carry that a little further, then, do you believe that medical marijuana is a consistent treatment or a valuable treatment for PTSD or mental illness? To carry it even further, are there studies out there that without a shadow of a doubt show that it works?

I see you shaking your head, Ms. Aiken. I'm going to ask you to comment on it as well when Dr. Merali's done.

[Dr. Zul Merali]

From what I know, if you do the PET studies looking at cannabinoid receptors, the receptors in the brain that actually bind to components from the marijuana plant, to the tetrahydrocannabinol, you see that those receptors are much more highly expressed in situations such as PTSD than in controls. That tells you that something is going awry in the internal system.

I don't know whether with the use of drugs, which is quite common—it could be alcohol in the U.K. and it could be marijuana here—people are trying to self-medicate because they're not feeling well. I think that is a fact. People do seem to derive some benefit from it, and they're doing it because they're not feeling well.

Again, my old story is, well, let's find out: what is it exactly so that we can treat you properly?

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Dr. Aiken.

[Dr. Alice Aiken]

There aren't any large-scale studies. There really aren't. There is some great preliminary work on cannabinoid in Israel—for over 10 years—and they still haven't done a large-scale study. The reason is that nobody can patent it.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Okay.

I've talked to five or six doctors that I know in my community, including my own doctor, just in having a discussion about this, because the more people you talk to, it's valuable. I've talked to two of the doctors in the same context.

One of them said to me, “Look, Larry, you could have a mental or physical ailment, and I could prescribe to you to go home every night and drink six or eight shots of Scotch, or I could prescribe medical marijuana.” He said that what both of those will do in most cases—that's how he worded it—is that basically you're going to forget about it for a few hours, but he said that in the whole context of the thing, there's nothing out there that tells him that it actually helps your condition.

Based on that comment from two doctors, do you in general agree with that? Is that a fair statement?

[Dr. Alice Aiken]

What I always like to say is that the plural of anecdote is not data.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Okay.

[Dr. Alice Aiken]

I think it's really important that we get the data. All I'm saying is that we don't know.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

We don't know yet.

Dr. Merali, is there anything else?

[Dr. Zul Merali]

I think that doctor put his finger on it by saying that this is symptom relief. It's a temporary symptom relief that people are looking for in the absence of a proper cure.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Okay.

Mr. Frewen, do you have any comment?

[Paul Frewen]

Yes. Thanks very much.

These drugs, both marijuana and other forms of recreational drugs, are being used, and I think they're being used for their effects on the nervous system. They have direct effects, of course, whether they be relaxants or stimulants. They have various dissociative qualities, which you mentioned, such as the suppression of memory and distress in the immediate short term.

My thought here is actually the idea of “meditate versus medicate”. Some similar effects can be achieved through mental practices. It's not so immediate as far as the effects of the drug go, but with time these forms of mental training that I was referring to—the meditations, the biofeedback, and particularly the neurofeedback—can achieve some of those benefits of relaxing the nervous system, improving concentration, and improving mental control.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

I have one last question in the time I have left.

Ms. Aiken, your organization does some great work. You talked briefly earlier about the work done in the military field with veterans with PTSD and with first responders. Is there enough interaction between the two to help...? I know they're separate, but they both come back to something that was a trauma. Is there enough being done between the two that we can help each other progress?

[The Chair, Liberal, Rob Oliphant]

Go ahead, very briefly.

[Dr. Alice Aiken]

Yes, certainly, and I would say that in Canada it's a lot of the same researchers, many of whom you've heard from, such as Dr. Lanius and people like that, who are doing research on both groups anyway. They have expertise in biofeedback or brain biomarkers or PET scanning, and they work with both populations. I think there is a tremendous amount of overlap in terms of the people doing the work, and we're lucky to live in a country where we can capture that so that we're able to harness it for a national perspective.

So yes, there is a lot of overlap in the work being done.