Veterans Affairs Committee on March 18th, 2019

[Andrew Baldwin-Brown]

Because it works, sir.

Veterans are very community organized. If we're sitting in a hole together in Afghanistan, and I find a really good way to clean my rifle, I'll tell you. If I find a really good way to move from point A to point B and not get blown up, I'll tell you. We also have a very limited capacity to witness human suffering. If we see other brothers and sisters of ours who are in their basement drinking, going down a bad path, we're going to do everything we can to pull them out of it. If medical cannabis happens to work—and I'm not saying it does every time, because it doesn't, but if it does work—we're going to make sure that happens.

I think you're going to see a marked increase in the next 10 years with recreational cannabis being legalized and most of the armed forces being able to actually partake in that as well. I think if some of the soldiers who are in there now tried cannabis recreationally, they would find out that it would work to help them sleep. It would help with their back pain. It would help with their knee pain. They'll become medical patients when they release from the military as well.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Kitchen, you have six minutes.

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

Thank you, Mr. Chair.

I'm going to defer to my colleague for just a second.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Chair, I just want clarification, because it was pointed out to me that I should put on notice, or I'd like to put on notice, a motion as to whether the minister is able to attend our next meeting, which I know is very short notice for him. I'd also like to put on notice now this exact same motion, that the minister appear before committee on April 1. I'd like to make that notice of motion, exactly the same, and just change the date to April 1, which I will be bringing up at our next meeting if he turns us down for the next meeting.

I'm just letting the committee know that.

[The Chair, Liberal, Neil Ellis]

Okay, thank you.

Mr. Kitchen, you have two minutes left.

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

Thank you, Mr. Chair.

Mr. Baldwin-Brown, thank you for your service.

Doctors, thank you for being here. One of the reasons we started this study was that in the past three and half years, we've heard a lot of anecdotal evidence from our veterans who have come here and talked about the challenges they've had. We've listened to them and to their families about their coming back and using cannabis versus the opioids they were on. We've heard from the parents and from the families about how they got back their spouse, for instance, or whatever it may be.

That's one of the ideas here. There's a lot of stuff. Obviously, it's very new. It's new for us just like it's new for you. That's a big challenge. Here we're dealing with and asking for guidelines and standards, which are two different things. They're based on research, but you don't have the research to provide those guidelines and standards, so it makes it very difficult for you to make that decision.

Dr. Ayonrinde, you mentioned the three Ps, the patient, the physician and the plant. I think that's a very good way to look at it.

I want to focus on the physician part of it. As you mentioned, we're dealing with a situation where we have medical schools that are teaching our doctors based on these guidelines and standards that are out there, and we don't have guidelines and standards for our physicians to make these decisions. What's the appropriate dose? What's the appropriate strength? Should it be smoked or should it be ingested, and so on?

We're asking to make this happen because our veterans are suffering today. How do we bridge that gap to make certain that we provide the service for our veterans that we might need to provide them but at the same time collect the information that will take years to get?

Dr. Ayonrinde, perhaps you could comment on that.

[Dr. Oyedeji Ayonrinde]

I think my colleague Dr. Hurd raised the point about the urgency. We need to see this as a very urgent issue and mobilize as much research as we can, making it a priority area, which Health Canada has done to some degree and CIHR has done to some degree. I think it's an issue of immense urgency. We can't continue to practice with anecdotes for such a serious issue. It is an area of urgency for medical education. My colleague Didier.... I didn't get his surname, or I don't recall it; my apologies.

I think the urgency with which this should be treated should have all the same regard as medicine, i.e., can we dose it and all the rest? It's urgent. We can't wait and wait. There's human suffering here. The research needs to drive it really quickly. People are keen. There are lots of clinicians, researchers, biomedical scientists, geneticists and neuroscientists. In fact, I sometimes say, loosely, that the “green rush” had it on us: We woke up and they had gone. The research that has gone into plant development and so on, it's gone way faster than the medical profession. We're playing catch-up.

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

Dr. Hurd.

[Dr. Yasmin Hurd]

I completely agree, but I want to add one thing. I think it's really great that many people have found relief in smoking cannabis, but we are not talking about that. Really, one thing from today would be that smoking is not a medicinal route of administration.

As well, as a lot of my colleagues have indicated, the committee needs to know that the cannabis plant is very complex. You have over 500 chemicals in the cannabis plant, and more than 140 of them are cannabinoids with biologically active properties. We used to take the bark of a tree and that alleviated pain. We then isolated the active ingredient in that bark and realized it was aspirin. It's 2019. We should be developing medication by extracting or knowing which components of the cannabis plant are helping which particular symptoms for veterans and the general public. We owe it to our society to not use 10 grams or three grams.... It's crazy that someone could be ingesting 10 grams a day and saying that this is alleviating anything, because at that amount, the intoxication, the toxicity....

If we continue with smoking, we'll cause health risks in our veterans. We need to develop medications to help people, not to continue to contribute to just masking something in the short term and producing huge problems in the future. We can all develop together, very fast, which cannabinoids and which routes of administration are for which symptoms. It's not impossible.

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

Dr. Jutras-Aswad.

[Dr. Didier Jutras-Aswad]

I don't know if I'm allowed to do this, but I would actually ask a question. We have a number of processes already in place to test, to evaluate, to study and to finally approve new medicine and new treatments. The question is actually, why would we do it differently for cannabis, if we're talking about therapeutic cannabis. We're supposed to do it with all other treatments. Again, all these rules and processes are in place to actually protect the public and make sure that we're not giving a product or a treatment to the population that would actually not be useful or in some cases may even be detrimental.

The question I have is, why should we not follow the usual rules that were put in place in our country and others to actually make sure that what we're doing for the population is the best thing possible and the safest.

[The Chair, Liberal, Neil Ellis]

Thank you very much.

Mr. Bratina.

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

Sorry, I missed the early part, but it's a tremendous conversation, although I have to say that the conversations that we've had with other experts up to and including now leaves a bit of confusion in terms of where we're going with this. As an example, I looked at some data from the University of Texas at Dallas about brain mapping and how the reward system of the brain is changed with continuous use of marijuana, or cannabis. We hear all the good things that are happening for veterans, and that's why we're here, to make sure that something efficacious is happening for them. On this whole notion of marijuana, I see that it has a 6,000-year history that got interrupted in the early 20th century. What can we say at the moment about our understanding of the impacts on the brain through the scanning and the imaging and the other things that are occurring? Can we say much for sure about what the outcome would be of a continuous use of cannabis?

Who would like to answer that?

Dr. Hurd.

[Dr. Yasmin Hurd]

Yes. It depends on the age at which the cannabis is consumed. We have studies, for example, on THC and on many people around the world, and imaging studies in humans. Without a doubt the chronic use of cannabis does change the brain. It can change the brain in some aspects that are positive, obviously, and in others that are negative. In the developing brain, we see that it has a long-term impact. In prenatal exposure, adolescent exposure, and when you look at the brain of adults, you see sensitivity of reward, sensitivity of stress reactivity in the brain. We see changes that in some individuals are even reflective of a psychosis risk, which is consistent to what was mentioned before, that in some individuals that can occur.

Cannabis is not benign. It is definitely having an impact not only, as I said, on reward, but also cognition and emotional circuits. For example, PTSD activates the part of our brain, the amygdala, which is very important for emotional regulation. There have been studies to show that cannabis reduces that hyperactivity. However, the chronic use is definitely long term, impacting all brain circuits that we can see, and in other people as well, both in imaging....

You mentioned marijuana, cannabis, has been around for 6,000 years. Opioids are also natural and they've also been around for thousands of years. What we as humans have done is to leverage things in our environment to help us medicinally. To Dr. Jutras-Aswad's question, I think it's very important that we need to make sure we are standardizing in the same way that we develop all other medications.

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

I'm concerned, I guess, that we're going to come to a simple conclusion that so many grams of marijuana should be provided for a veteran based on such and such, when what I'm hearing about is all of the research that is going on at the moment that isn't conclusive yet.

I'm going to share my time with my colleague Ms. Ludwig.

[Karen Ludwig]

Thank you.

I did have a question about some topics of discussion today on the type, in terms of smoking marijuana. What's the impact on the lungs? Are there any side effects physiologically from smoking versus ingestion, say, in a pill format?

[Dr. Oyedeji Ayonrinde]

I have a quick comment on that.

Smoking, as mentioned earlier, carries considerably more harm. We have all the lessons we've learned from tobacco to bring us up to where we are now. Some people actually mix tobacco with their cannabis when they smoke it. There are many, many years of lessons and experience to learn from and apply. Certainly the impacts on lung disease, respiratory disorders and so on are considerable.

Ingestibles—also looking at the legislation which may be around the corner regarding edible cannabis products—are a completely different process. The way it's metabolized and so on takes longer, and the effects peak within a half an hour to two hours.

[Karen Ludwig]

If I may jump in on the edible format, what I've heard from older constituents in my riding is that they would be open to using or accepting an approved medical marijuana, but not in smoking format.

Doctor, you gave the example of one child to the next saying, “Your father smokes pot.” I find that even with older people there is a stigma about smoking marijuana.

[Dr. Oyedeji Ayonrinde]

Yes.

With licensed products, there are a range of preparations, including gels, and there has been a concerted push to come up with other non-smoked preparations. It's not only smoked products; there are infusibles, oils, gels and so on. That allows for better circumscribed doses. Some of those come in considerably lower doses, 2.5 milligrams of THC and so on. It does exist.

If I could be very naughty and quickly comment on the historical point, it was around 1836 to 1843 that William O'Shaughnessy, who was a military physician, took samples of Indian hemp to London, England, to be tested for trials on this sort of issue. It was in the mid-1800s that the British Parliament was having a very similar discussion to this one.

I'm in the process of publishing a study which has very similar findings to what we're talking about now: low dose, higher dose, high potency, what was then referred to as Indian hemp insanity, the impact on taxation and so on, and suggesting that young people below the age of 16 shouldn't use it. There's also a considerable amount of military evidence that was considered.

I think there is urgency. We need to show that we've moved on from 1836.

[The Chair, Liberal, Neil Ellis]

Ms. Wagantall.

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

Thank you, Chair.

I appreciate your ending with the term “urgency”, because right now in Australia, in a concerted effort, in a minimal amount of time, that government took major testimony from veterans on the issue of mefloquine. It came up with significant results, indicating that this is something we need to deal with right now.

On the urgency issue for government—if it were an urgent issue to them—we could deal with this in a reasonable time frame. Is that correct? Yes or no.

[Dr. Oyedeji Ayonrinde]

Correct.

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

Absolutely.

I'm hearing that there's been a disconnect, obviously, between medical research here in Canada, Veterans Affairs and veterans groups like Spartan Wellness. There are many, many veterans who have felt that they needed to do what they need to do to take care of each other.

I'm aware of Spartan Wellness. I believe, from what you've shared again today, Andrew, that you're working very responsibly and as effectively as possible to take care of your own.

You have a database that you mentioned, and you have medical people involved.

[Andrew Baldwin-Brown]

Yes, ma'am.

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

What would you like to see done with that medical base, that research you have?

Also, for those of you who are doctors, with all of this going on and having gone on already—and there's a lot of this kind of evidence—are you prepared to take it, or are we starting at square one?

Andrew.