Ms. Ludwig.
Evidence of meeting #110 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was use.
A recording is available from Parliament.
Evidence of meeting #110 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was use.
A recording is available from Parliament.
4:55 p.m.
Karen Ludwig New Brunswick Southwest, Lib.
Thank you.
Thank you all for your testimonies this afternoon.
One of the things we have consistently heard before this committee regarding cannabis and veterans has been about the challenge regarding research. Someone came in to testify a while ago and said the first case of authorized cannabis for medical use was in 1999. We saw at Veterans Affairs Canada a whole-of-government approach from 2008 to 2014.
I'm going to start with Dr. Walsh.
Where are we with the research? We've been authorizing medical cannabis for a significant amount of time. Are we anywhere close to having the research catch up, when we're talking about strands or dosages?
4:55 p.m.
Associate Professor, University of British Columbia, As an Individual
You know, when it comes to strands and dosages, we're still quite a way off. The ultimate answer is going to be a lot of variability. As much as we'd like it to conform to sort of a single molecule medicine, where we can say we're going to give you this pill and that's the dose, I'm not sure that's where we're going to get with cannabis.
Cannabis may in some ways require us to reconsider how we approach medicine. The challenge in research is not only going to be determining if cannabis is effective, because there are so many people with PTSD—veterans and other—who are reporting that it's effective that, if we were to come out with a study and say it's not effective, they would continue to trust their own experience over the study.
Unlike many medications that start in research and then move into the clinic and then to patients, this is something that's starting with patients and moving backwards to the research, which makes it almost unique. When we try to squeeze it into that pharmaceutical model, we come up with some of these problems.
You've asked where the research is. I am hopeful that, as we complete our study and as we learn more about what the study that Dr. Bonn-Miller was talking about finds out, we'll start to get some signal. But we also need to look at cannabis in a more naturalistic environment and find stories like those we're hearing from veterans and follow them up. How are veterans who are using cannabis therapeutically doing, compared to those who are not, and what works for whom? If cannabis is not effective for some veterans, which ones is it going to be effective for?
Rather than a blanket statement that it's good or it's bad, I don't know if we're going to get to that point. I think what we're going to find is that it's going to be effective for some people in some conditions; certain types of cannabis perhaps combined with other types of interventions are going to be maximally effective, and we'll start to look at fine-tuning it and looking at it more naturalistically. I don't think we shouldn't be doing the RCTs. Those are going to tell us something, but if we rely exclusively on those, we're missing the boat and we may miss some important information and we won't have the impact we'd like to see on the lives of veterans.
I'd like to see research focused on how we can combine cannabis with some of the behavioural interventions. What Dr. Bonn-Miller was talking about with CBD and behavioural exposure for PTSD is very interesting. Those kinds of studies are where I'd like to see it go rather than sort of a yes or no, thumbs up or thumbs down approach.
5 p.m.
New Brunswick Southwest, Lib.
Thank you for that.
I'll go to Dr. Bonn-Miller on this as well.
Certainly the medical model is maybe one of our challenges here, trying to fit a round peg into a square hole. When we look at the level of training within medical schools, where are we with that? With the expertise I'm hearing today from you as witnesses and certainly as veterans advocates and from those who are using this in terms of medication, where are we with regard to the training?
Ultimately, who are the specialists who could be authorizing or eventually prescribing medical cannabis?
5 p.m.
Associate Professor, University of British Columbia, As an Individual
If you don't mind, I think I could respond.
I was actually just reviewing a paper that we're submitting in a week that was the first survey of medical students on their training in medical cannabis. Right now in the Canadian medical school curricula that we surveyed—hopefully this will be coming out in about three to six months—we found that they're getting about a quarter of what they want. The average amount of cannabis education they are getting is about 1.5 hours, and they'd like to get up six hours. So across the board, across different categories, the trainees are not getting—
5 p.m.
Associate Professor, University of British Columbia, As an Individual
That is in the entire medical training, yes.
5 p.m.
Director, Sleep Wake Awareness Program
There is no training. It's not only here but in countries around the world. Doctors are very resistant to incorporating it.
5 p.m.
Associate Professor, University of British Columbia, As an Individual
What we found in that study is that it coincides with what we found—
I think Dr. Bonn-Miller has to go.
5 p.m.
Perelman School of Medicine, University of Pennsylvania, As an Individual
Yes, my apologies, but I have a hard stop that I'm already over and somebody else needs to be in this room, apparently, so I do have to jump. I'm sorry.
I will just say really quickly, not to interrupt, that what was said on the training side is right. The fact that you're having a whole bunch of scientists here who don't know the answer means that it's not being taught, because we don't know the answer. That's what needs to get figured out.
We've done numbers of studies that have looked at physicians' attitudes and what's currently available, and there is just really nothing out there from a training perspective, for anything, let alone PTSD.
There are courses that are starting up right now that are going to help resolve this, and there are initiatives from universities like the Thomas Jefferson University in Philadelphia, but the reality is that we have a lot of catching up to do.
Thank you so much for having me. I'm sorry for having to jump a little bit early.
5 p.m.
New Brunswick Southwest, Lib.
Thank you.
Dr. Thirlwell, I live in New Brunswick. If we had a veteran in need of neuroscience help, for example, what's the closest location for them to get that level of expertise?
5 p.m.
Director, Sleep Wake Awareness Program
To even begin to have access to that level of expertise, you would have to go through some of the clinics that are helping veterans. It's not through the OSI clinics. It's not through the VAC workers. The expertise is sorely lacking. I've given up three nights a week for two years of my life now to help the veterans who are just trying to find a specialist, let alone a specialist who will do medical cannabis.
5 p.m.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you, Chair.
Thanks to all of you again.
I have a question that I wanted to present to Dr. Bonn-Miller. He couldn't stay, but perhaps Dr. Thirlwell and Dr. Walsh can also shed some light on this.
I want to contrast the fact that in Canada we now have legalized cannabis and in the States they don't. From what Dr. Bonn-Miller was saying, it sounds as though there are significant challenges.
I was actually very impressed when I heard Dr. Bonn-Miller mention that there is now funding from the U.S. Department of Veterans Affairs. We were down in Washington, D.C., on a delegation a couple of years ago. When we mentioned medical cannabis to some VA doctors, they wouldn't even talk about it. They looked very uncomfortable. They changed the subject. So that's a very good development.
Cannabis has actually only been legalized for a very few months now. Are either of you seeing any indications that it will be easier to find funding for research now that it's legalized?
5 p.m.
Associate Professor, University of British Columbia, As an Individual
Certainly, as an academic researcher, I've seen notices from CIHR and other funding bodies. I think there is an increased interest from the tri-council agencies in funding cannabis research. I'm always going to say that we need more, and I think we need broader research, but I think there is increasing interest. As well, the development of licensed producers provides someone other than the government who's interested in funding this research.
So yes, I am hopeful that we're going to see more research on how best to use cannabis in PTSD and other conditions.
5:05 p.m.
Liberal
5:05 p.m.
Director, Sleep Wake Awareness Program
Legalization has not helped consistency of treatment for our veterans; it has hindered it. Since legalization in October, many veterans have not been able to access the oils and the strains they need. The Canadian government did not put in place protective measures to ensure that our veterans got the medication they needed to optimize their functioning. They did not put in money or policy toward mandating that doctors learn about medical cannabis.
5:05 p.m.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
What changed? You said that things got worse after legalization.
5:05 p.m.
Director, Sleep Wake Awareness Program
Yes, absolutely; it was because of supply. Suddenly licensed producers had an opportunity to make money with recreational, and you're looking at the same pot of cannabis. Not only that; in terms of governmental people who look at the standard of cannabis, the government didn't hire enough people to go through the cannabis supply. Cannabis was left in warehouses, waiting for inspectors to come in and make sure it met medical grade.
As well, the day before it was legalized, licensed producers found out that they had to change their labelling overnight for medical cannabis. They couldn't have any colour on their labelling. It had to be black and white. They couldn't ship out the medication to the veterans until they changed that labelling.
5:05 p.m.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Okay. Thank you.
Mr. Gaboriault, I'm glad I have the chance to address you again. When I was talking about whether cannabis could make it less likely that a person would develop a problem with alcohol, you were waving. I think you were trying to speak. Did you want to speak to that?
5:05 p.m.
As an Individual
Yes. Actually, I don't drink—no more than you would, let's say. I'll have maybe a beer. I have no interest in it. A big thing to understand is that this is medication. This isn't for fun.