Veterans Affairs Committee on Feb. 25th, 2019

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Mr. James, you've had experience as a pilot and as a first responder. Do the comments regarding veterans as a separate group in terms of our discussion sit well with you?

[Mark James]

Not particularly. When you look at first responders, you look at police officers, you look at.... There have also been cases we've seen in the press of people who were exposed to very graphic evidence at trials. If the right clinical research is done, it will be applicable to patients across the board.

Indications such as the anxiolytic properties of cannabis are one thing, but pain and CINV, for instance, are different indications, and I believe they will require different formulations to address.

[The Chair, Liberal, Neil Ellis]

You have 50 seconds.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Mr. George, what's the effect of cannabis on the body? Do we have the full picture of everything that happens from the ingestion of cannabis?

[Dr. Tony P. George]

That's a great question.

We're still learning. We probably know much more about its effects on the brain. We do know that many of the components in tobacco are also in cannabis, including some potential carcinogens. That's why I like hearing this discussion about alternatives to smoking. We can isolate the therapeutic components to truly understand that and get rid of some of those that are potentially harmful.

As has been said, we still have a lot to learn to understand the effects of cannabis, which is a mixture, on the body.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Thank you.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Kitchen, we'll end with you. You have five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you all for being here.

In many ways we're in a bit of a pickle. I agree with you, Dr. Zacharias. In your opening statement you said we've put the cart before the horse. The reality is that we have no guidelines, no standards, no prescription levels. We don't know how often it should be taken, whether it should be taken in pill form, how much should be taken and for how long. That's a challenge.

It's a big challenge for us, because we've heard lots of testimony from veterans and from family members who've come in and said, for example, that they have their spouse back after dealing issues of PTSD, etc.

Dr. Zacharias, you made comments about opioids and how there is some indication or some link along those lines. We don't have research today. We can have anecdotal research, but ultimately the best research is an RCT. That's the only way we're going to know where we need to be on this. That's a challenge, because that research takes years to come up with.

How do we do that without falling into, as you indicated, Dr. Zacharias, the challenges we've seen with opioids and the side effects we had from their prescription?

[Dr. Ramesh Zacharias]

I think it's been said: Don't let what you don't know today keep you from doing what you do know today. We do know that there's a safe and effective way of prescribing these products. While we might not have every issue identified, we know there's a way of prescribing it and monitoring people well to be able to identify early those who are going to have problems.

This is where the guidelines, I think, will be helpful. As I said, with opioids, Canada did not create its first guidelines until 15 years after OxyContin was released. I hope that's not going to be the case with cannabis. One of the recommendations I would really like to see this committee adopt is encouraging the CIHR to fund the creation of the guidelines.

In the interim, it's a safe product in the right hands for the right patient, so if you can educate people to know their products well, which ones work, but more importantly, when you are starting to see signs of complications.... I've seen that in veterans who I've had in clinics. Early on you will identify that they're taking the wrong combination or they're taking too much of one product and not the other.

As I said, I've been prescribing it for 10 years. I believe it's safe as long as you screen people and, more importantly, monitor them. You can't prescribe this product and then see them in a year. You and I would never agree to an endocrinologist seeing a diabetic patient, prescribing insulin and then saying, “I'll see you in a year.” That would not be good medicine.

I'm seeing that the way we're prescribing—and most of the veterans tell me this—is that they get their appointment and the next appointment is scheduled for a year later.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I was a regulator before for the chiropractic profession.

Doing things over the phone without seeing that patient's face up front is a huge issue, as you mentioned about Skype. How do you do it without assessing that patient and knowing them?

[Dr. Ramesh Zacharias]

I agree with you. I think you can monitor people once you have prescribed it.

Distance is an issue with some of the veterans. They have decided not to live in metropolitan areas—and I completely understand their choice—but I think you can use various technologies to monitor them.

My issue is how they were prescribed and the fact that they were left alone for a year. That's what they have reported to me.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Dr. Lucas.

[Philippe Lucas]

Thank you so much.

I just want to point out that UBC is doing a phase two randomized clinical trial on medical cannabis as a treatment for PTSD, looking at two different preparations or combinations of THC and THC and CBD. That research is ongoing.

But do you know what? Even when that study is done, we're not going to have all the answers. Ultimately, science is not about an absolute yes or no, or right or wrong. It's about the weight of evidence. Right now the weight of evidence is that medical cannabis, while not the perfect treatment for all patients under all conditions, is relatively safer than opioids. It's relatively safer than the use of benzodiazepines by any objective measure that's been done academically.

Additionally, the use of medical cannabis seems to reduce the use of opioids. Also, interestingly enough, and particularly relevant to veterans, it reduces the use of alcohol and illicit substances as well on an ad-hoc basis.

With all of that in mind, I think that all we can do right now is to keep supporting that patient experience when it comes to veterans who are using it for PTSD, continue to do the research and increase the amount of funding and support we get for research. We can all hope that, through all of that, we'll have a better understanding next year and the year after that than we have right now.

Certainly the wrong thing to do right now would be to cut off veterans who are finding benefit from this and whose families are finding benefit from the use of medical cannabis. I really urge this committee to keep this in mind as it's making decisions based on this testimony today.

[The Chair, Liberal, Neil Ellis]

Thank you.

That ends our time for witness testimony today.

On behalf of the committee, I'd like to thank the witnesses today for their patience and their testimony.

That adjourns the meeting.