Mr. Chairman, good afternoon honourable members of the Standing Committee on Veterans Affairs addressing the issue of cannabis use among veterans and its effect on their well-being.
My name is Dr. Ramesh Zacharias. I am an assistant clinical professor in the department of anaesthesia at McMaster University. I'm also the medical director of the Michael G. DeGroote Pain Clinic. I'm also the co-chair of the physician advisory group for the centre for medicinal cannabis research at McMaster University.
It is truly my honour to address the issue of medicinal cannabis use by veterans and the impact on their well-being.
I'm going to frame my presentation around identifying three of the current challenges and propose three opportunities to ensure the safe and effective prescribing of cannabis.
The first challenge is what I call “the cart before the horse”. Since cannabis was legalized on October 17, 2018, the availability of cannabis for medical purposes was instituted prior to our understanding of the efficacy and safety in a variety of conditions. As a consequence, the medical claims are either overly positive or negative. On the one hand, cannabis is being viewed as a panacea with a cure-all for many medical ailments and at the same time, there are those who see legalization as a Pandora's box, the use of which predisposes the public to unknown harms.
I have been involved in prescribing cannabis for over 10 years. I am of the opinion that with the appropriate patient selection, the use of validated screening tools and informed prescribing, cannabis will be a benefit in a number of conditions.
Although anecdotal evidence has highlighted the potential beneficial role of cannabis for symptom management, such as pain, sleep, nightmares, anxiety and PTSD, the research community is far from having a complete understanding of the mechanisms of cannabis use for common health problems faced by Canadian veterans.
Second, in addition to my work at McMaster University and Hamilton Health Sciences, I have been an investigating coroner in the province of Ontario since 2012. Over that time period, I have either been the investigating coroner or the regional supervising coroner investigating over 1,000 cases. Sadly, a number of those were opioid-related deaths.
The majority of education that was provided to physicians with respect to the prescribing of opioids was provided by the pharmaceutical industry, and unfortunately today, the majority of education for health professionals completing medical documentation is once again being provided by the licensed producers.
The third challenge is the way cannabis is currently being prescribed in Canada. My practice involves looking after veterans. Unfortunately, a number of our veterans have received their medical documentation over Skype without actually being seen by a health practitioner in the office. Once the medical documentation was completed and submitted, they were then scheduled for a follow-up appointment in one year. I find it hard to believe that we as a society would support a process for prescribing any treatment for chronic disease over Skype, with a subsequent monitoring one year later.
Having laid out the challenges that we currently face in Canada, I would like to propose three solutions. I do believe we have a great opportunity to make changes in the way cannabis is currently being prescribed.
In order to address this issue, one year ago we established a data registry called DataCann. The purpose of it was to gather real-time prospective information on patients using medicinal cannabis. We collect information on their diagnosis for which they have been prescribed medicinal cannabis, but equally important, we use validated tools to assess overall functions: sleep, anxiety, depression, PTSD, as well as the early identification of those who could possibly develop cannabis use disorder.
I believe we have a great opportunity to monitor the effectiveness and safety of cannabis among veterans by having them enrolled in this registry voluntarily. This registry has been funded by the Michael G. DeGroote Pain Clinic, the national institute for pain, at McMaster University and the Centre for Medicinal Cannabis Research. We have received no funding from industry.
The second opportunity we have, if we want to learn from some of the mistakes of the opioid crisis, is that we need to develop Canadian guidelines for the prescribing of cannabis. The first Canadian opioid guidelines were developed 15 years after OxyContin was released. It is extremely important that we create evidence-based guidelines for all health practitioners who are prescribing cannabis. I think it would be important for this committee to encourage CIHR to fund the guideline development.
Finally, the federal government can play a significant role by supporting data collection today, as well as funding much-needed research. We have the infrastructure and a network of outstanding researchers in this country that, when funded appropriately, can give Canada a leading role in informing the dialogue about appropriate use of medical cannabis.
Once again, I would like to thank the chair and this committee for the honour you have given me in presenting to you today on this important topic.