Good afternoon, honourable members of the committee. There are no words to say how grateful I am to receive this experience to speak before you today.
I would like to talk to you about my experiences as a soldier, tell you about the obstacles we face as veterans when we seek treatment, and discuss the research I am doing with Dr. Zhang.
I would also like to say a big thank you to Dr. Robert Laprairie, who is a cannabis pharmacologist at the college of pharmacy who helped us review this, as well as Madam Kelly Malka from Montreal, who helped me a little with the translation to make sure it was correct.
I did a 1,000-hour primary care paramedic course at John Abbott College in Montreal. Then at age 19, I left to voluntarily join the military. I served with a light infantry regiment in a combat role as a combat medic, and then in 2013 the contract ended. It was up or out; I chose out and was honourably discharged.
I can say that I'm intimately familiar with PTSD, because unfortunately, I have different friends across the military, as well as EMS circles, who were affected in different ways. I know a paramedic instructor and a friend from the military who chose the permanent end to the temporary problem, which was suicide.
I can also say that the transition period is extremely difficult to live through. Many studies have shown that this period may be the most volatile and where there can be very prevalent use of substances.
In my case, I went from being mostly respected and appreciated as the company and platoon combat medic, to having extreme difficulties with licensing bodies to get back to work in a timely manner. Unfortunately, it's really common to hear about cases like this. That, combined with the fact that you're free to consume drugs and alcohol outside of the military or paramilitary organization that you belong to, is often the deadly concoction that leads to unemployment, homelessness, suicides and other devastating outcomes.
In the military, there's a very strong prevalent culture of substance abuse. Soldiers across the ranks often use alcohol as a tool to self-medicate, and even sometimes to let loose after a stressful deployment or stressful longer period. It's also not uncommon to see especially junior platoons be completely hungover for a 05:00 training session.
Also, many soldiers consume dangerous amounts of things like energy drinks and painkillers like acetaminophen and ibuprofen. They're often combined with cigarettes, chewing tobacco and energy drinks.
In my time, there was also a bit of use of synthetic cannabis. The product was called “spice”, which is a very high-content THC product that has negative effects. It couldn't be detected in urinalysis at that time. I think it can now, but I'm not sure.
Having said that, veterans are often their own worst enemy. There's a reluctance to seek treatment, and there's also some difficulty after service in connecting with others for different reasons. The desire for effects to happen right now hinders progress.
Many veterans who suffer from acute episodes of PTSD are often prescribed very powerful drugs like haloperidol and quetiapine, which are usually reserved for cases of severe psychiatric patients. This is an issue, since PTSD is very hard to diagnose, especially in the early stages, and is often comorbid with other conditions like anxiety, insomnia, chronic pain, hearing loss, tinnitus and others.
The stigma of being soft for seeking treatment, along with being given by physicians what many veterans refer to as the “zombie cocktail”, and being stubborn about treatment, can create a never-ending vicious cycle of distress between patient and clinician.
The fact that PTSD is also comorbid itself with different types of addiction is often a valid reason for physicians to be reluctant to prescribe drugs outside of the recommended guidelines, such as cannabis.
It was at that stage in my life I found that many people, especially veterans, talk but don't proactively take it upon themselves to change the solution. I saw also in friends that the symptoms were from very benign to very severe. For example, one just decided that he was going to defer medical school for a year and take some time off to calm down. At the other end of the spectrum, there were a few who needed intensive treatments, medications, and even hospitalization, for insomnia and nightmares in the early stages of PTSD.
I heard anecdotal evidence that there was some relief from these issues with medical cannabis. It was right when I got out. That's when the story of cannabidiol oil for the aggressive seizure condition, Dravet syndrome, really caught my attention.
I also came in contact with a man by the name of Boone Cutler. He was an American army soldier. A direct mortar impact caused a TBI and he found himself addicted to the very medications that the physicians at Walter Reed prescribed him. He switched to high-content CBD cannabis with THC as needed and has since become a radio host, author, columnist, video director and advocate in general. He made the Spartan pledge, which encourages veterans never to take their own life and “to find a mission to help my warfighter family”.
This led me to follow the military model to lead from the front and take it upon myself to study this. I took eight months after honourable discharge before going back. Even now in school student veterans are hardly seen and we're definitely under-represented just because there are hardly any veterans, period, or clubs on campus. It's also really hard to reach out.
Education on the subject is highly lacking. Even in the pharmacology program where I am now, there are still a few professors who are unaware that new technology has allowed for different compounds of the plant to be isolated and delivered in oil form within an accuracy of 0.01 milligrams per millilitre and as much as 0.25 milligrams per millilitre, depending on the company. Many are also unaware that companies registered with Health Canada as licensed producers usually have really strict guidelines to adhere to. The reputable ones, for example MedReleaf, Aurora, Canopy—I'm not endorsing them; I'm just saying—hold not only GMP but also ISO certification, which is a more strict form of regulation. They have many forms other than dried leaves, such as oils, edibles, vaping solutions and creams.
The issue, though, as both doctors have said, is that many studies and opinions contradict each other. There's not only a chasm between countries, but even within a province. For example, the CMA currently does not seem to support cannabis for PTSD. However, the Israeli Ministry of Health supports medical cannabis after traditional pharmacological options fail or if there's not enough help from psychotherapy within two months. In Israel they also recommend low doses of THC for severe PTSD.
Although patients can be authorized medical cannabis and seem to have reasonable insurance coverage, it's often very bureaucratic and confusing to begin the process since there are so many different requirements within each province, as well as at the federal level.
I believe we need more research into cannabis-based medicines so we can demonstrate their efficacy, if any, in individuals with PTSD. There is also a serious need to better educate health professionals as well as professors teaching these subjects so we can distinguish appropriate compounds from recreational and harmful use.
The current guidelines allow for three grams daily. When we think that this is enough to deliver half a gram of cannabis six times in an 18-hour period, it may seem like a lot but many patients, especially patients who have been to combat zones, may have more severe conditions and may require larger amounts, especially if they have a tolerance or if they're using smoked cannabis, since with smoked cannabis, the maximum bioavailability quoted in the literature that I could find was 56%.
At the moment powerful opioid drugs are prescribed to patients with chronic pain roughly every four hours according to the pain guidelines. Given that they're extremely dangerous and that it's also the driving force behind the current fentanyl epidemic in North America, to me it seems logical to allow for possibly higher doses in severe conditions, especially if they're using smoked cannabis.
Pharmacological information regarding dose responses by body weight, route of administration, and also the type of compounds is completely lacking, even non-existent. Studies in human patients are going to be needed to allow the full elucidation of cannabinoid pharmacology. The lack of treatment options without serious side effects and knowing that cannabis products were being used prior to legalization in both Canada and the United States led to my interest in studying cannabis as a potential therapeutic agent for PTSD.
Although it's a controversial topic, there is some anecdotal evidence of veterans using cannabis to alleviate the symptoms caused by mefloquine toxicity. I needed to determine and I hope to show that even if there are safety risks with cannabis, the benefits outweigh those risks.
During my undergrad I optimized an animal model of PTSD to mirror human exposures and conditions. Animals are subjected to daytime and nighttime exposure and then they get daily cage changes to simulate either a combat deployment, or an EMS shift with different personnel. Using this model, we have found that a low dose, five milligrams per kilogram, of CBD oil can really decrease the PTSD symptoms, and does not seem to have any addictive properties. Although the results are promising, it's still really early and we can't responsibly make any conclusions with respect to humans at this time. We do hope to explore different compounds, doses and ratios in both male and female rats before doing larger randomized clinical trials, hopefully with the Legion.
This is going to be the basis, and it's also the goal for my M.Sc. thesis. We think that more knowledge of the intricacies and mechanisms of our body's endocannabinoid systems will allow us to properly define optimal dosing for each strain and compound of the cannabis plant. Human studies into safety for pediatric conditions, such as Dravet syndrome epilepsy, as well as safety thresholds for cognitive effects when using THC are needed to make better decisions. We think these would benefit clinicians and patients alike.
Thank you.