Evidence of meeting #111 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 medical.
A recording is available from Parliament.
Liberal
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
Thank you, Chair, and thanks to all of you for your testimony and the information you've provided.
Thank you, Mr. Baldwin-Brown, for your service. It's very much appreciated.
I'm hearing that more and more people are indicating that the use of marijuana reduces the use of other medications such as opioids and others. Could you please comment on that?
Co-Founder, Spartan Wellness
Yes, for sure.
I do have one particular case. A friend of mine has been on cannabis for a while. He said that it's okay to talk to you guys about his case. He was a member of the Royal Canadian Navy. They hit some heavy seas. He ended up falling down a ladder and massively injuring his back, resulting in a medical release. Since then, he's been diagnosed with depression as well as degenerative disc disease, and he's going to be going down for a little while.
That individual was on every type of opiate I could possibly think of. He was unable to walk and unable to function. There were massive implications for his digestive system and cognitive abilities. He also went over to fentanyl patches and the like. He was prescribed, I believe, three grams a day to start. He ended up going to approximately six, almost exclusively on CBD, cannabidiol, a completely non-psychoactive variant of cannabis.
In 2016, we did see a reduction in initial coverage from 10 grams a day to three, and he had some issues getting specialist appointments lined up in time in order to facilitate that changeover. That patient did go back down to three grams per day and also as a result had to increase his pharmaceutical intake, so it was back to opiates and fentanyl as well.
Liberal
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
Thank you.
Maybe some of the doctors could share some information on that question, as well, quickly.
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
The use of cannabis and cannabis products as an alternative to the use of opioids and opiates carries its own risk. A lot of people do use the cannabis products for symptom relief, and with some symptoms, they may get relief from similar symptoms as they do with the use of opioids.
The research to actually make this sufficiently robust for medical science is limited. Again, I emphasize that there's no single cannabis. We can't ignore individual anecdotes and symptom relief, but as a clear substitute, as we would substitute other things in medical practice, the evidence isn't sufficiently robust.
Liberal
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
I open the floor to the other two, please. Do you have comments?
Dr. Hurd.
Professor, Psychiatry, Neuroscience, Icahn School of Medicine at Mount Sinai, As an Individual
In fact Didier Jutras-Aswad was a fellow at Mount Sinai who helped with the initial studies, and we have gone on.
We've definitely seen that CBD decreases craving and anxiety. But these studies are still small, and we are now conducting larger studies. Other groups have also seen CBD decreasing use of other drugs. Perhaps nicotine and alcohol are the two that most people have seen where CBD can have a positive effect. Most of the studies we do are on CBD.
As the doctor said, there is still a lot of research that's needed. But our studies show a potential benefit.
Liberal
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
Dr. Jutras-Aswad, do you have anything to add?
Addiction Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
If I may comment on this, I think we need to take a step back. I think that looking at this question with the two possible answers being cannabis and opioid may be misleading.
In medicine in general, when we talk about treating a condition, we have guidelines. We have practice guidelines. We have different levels—first level treatment, second level treatment, third level treatment—based on scientific evidence. I think the question should not necessarily be whether it is opioid versus cannabis, or SSRIs versus cannabis, but rather, what the best interventions are that are available for different conditions, and where cannabis use may or may not be based on scientific evidence to treat that condition. I think it's very important. We've heard a lot of discussion around whether it is cannabis, opioids or whatnot. I think we should go back to how we usually consider treatment for different conditions, including pain.
Liberal
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
Again, I open this question to any one of you.
We hear testimony from individuals that it is helping them tremendously, and we hear of some research that supports that and of other research that doesn't. Where are we exactly? What is the most important piece of research we could do right now to help us better understand this question?
Addiction Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
The most important piece of research we could do is a well-designed research trial to get the effect of very specific compounds for very specific conditions, and that's what's lacking. I think an anecdotal report, a patient or user reporting positive effects, is very valuable to start that process. But at some point I would strongly support the idea that we need a well-designed randomized control trial to test whether cannabis or cannabinoids may be helpful for specific conditions with specific dosage, which is not the case at this point.
Professor, Psychiatry, Neuroscience, Icahn School of Medicine at Mount Sinai, As an Individual
I would just add that a lot of placebo effects are here, because many people do want to feel something that they've never felt before. That is why I concur with Didier, Dr. Jutras-Aswad, that we need placebo-controlled, randomized studies.
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
I would concur with Dr. [Inaudible—Editor].
North Island—Powell River, NDP
Thank you.
Thank you, all, for being here today.
As a member who represents a lot of veterans who deal with multiple issues, I think this is a really important topic that we're discussing.
I want to come back to a couple of things.
I want to talk a little bit more about the data. I think you guys did a fairly precise job of telling us where the gaps are, but I would still like to hear what the gaps are. Is any research happening internationally that would be beneficial for us to look at?
There's another thing I would love to have you touch on. I heard again and again that the focus is on smoking. Right now we know that the licensed cannabis producers are responsible for determining the quantity that they might be getting from fresh or from oil, and comparing that to dried grams. You also talked about concentration. This is a challenge. I feel there's a lot of uncertainty here about what that looks like.
What kind of recommendations need to go to the government around making sure that we're protecting veterans?
I'll start with you, Mr. Ayonrinde.
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
The exciting bit is that research into cannabinoids and cannabinoid medicine is rapidly growing and the momentum is building. There is also significantly more collaboration between researchers and centres around the world. Canada has a bit of a legislative advantage compared to some parts of the world. There's a lot of medical interest across the range of medical specialties regarding this. The evidence with therapeutic benefits of CBD and the cannabinoid CBD preparations is more robust and gaining more consistency than for THC with regard to ratios, the numbers and so on, but there's still a lot more we don't know.
In Canada, for instance, there's a Canadian consortium for investigations of cannabinoids. Different centres are beginning to harness their skills and work together. The partnerships are getting stronger. Veteran numbers are large globally and I think it does present a lot of opportunity, provided there's solid research funding to back this up.
North Island—Powell River, NDP
Thank you.
Dr. Hurd, do you have anything to add?
Professor, Psychiatry, Neuroscience, Icahn School of Medicine at Mount Sinai, As an Individual
I concur.
In the U.S., Europe and also in Canada, a lot of research has focused on CBD with psychosis, where some of the data is looking positive with opioid addiction. Obviously, with epilepsy and anxiety..... In the U.S. there are a number of studies being done on PTSD with CBD, but all of them are either just about to start or are in the mid-stages. I think that within two years we will have significant information.
This is the problem that I have. Canada has already stepped into the legalization on both recreation and medicinal, but I think we could address this very quickly. With the funding, we can identify collaborative centres to carry out this research, so it can be done quickly. We don't have to wait how many years. I think that if the veterans administration really wants answers, they have the resources. There are a lot of us scientists and physicians all over Canada, the U.S. and other places who can do collaborative studies very quickly to get the answers.
North Island—Powell River, NDP
Thank you.
Finally, Dr. Jutras-Aswad, do you have anything to add?
Addiction Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
Yes. I will not repeat what my colleagues already mentioned.
One thing is for sure. I will concur with Dr. Hurd that there are a number of networks in Canada and the U.S. Just in the field of addiction, for example, there are two very strong networks in the U.S. and in Canada that should be supported to conduct clinical trials.
The other piece of information and advice I would like to add is also the need for non-industry funded research. We've seen, of course, industry having a lot of money to put into that for [Technical difficulty—Editor] reasons. Collaboration with industry is important, but there is clearly a need for independently conducted research to provide the country and other countries with non-biased data surrounding the use of cannabis for a number of conditions.
North Island—Powell River, NDP
Thank you so much.
One of the other challenges is that we have a huge country with a lot of rural and remote communities that have really big barriers to addressing services for veterans as it is. This just adds another layer.
I'm wondering if I could come back to you, Mr. Baldwin-Brown, and ask you if you know anything about that. Could you talk about that in the context of the work that you do?
Co-Founder, Spartan Wellness
Specifically regarding veterans in rural areas?
Co-Founder, Spartan Wellness
As we found, a lot of veterans, specifically those who are struggling with post-traumatic stress disorder and depression retire into very rural areas. They want to live at peace; they don't want to deal with the hustle and bustle of city life. We found abilities to still be able to see those veterans, and if need be we can put another veteran across the table from them to get that one-on-one experience and explanation. I found, as a veteran with PTSD myself, over the phone is not always the best way.
There are a lot of veterans out there, and where they're recruited from has a huge play. As we know, Nova Scotia has a very high number of veterans per capita. Newfoundland, rural areas of Ontario and Quebec have as well.
