I'll be speaking to you in French, and I can then answer your questions in both languages.
I want to thank the committee for inviting me to appear today to discuss an extremely important issue that affects thousands of men and women who have served this country. These citizens deserve not only our respect, but also access to care that meets their needs, both during and after their years of service.
I'll start by introducing myself. My name is Didier Jutras-Aswad. I'm an addiction psychiatrist and a researcher at the CHUM Research Centre, where I'm the head of a mental health and addiction research program. The program focuses specifically on cannabis and cannabinoids, and looks at both their harmful and sometimes therapeutic effects. I'm also the head of the Centre for expertise and collaboration in concurrent mental health and addiction disorders at the Université de Montréal, where I'm an associate professor in the department of psychiatry and addiction studies.
I'd like to start by establishing an important premise for this presentation. I believe that cannabis—as my colleagues have pointed out—is a complex substance that can have positive effects for some people, but harmful effects for others. I believe that both the dramatization of the negative effects and the excessive promotion of the therapeutic effects, which are often not scientifically proven, are counterproductive when it comes to addressing the many and sometimes complex issues concerning this substance. I hope to present to you today a balanced approach to a very important topic, namely, the proper use of therapeutic cannabis by veterans.
The appropriate choice of prescription for a treatment—as with many other medical conditions—is usually based on a careful review of the risk-benefit ratio of the proposed treatment.
In the case of medical cannabis, a number of so-called pleasant or soothing effects have been reported by users for a range of health issues. Some of these benefits have been studied and supported by scientific data, but others have not. The data that provides a more scientific perspective comes from studies that use various methodologies. These methodologies often include the administration of cannabis in the form of products with well-controlled doses and concentrations, and not cannabis smoked ad libitum without any control over the frequency, intensity and dose consumed by the user.
The health issues for which smoked cannabis has thoroughly demonstrated its effectiveness include chronic pain and a lack of appetite in people who have other disorders. The amount of cannabis involved is generally no more than one or two grams in most cases. Other health issues that can sometimes be adequately treated with non-smoked cannabinoids, such as tablets or inhalers, are most often nausea, spasticity and insomnia.
The risks sometimes associated with cannabis are becoming better known. While most people use cannabis without experiencing any issues, it can still have a negative impact in some situations. It can affect mental health in particular, by leading to symptoms of anxiety and depression, cognitive impairment, the development of psychotic presentations or symptoms of psychosis, or the development of a pattern of uncontrolled cannabis use. We're obviously talking about drug addiction here. All these risks are influenced by a number of factors. These factors are the person's individual profile, in particular the person's genetics, psychological profile, the context or time of use, the type of cannabis used, or the frequency and intensity of use.
I'd like to draw your attention to the fact that the use of the more potent cannabis—with high THC levels—or regular use, such as several times a week or every day, is often associated with an increased risk of developing issues related to the substance, particularly mental health issues.
I believe that all this information combined helps us identify the four conditions under which access to therapeutic cannabis has a greater chance of presenting more benefits than risks for veterans.
The first condition is the prescription of cannabis only after a thorough assessment of the underlying medical issue and the use of cannabis only for health issues for which we have enough data.
On that note, we have data from various studies that shows that the assessment conducted before the prescription or authorization of medical cannabis often lacks rigour. We also know that many of the people who use cannabis for therapeutic purposes will do so for health issues for which we don't have enough scientific data.
The second condition is the use of the most evidence-based treatments that follow the good clinical practice guidelines for the different health issues in question. In most cases, cannabis shouldn't be a first-line treatment for veterans.
The third condition is the administration of cannabis in the form for which sufficient data is available. In most cases, the smoked form shouldn't be the preferred cannabinoid form.
The fourth condition is the administration of cannabis in controlled doses, at the lowest possible dose to minimize the risk of side effects. Clinical attention must be paid to the concentrations and the frequency of administration, as is the case for any medical treatment. I'd like to mention here that the scientific data is weak and often non-existent for doses above one or two grams a day.
Lastly, I'd like to remind you how often veterans experience physical or mental health issues and addiction. Most of these issues can be treated through various forms of psychotherapy or through certain drug therapies. However, these treatments aren't always available to veterans. In many cases, cannabis is most likely not the preferred first-line treatment to properly help veterans. That said, and particularly when we're talking about tightening up the procedures for regulating access to therapeutic cannabis, it seems more important than ever to ensure that veterans have better access to care or services that are known to be effective.
I'll be pleased to answer your questions during the question and answer period.