Veterans Affairs Committee on Feb. 27th, 2019

[The Chair, Liberal, Neil Ellis]

I'd like to start the meeting. Pursuant to Standing Order 108(2), we are conducting a study on medical cannabis and veterans' well-being.

Today, as individuals, we have Dr. Zach Walsh, associate professor, University of British Columbia; Dr. Marcel Bonn-Miller, Perelman School of Medicine, University of Pennsylvania; Max Gaboriault from Courtney, British Columbia; and Dr. Celeste Thirlwell, director, Sleep Wake Awareness Program.

We'll start with Dr. Marcel Bonn-Miller.

Doctor, the floor is open to you. Thank you.

[Dr. Marcel Bonn-Miller, Perelman School of Medicine, University of Pennsylvania, As an Individual]

Just so I understand the parameters here, do I make a 10-minute statement?

[The Chair, Liberal, Neil Ellis]

You have up to 10 minutes for an opening statement, and everybody will have up to 10 minutes. Then we'll open the floor to questions.

You have to leave around 5 p.m., don't you?

[Dr. Marcel Bonn-Miller]

Yes, that's why I was hoping to be at the earlier end of things. Thank you for accommodating me.

[The Chair, Liberal, Neil Ellis]

I'll tell the committee that, if they have any questions for you, we'll get them to you before 5 p.m.

Thank you. The floor is yours.

[Dr. Marcel Bonn-Miller]

Thank you.

In terms of background, I've been a cannabinoid researcher for over 15 years: at the Department of Veterans Affairs in Palo Alto in the United States for almost 10 years, and at Stanford University as well as the University of Pennsylvania. I have pioneered a lot of the clinical research on PTSD and cannabinoids in this space. I've seen it evolve quite a bit over time.

I think that where we are in the literature right now and in our understanding has evolved a bit over the past five years or so. We're getting emerging findings and a number of reviews that have come out over the past two to three years and that really lay out where our knowledge base is.

Still, the majority of work that has been done on cannabinoids and PTSD has focused on specific symptoms or specific mechanisms, and primarily from a preclinical side in looking at research on rats and things like that. That's been on one side in terms of the administration of cannabinoids. On the other side, it's been observational work: asking veterans with PTSD what they use and what symptoms it helps with.

The middle part in this space, those clinical trials where we're actually administering cannabinoids to humans or veterans with PTSD and trying to understand if there are certain cannabinoids that may be more or less beneficial for individuals, is only recently coming to a head. We are just finishing and will be soon publishing the results of the first large-scale phase two randomized controlled trial of cannabinoids for veterans with PTSD.

In that trial, we looked at both THC and CBD, as well as a one-to-one combination of both relative to placebos. That's at the forefront of what has gone on and what's going on in the clinical space from a trial administration. A few studies have gone on over the past few years with very small samples, some placebo controlled, which have shown that THC or nabilone, an analog of THC, can be helpful for nightmares for veterans with PTSD. Aside from those few studies, really—and again, small samples—there hasn't been a whole lot of human work in this area in the form of clinical trials, which is really our gold standard in terms of understanding the benefits and harms associated with cannabinoids.

I think what we really do know is that THC.... I'll step back and say that as we talk about cannabinoids in this space and try to ask if cannabis is good or bad for veterans with PTSD or individuals with PTSD more broadly, it's really important to understand that cannabis is such a heterogeneous drug that it varies a lot depending on what you get in terms of what we're talking about. A lot of the research is really focused on trying to understand the individual effects of certain cannabinoids within the plant so that it can help for recommendations in certain areas. Saying that cannabis in and of itself is helpful or harmful is a kind of misnomer and is really difficult in terms of actual pragmatic medical advice.

Really, we know that THC, like I said, can be helpful for nightmares. It appears to be helpful at only low doses for anxiety. At higher doses, it can actually increase anxiety. It doesn't seem to be that helpful for depression. In fact, it may exacerbate depression over time. Most importantly, on a consequences standpoint, THC has been associated with withdrawal, tolerance and craving. This is a substance that, particularly at high doses, can lead to addiction, and that's an important caveat when we start talking about THC.

On the flip side, CBD, or cannabidiol, doesn't have that addiction potential and can be administered at high doses, and we're only really starting to understand its benefits. It appears to have help for sleep. Preclinical and animal models show that it may be helpful for depression, though we really need to scratch the surface a little bit more on that, and it can help with inflammation, which really ties into traumatic brain injury and other things that co-occur and may be causal for PTSD in some forms.

Then there are combinations of those, too, and that's really where the literature is at this point. I couldn't stress enough how important it is to dig beyond cannabis—because in the field right now it's relatively meaningless—and talk about what compositions of cannabis and cannabinoids we're talking about, because they can have very different effects. Like I said, THC and CBD are an example of complete opposite effects for anxiety.

Broadly speaking, high doses of THC can cause panic and theoretically can lead to worsening of PTSD symptoms. CBD has an opposite effect. Really understanding its composition is helpful. From a clinical trial perspective, we're also going to know a lot more over the coming months with the results from our trial and from other studies that are out there. We're also doing a prospective, 12-month study where we're looking at what individuals are choosing to use at dispensaries and the impact of that over time on PTSD symptoms.

Then there's a U.S. study that's about to start up in San Diego, which is going to look at CBD as an adjunct to prolonged exposure, really looking at our existing behavioural treatments—prolonged exposure being one of the top treatments for PTSD from a behavioural standpoint—and at whether CBD could help increase the efficacy of that treatment. A bunch of work has shown that it may actually speed up recovery—in animal models and early clinical models at least—for extinction, which is one of the bases of treatment for PTSD.

That's the broad sketch. That study's going to be starting up within the Department of Veterans Affairs in San Diego, probably this spring. That's the forefront. There are a lot of other things that are going on. Tilray is conducting a study. Zach's there and will speak to that a bit. It's an extension of the study we're just finishing up in the United States.

There are other folks who are using early human models and experimental models to test different components of cannabinoids and how they interact with different aspects of PTSD. What we really need to move for though, and what we're starting to see with our trial and other trials coming up, are those phase two and phase three clinical trials where we randomize individuals to certain cannabinoid preparations and placebos and look at the impact of symptoms over time. We're starting to get that. We'll have results, as I said, in the early half of this year, and as other studies are completed we'll have more data in that area.

That's the general overview. I know Canada has been looking at funding or potentially funding other areas in this space, and I think that's important. Right now a lot of the funding is coming from state grants within the United States. The Colorado Department of Public Health and Environment has funded some of these studies. From a corporation standpoint, Tilray is funding some of these studies. Also, the one in San Diego is the first study that the United States Department of Veterans Affairs has ever funded on cannabinoid administration, so applaud them and applaud the State of Colorado and Tilray for pursuing this. Really, the costs of these studies are great. Aside from granting mechanisms, it's pharmaceutical companies and cannabinoid companies that really need to be funding this work.

We need more government resources to do more phase two and phase three trials. That's really the crux of this, because right now I think we can say that certain take-home cannabinoids seem to have a decent likelihood of helping individuals with PTSD, but we have to be aware of the consequences associated with some, like THC. Whether it's CBD, whether it's a combination of THC and CBD or whether it's THC at low doses needs to get figured out, as does the concurrent use of prescription medications like opioids in this population and how those interact with cannabinoids and could potentially be used from a therapeutic standpoint.

That may leave you with more questions than answers, but that's the lay of the land in terms of the research in this space and what's been published. Again, I'd be happy to pass along or send citations for a lot of the reviews that lay this out and have been published in the past few years.

[The Chair, Liberal, Neil Ellis]

Great, thank you.

Next is Mr. Gaboriault.

Max, the floor is yours.

[Max Gaboriault, As an Individual]

I'm not as eloquent as the previous speaker. I'll just give you a quick history about me.

By the way, I have a speech impairment, so I might stop talking at any time.

I'm a 13-year veteran of the Canadian Armed Forces. I was in the signal corps. I was deployed in 2006 in Afghanistan for the first rotation of nine months. I was working for General Fraser. It was a very hard tour, as you guys already know. We lost a lot of people. I lost three friends at once.

My main role while I was in Afghanistan was as a bodyguard for journalists, and also electronic countermeasures, ECM, in G-wagons. For people who don't know what ECM means, essentially I jam the signals for bombs that I don't see, and hopefully never will, and protect in a magnetic field everybody who's within that cordon. It's a lot of stress, and obviously, I had many other roles.

I think I did send a story about that for you guys to review. I have no memory anymore.

Having said that, when I came back, six months later I started showing signs of extreme aggressiveness. When I say extreme, I mean extreme. At first I tossed it off as being a war-hardened veteran, and the young troops weren't just cutting it. By the way, I trained most of the following rotations out of Edmonton, with combat first aid, first aid and all the drills to keep you alive overseas.

Having said that, after a while I dodged many insubordinations and things like that, and I took it upon myself to start looking into it. There was really nothing in 2006, so I was not really guided properly. Meanwhile, to make a long story short, I got posted to Comox, B.C., in a non-traditional war role, because that's all I know. I sought help at the mental health clinic and got diagnosed with a generalized anxiety disorder or PTSD or whatever you want to call it. Essentially, it's just a big umbrella; it depends on the doctor and what they think is right.

In PTSD the D is wrong. It should be an I. It's an injury; it is not a disorder. You can progress to function at a certain level. I'm far beyond that, but I don't want to advance any claims on that right now, as I'm getting medical support.

I was put on a regimen of pills by the army, because with all that I was still serving, which affected my ability to work and remember. Anything that had to do with my personal life was completely destroyed. At some point I approached the doctor and said that I couldn't remember anything. I couldn't function properly. I couldn't take care of my kids. My wife was beyond frustrated with me. I needed something else. They put me on this anti-psychotic pill called quetiapine. I took half of the lowest dose for a week and I started stuttering really heavily. That's why I have a speech impairment. The other uncommon side effect was death. My wife and I made the decision that I would quit pretty much all pharmaceuticals right then and there, because they were killing me.

I managed about three years with teas and the best wishes from my wife to support me in any way, shape or form, until I was introduced by other veterans to cannabis. That was three years ago.

Since then, I haven't taken any pharmaceuticals. As you can imagine, my opinion of pharmaceuticals is pretty darn low. Obviously, the normal pills that we take every day are all right, but anything else, for what I'm dealing with, is completely and utterly useless.

I started using cannabis. It's a steep learning curve. There is no real guidance. I obtain it from a licensed producer. The implementation was pretty painless. I've been on a regimen of seven grams a day for the last three years.

I don't smoke; I ingest oil, as it is the healthiest alternative, through the body. I also learned how to make my own medication and play with the THC and the CBD, the combinations and the different strengths. Some are better than others for different effects. It's all trial and error. What works for me might not work for somebody else.

Right now I use sativa during the day and I use indica at night. But it's not how I started. I started with CBD, until the CBD wasn't working. I'm categorized as a severe case. I have 66% awarded from Veterans Affairs.

Having said that, I have a lot of benefits from it. I'm actually more patient with my kids. I actually can function and remember what I have to do within my arcs. I have immense support from my wife, because I can't remember anything due to my brain. It changed my life completely. I can actually go out in public.

I cannot work; I'm fully retired. I did try, but at the time I was not medicated. That was in those buffering years, just after I retired. I see tremendous.... I have joint pain. I have ligament pain. Name a pain and I probably have it. Just like guys who have been blown up and things like that....

Other than that, that's pretty much.... For me, I don't know what I'm walking into in this committee. I was told absolutely nothing, other than that it was on cannabis. I'm willing to answer any of your questions.

So, that's me.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Walsh.

[Dr. Zach Walsh, Associate Professor, University of British Columbia, As an Individual]

Good afternoon, and thank you for inviting me to present. It's a real privilege.

In terms of background, I'm a researcher in cannabis and mental health and a tenured psychology professor at the University of British Columbia where I study issues related to the use of substances. My focus for the past several years has been on cannabis use, both medical and non-medical, and its effects on mental health. I am currently funded by the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada to examine the consequences of cannabis use and legalization on the health and well-being of adults. My past work has included some of the largest surveys of medical cannabis users in Canada and an extensive review of the impact of medical cannabis use on mental health. I also lead an ongoing randomized control trial of cannabis for PTSD, which together with a parallel study in the U.S. will be the first to evaluate this treatment. Dr. Bonn-Miller has talked about the parallel study in the U.S.

I'm also a clinical psychologist. As a clinician I've had the opportunity to work with individuals who struggle with the aftermath of trauma. I've worked in the VA hospital in the U.S. and I currently supervise graduate student trainees in the assessment of PTSD. My testimony today is going to draw primarily on my own research and knowledge of the empirical literature on cannabis and PTSD, but is also going to be informed by my first-hand experience in working with individuals who use cannabis to treat PTSD. I want to focus my comments on the stated aims of the committee.

To start off, with regard to the experience and opinions of veterans who have used cannabis for medical purposes, and their family members, I think the reports that we just heard in the previous testimony really speak volumes and I hear many reports in a similar vein. Also consistent with what Dr. Bonn-Miller was saying, the evidence for the effectiveness of cannabis for PTSD is sometimes characterized as not strong, primarily in referring to the lack of randomized controlled trials, RCTs, testing cannabis for PTSD. I agree that such trials will add to our confidence in how best to use, or not use, cannabis for PTSD, and that's why we're currently undertaking that type of research.

However, despite the lack of RCT evidence I do think there is reason to be hopeful regarding the potential for cannabis medicines to help improve the lives of individuals with PTSD. Human studies that are not RCTs deserve attention and Dr. Bonn-Miller's testimony pointed to some of the key features in those studies showing differences in the naturally occurring cannabis system, the endocannabinoid system, of individuals with PTSD, suggesting that alterations in that system might explain the high rates of cannabis use among PTSD patients and certainly point to an important role of that system in the pathology of PTSD. There's converging research that has confirmed an important role for the endocannabinoid system in an emotional response, learning and memory, all of which point to the potential of cannabinoid medicines that interact with those systems.

In addition to advancing brain science, we can learn a lot from patient behaviours, particularly in areas where other evidence, such as RCTs, is currently lacking. Surveys of medical cannabis users identify high levels of use to treat PTSD, and retrospective studies, although methodologically limited, have found that medical cannabis patients report substantial reductions in PTSD symptoms after the uptake of medical cannabis use. Studies also highlight cannabis use helping with sleep and coping with the anxiety that is part of PTSD. Sleep disturbance often emerges as one of the most debilitating PTSD symptoms, and it's one for which there's evidence it may respond to cannabis therapies. Restorative sleep is, of course, key to health and well-being and when it's disrupted, other aspects of health, mental and physical, rapidly deteriorate.

I have spoken with many individuals who use cannabis for PTSD who report going from sleeping in only brief stretches interrupted by terrible nightmares to having their first restful sleep in years after initiating cannabis therapies. As Dr. Bonn-Miller reported, among the benefits of cannabis in PTSD related to sleep disturbance, synthetic cannabinoids have demonstrated good effects in reducing nightmares and improving sleep amongst PTSD patients. I think our experience in Canada and also in the U.S. over the past few years also speaks to the therapeutic potential of cannabis for PTSD. The dramatic increase in enrolment by veterans in the ACMPR and in the preceding programs has caused concern in some quarters, but it's also what we might expect to see from the introduction of an effective treatment: slow and steady increases at first and then a tipping point caused by positive word of mouth leading to exponential growth in uptake.

Of course, patient self-reported efficacy and treatment uptake are not the gold standard for determining the effectiveness of a medication. However, the devastating consequences of untreated PTSD and the limitations of existing treatments make it essential that all promising avenues are explored. Cannabis must be compared to existing options, not to a hypothetical gold standard. With regard to exceptions from the three grams a day maximum, it is true that the quantities of cannabis being used by some veterans may appear excessive, but perhaps no more so than the combinations of prescription medications that are also used to address PTSD as an alternative. For many, the side effects of cannabis are well tolerated compared to those of the antidepressants, sedatives, antipsychotics and other medications, which have side effects such as weight gain, impotence, memory loss and lethargy, all of which dramatically decrease quality of life. In contrast, even at high doses, cannabis is a relatively gentle medication with low toxicity. Perhaps the greatest concern is the development of cannabis dependence. However, effective use of a medication to treat symptoms of a chronic condition need not be considered disordered, and the cannabis withdrawal symptom is short-lived and relatively mild compared to the problems in withdrawing from a number of other medications that may be used for PTSD.

With regard to current research and knowledge about cannabis use for the treatment of medical conditions common among veterans, such as PTSD and pain, one benefit of cannabis therapies is the potential to treat co-occurring conditions and replace several medications. Specifically, a recent comprehensive review from the National Academies of Sciences, Engineering, and Medicine concluded that cannabis was effective for treating chronic pain in adults, which is particularly important given the high rate of opioid use disorder among individuals with PTSD—opioids often started to treat pain. Indeed, growing evidence indicates that cannabis is increasingly being used as an opioid substitute that may reduce fatal opioid overdoses. Reporting from the Globe and Mail that focused specifically on Canadian veterans supports the conclusion that cannabis is being used instead of, rather than in addition to, other medicines.

I think that's so important for understanding the potential benefits of cannabis, whether it's being used on top of or as a substitute for other medications. Research from our group found that cannabis reduced pain, but also helped patients in some cases to be more active, despite chronic pain. Given the negative effects of the isolation that plagues too many veterans with chronic pain and PTSD, the potential of cannabis to facilitate activity and social integration is important, and I look forward to therapeutic interventions that highlight that in combination with cannabis therapy.

Our review of medical cannabis and mental health found that medical cannabis patients overwhelmingly report using cannabis to reduce anxiety in addition to primary complaints of pain. The potential of cannabis to address both pain and anxiety is particularly important in the context of PTSD, given the potential lethality of combining benzodiazepine sedatives and opioid painkillers, both of which are widely used among veterans with PTSD. Cannabis also has the potential to substitute for alcohol, and cannabis may protect against domestic violence, which is also a heightened risk among people who suffer from PTSD.

With regard to the potential effects of cannabis legalization on veterans, I believe that Canada's public health approach will have a positive effect on the lives of veterans. Our research identified fear of negative judgment as an impediment to open communication with caregivers regarding cannabis use. Veterans of mental health conditions who use cannabis bear the burden of a double stigma that could be a substantial barrier to accessing medical care and engaging in frank conversation with their providers. To the extent that legalization reduces stigma, it will have a positive effect on the health of veterans. Legalization will also have a positive effect by fostering research on the development of best practices for the therapeutic use of cannabis.

I certainly agree with Dr. Bonn-Miller that we need to go beyond simply talking about cannabis to talking about how cannabis can work and how it can be integrated with other approaches.

One concern that I do have with regard to legalization involves the per se limits for driving. Veterans who use cannabis therapeutically are likely to consistently exceed the proposed nanogram limits irrespective of acute intoxication. No one should be impaired on the roads, but veterans who use their medication responsibly should not be forced to abandon driving entirely.

Finally, there are the considerations associated with access to health care practitioners to obtain medical cannabis authorization. In our study of medical cannabis users under the MMAR—that was around 2011-12—we examined the extent to which physician communication represented a barrier to access. We found evidence of substantial concern related to perceived stigmatization associated with discussing medical cannabis with a physician. Over half of respondents reported that they wanted to discuss medical cannabis with their physician, but did not feel comfortable doing so. Similarly, over 60% reported worrying about discrimination from physicians related to cannabis use. In general, many patients reported a fear that discussing cannabis with their physician might negatively impact the relationship.

This study also produced evidence that accessing information related to the use of cannabis as a medicine may have been problematic due to limitations with physician communication. Half of respondents reported being relatively dissatisfied with their communications with physicians related to cannabis.

We did a subsequent study under the MMPR and found that many of the obstacles under the MMAR appeared to have persisted under the MMPR at least until 2015; namely, it continued to be difficult for Canadians to find a physician to support their application, and many were charged a fee. In this study we further concluded that affordability and cost of physician evaluations may be a barrier to access for lower-income individuals.

My personal experience as a research scientist who has interacted extensively with medical cannabis patients highlights the importance of access to specific strains of cannabis. Again, this is not one medicine but perhaps many, and we still have a lot of research to do to figure out the distinctions amongst types of cannabis and constituents of cannabis. However, this experience highlights the barriers to accessing specific strains from a specific licensed producer based on substantial variability and product availability. Access to licensed producers is limited by physician communication, and as such, many patients will have access to only a single licensed producer who may not have the desired strain that may be most effective at a given time.

Thank you.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Thirlwell, the floor is yours.

[Dr. Celeste Thirlwell, Director, Sleep Wake Awareness Program]

Thank you.

I have worked with veterans intensely for over two years now with the change of the policy from the 10 grams approved down to three grams being approved for veterans. I'm going to speak to you today from a perspective of the veterans' well-being and my mandate as a doctor following the Hippocratic oath to do no harm.

The first part of the presentation will be some of the neuroscience behind PTSD and what the veterans are dealing with so that you have a better understanding of what we're dealing with. I don't think anybody has spoken about this directly. Second, we will launch into the trenches, into the battleground.

With PTSD, what is happening is that the on system of the brain is in flight. Their brains are going 900 kilometres an hour. There are no brakes, which causes a problem at night as well. You have a daytime hyper-arousal, and then you have the nighttime hyper-arousal. With that hyper-arousal at night, you have fragmentation of sleep; you have nightmares and you have acting out. Because of the lack of good quality sleep, you then have more cognitive issues during the day, problems with memory and concentration and problems with impulse control.

As background, this is a study done by Dr. Moldofsky at the London OSI clinic. They followed veterans for 14 years. Irrespective of combat or not, veterans whose brains did not turn off, whose brains were set to fight and flight.... It could be from childhood or from other traumatic events even prior to entering the military. If they had a brain that was set to 900 or 800 kilometres an hour, they were more predisposed to develop PTSD than other servicemen, regardless of whether they saw combat or not.

We are dealing mainly with a problem, in terms of PTSD, with the brain not turning off. What I have found in our studies is objective data of before and after cannabis use of helping the brain to slow down, to boost the off system of the brain, which is the relax and restore system.

This is an example of a graph of the interference pattern that happens in the brain at night when the brain is trying to turn off. Those highlighted parts in grey are breakthrough sympathetic nervous system bursts, which means the fight and flight system is popping up. The brain is trying to turn on, but their PTSD brain is like a light switch that keeps flopping back on, on and on again.

With civilians, their brains might be set to 300 kilometres during the day, and at night they're going down to zero. If we're lucky, a veteran might go from 900 down to 600, but they're not getting down to zero and turning off properly.

With medical cannabis, we have been able, in our clinic, using low CBD microdose through the day and CBD with higher THC at night, to improve these objective measures in sleep. The reason I treat and microdose during the day is so that their nervous system doesn't ramp up to 900. With the CBD oil microdosed through the day, I can have their nervous system stay at 400 or 500 kilometres an hour and not be triggered into massive fight and flight. At night, we're going to sleep from 500 to zero rather than 900 to zero.

Many of my veterans, as Dr. Walsh said, will tell me, “The first time I smoked a spliff, I got the first good night's sleep in 15 years.” They've gone from fragmented sleep, waking up once every hour or two, to four to five hours straight, solid sleep.

You might not be aware that poor sleep quality makes pain worse in the body because, if you have extended periods of low quality sleep—you try it, deprive yourself three nights of sleep—the inflammatory factors in your body will get regulated up, and then you get aches and pains all over your body.

They might have an initial operational stress injury like a shoulder or knee injury, but then you layer on top the masked inflammatory effect throughout the body. You have a double-pain syndrome. You have someone who doesn't sleep. They have the initial pain from injury and then they have widespread musculoskeletal pain throughout their body.

My focus in dealing with PTSD and chronic pain, because the pain also exacerbates the fight and flight system, is to look at the parasympathetic nervous system. I see medical cannabis as the first step in decreasing parasympathetic nervous system tone. From our sleep studies we've been able to show that we are actually decreasing this increased sympathetic fight and flight drive to enhance the parasympathetic nervous system tone, the off system of the brain.

Once the veteran has decreased their brain process from 900 kilometres an hour, to 300 or 400 or maybe 500 kilometres an hour, then they can make it to the psychologist, to rehab programs, to other things that will be helpful, and they will remember them. When they are in a PTSD brain, they do not encode memories. Once they are able to do that, then their healing process moves further along. I see medical cannabis as a step in the multimodal approach towards healing.

We have an opportunity in Canada to be world leaders in this. We really need to have the same fighting noble integrity that our service people have in dealing with this. There are cutting-edge neuroscience techniques like neurofeedback that can be used very effectively once their brain has been stabilized on the medical cannabis first.

On pulse electromagnetic field therapy, I'm one of the first doctors in North America to have a pulse electromagnetic field machine that is used in rehab hospitals in Italy with great effect. The American military is extremely interested in this technology for their veterans. As well, there are other techniques like yoga, tai chi, swimming, all of which enhance the off system of the brain.

As was referred to earlier cannabis decreases inflammation. When you have inflammatory factors circulating throughout the body and within the blood, they go to the brain. The brain says, “Oh, my, there's inflammation. There's some danger. I cannot turn off. I must remain in a fight and flight state.” Not only is the cannabis helping regulate the on-off system of the brain, it's also decreasing the inflammatory factors that were previously sending the signals to the brain that it must stay on high alert.

A very important book that you must read to understand PTSD is The Polyvagal Theory by Porges. Basically, what we're talking about in the PTSD brain is that you are staying in the reptile part of the brain. You do not have access to the emotional part of your brain, which is the centre brain, nor do you have access to the social part of your brain, which is social conditioning. When you talk about unbridled anger after being in military combat, you're talking about being stuck in the fight or flight reptile brain. What cannabis does—and I've had personnel tell me this—is it slows down your reaction time long enough so you can start to reset the connections between the reptile brain, the emotions and socialization.

I'll never forget the story that one veteran told me. He said that when he was going down an escalator he thought for sure there was someone standing with an AK-47 at the bottom. He was ready to go. His cannabis allowed him to slow down his reaction time long enough to realize it was a mother holding a baby.

These are the brains we're dealing with—900 kilometres an hour. They are trained that way because if they don't react fast enough, someone is dead, or they're dead.

The other piece of military training that I want to share with you, which no one's talking about from a scientific perspective, is that they are trained to disconnect from their hearts so that they can kill. What they are then set to is the military compass. They belong to the military. The military says, “Jump” and they say, “How high?”

When you are released from the military you are ripped away from that compass, and then you are lost. You're not even connected with your own heart. Part of connecting with your heart is being a socialized member of society.

First, we must calm down their brain and bring them to a point where they are not in the fight or flight mode of PTSD, so they can start to reset the connections between the emotional and socialized brain to rehabilitate and return to civilian society. There needs to be just as much retraining once they come back as there was upfront to train them to go.

This is an issue, in terms of policy within the government and within medicine. They are looking at it ass-backwards. Instead of having the veterans going directly to rehab when they come back, the veteran has to prove that something is wrong with them. It should be assumed that something is wrong from combat immediately and then looked at and addressed. Don't play catch-up afterwards. We're wasting too much taxpayers' money playing catch-up years and years later. Veterans have lost five to 10 years of their lives.

Yes, there is a place for the pharmaceuticals, but I see them as a cast that you put on when you have a broken leg. What happens if you leave a cast on a broken leg? You lose the function of the joint. That's what has happened to my veterans. They've lost five to 10 years of their lives drooling on the couch, losing wives and losing children because they've been zombified. There is a place for those medications acutely, but the next transition phase could be a brace that moves, like cannabis. Then once we have them doing the rehab, through the underlying psychological and physical work and the cutting-edge neuroscience techniques that are available globally, we can have them functioning and rehabilitated.

I have never met a veteran who didn't want to get up and work and do something. Their drive is to serve and protect and help mankind. They don't want to be sitting there drooling on the couch, but at every turn, they're foiled over and over again by a system that is backlogged with paperwork.

[The Chair, Liberal, Neil Ellis]

I have to apologize, but we're down to about 30 seconds.

[Dr. Celeste Thirlwell]

Yes.

I would like to finish off by highlighting the fact that the lengthy approval process times have been detrimental, for both their injury conditions and for medical cannabis. If we did not have cancer medication available at the proper dose, there would be a hue and cry. These are people who got stabilized on six to 10 grams of cannabis a day. Suddenly, overnight, it's down to three and they're isolated again in their basements and losing their families. This is a social justice cause and we need to work together. Canada could be a leader in this globally.

Thank you.

[The Chair, Liberal, Neil Ellis]

Thank you.

We'll start the questioning with Ms. Wagantall. You have six minutes.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you very much.

Thank you to all of you for being here today. What we're hearing is so helpful.

Max, I very much appreciate your straightforward presentation on your scenario. I'd like to ask one quick question. First of all, when you decided you needed to get off the pharmaceuticals, did you have the help you needed to go through that process?

[Max Gaboriault]

Absolutely not.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Absolutely not. Thank you. I actually have heard that often. I've heard your whole story often. I have the story of an individual who was bedridden for years and his wife used a cannabis suppository and had him back for a half hour, but she couldn't find anyone to help her. He was on a thousand pills a month, three of them stronger than opioids, but she could not find anyone who would help her with that. As we move forward, number one, I think that's a huge issue.

I also want to bring up an issue around mefloquine. We're going to be doing a study on it following this one. We did one two years ago.

Were you on mefloquine when you were serving?

[Max Gaboriault]

Yes. Actually, the object of my upcoming MRI is to support the damage of mefloquine on my brain. I took it for literally nine months straight, which is twice as long as the recommended use. Essentially, I have every single symptom. Yes, I've seen some shit and I've done some stuff that nobody should ever do, but regardless, besides the psychological issues, there are also physiological issues that I'm dealing with that cannabis actually helps alleviate.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Right.

Can I just mention—

[Max Gaboriault]

Yes. Sorry. Go ahead.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

I appreciate that.

I would just mention as well that this is what I'm hearing over and over again. There has been a simple assumption of PTSD, which may be there as well, but the treatment needed for mefloquine toxicity.... It is a brain stem physical injury, and the pharmaceuticals actually cause more duress. That's why so many I speak to who are dealing with mefloquine toxicity really have found cannabis to be a better source of treatment.

[Max Gaboriault]

Yes.

I would like to point out that from my perspective—I'm no doctor, but I've been dealing with it for 12 or 13 years now and studying as much as I can—the big difference between what I would call the classical PTSD—and, by the way, I can't hear the “D” anymore, because it is not a disorder; it's an injury.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

[Inaudible—Editor]

[Max Gaboriault]

The big difference between the classic PTS and the chemical PTS coming from the mefloquine is that with PTSD classic, through treatment, help, and medication, or whatever you want to call it, you can reach a certain normalcy, if I can use that word—you can have somewhat normal living—whereas, a guy like me can reach only so far because the brain has been damaged and there's no room for more improvement. I can reach only so far. My functioning and whatnot and my short-term memory are destroyed, not to the point that I can't function, but if you ask me tomorrow what we talked about today, I probably won't remember. Using cannabis stabilizes my moods, because I'm really high on the aggressivity scale. It allows me to interact with my kids and be more patient.

I have a seven-year-old and an almost 10-year-old who have been going through hell since they've been born. I was diagnosed after their birth. Even for my wife.... For the surges of whatever or aggression of any kind, the pills didn't do anything.