Veterans Affairs Committee on March 18th, 2019

[Andrew Baldwin-Brown]

With our evidence specifically, we would be more than happy to share it with Veterans Affairs. It is a sampling of veterans—mostly veterans. We have some civilian patients as well.

If we can take a look at that—it's able to be extrapolated; it's a very comprehensive system—and if we can use that to help out in any way, we're willing to do it 100%. From what I've seen in taking probably 200 to 300 veterans through the process and monitoring them throughout, like I said, the differences have been night and day.

I think it would be very much worthwhile. Our process right now is an initial prescription, as well as clinical follow-ups from medical professionals at three, six, nine and 12 months, as well as being checked up on by your veteran educator, who has experience and qualifications in cannabis.

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

Okay, thank you.

Doctors, I have more questions.

Would one of you like to respond to that? Is that information that could speed up this process? Would it be valuable to you, or is it just—and we keep hearing these words—anecdotal evidence?

[Dr. Didier Jutras-Aswad]

I think this information is very important, but again, just to start a process of formal, well-designed evaluation and studies. I think there are no shortcuts, and shortcuts may be dangerous.

When you want to treat, and when you want to evaluate a new treatment, there are different steps for that, which include a randomized trial where you have well-designed studies according to international standards where you will compare a new treatment to another condition. This has to be very specifically designed, of course, which allows us to get the results we need to see if we use that intervention or not.

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

I appreciate that clarification very much.

The challenge, from my experience at this committee and with many veterans when I hear “should only use when there is sufficient data” or “shouldn't be the first source of treatment”, is that there are so many veterans who see this as the means of being taken care of and of getting off of significantly huge doses of pharmaceuticals.

Andrew, can you speak to that?

[Andrew Baldwin-Brown]

I can speak to that from my own experience when I was getting out of the military. Granted, it was a few years ago. We used to call it “the death rattle” when troops would be walking down the hallway and they had three or four bottles of pills, of God knows what, in their pockets.

I don't know if it was an individual-based thing or what was going on. However, in having discussions with civilian caretakers and civilian doctors on the other end, when they would hear what we were prescribed, a lot of the times you had to pick their jaws up off the table.

Being in the military is a rough job. Obviously, we contract things like post-traumatic stress disorder, depression, arthritis and degenerative disc disease at a much higher rate and much earlier in our lives than most Canadians do, so that's definitely part of it. However, in having discussions with civilian doctors, they were sometimes taken aback.

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

Can I ask, too, about the whole question of how many grams? I have a friend who was on a thousand pharmaceuticals a month. His wife got him to use a suppository—this is not for fun, as I've said before—10 grams. It made a huge difference in his life. Over time, his wife, on her own, because a doctor would not assist her, brought him down to where he is basically no longer dependent on any pharmaceuticals.

[Andrew Baldwin-Brown]

That's fantastic.

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

When we talk about how much is needed, is it based on the type of treatment—

[Andrew Baldwin-Brown]

Very much so.

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

—and do you use different treatments?

[Andrew Baldwin-Brown]

Very much so. There is no one-size-fits-all treatment with regard to cannabis.

My post-traumatic stress disorder may be very different from that of another vet sitting beside me who witnessed even the same incidents.

I found that the amount prescribed is generally in correlation with the percentage of the disability of the patient: the number of different ailments the patient is suffering from, whether it be osteoarthritis, degenerative disc disease, as well as PTSD, as well as depression, as well as, as well as, as well as. That patient is going to need a lot more than a patient who just has PTSD or is managing with three grams per day, or two, or one.

The objective, from our end, of medical cannabis is to bring the patient in and, as you said, remove the opioid addiction portion, or at least help where we can with that, re-establish a quality of life and then titrate the cannabis down to the point where the patient doesn't need it anymore.

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

Where would veterans be when you hear the conversation around creating what they would see as a pill to treat?

[Andrew Baldwin-Brown]

We had to do that for a lot of years before we had oil coverage as well. Obviously, Veterans Affairs did not cover the oil originally, so a lot of the older, original patients had to take the dried cannabis that one would consider as smokable and then convert that into some form of coconut oil or MCT oil.

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

What about it coming in a form like most pharmaceuticals, such as a tablet or a pill? How would they respond to that?

[Andrew Baldwin-Brown]

Some would respond very well. I know that for me, dealing with the stigma of actually having to smoke or vaporize cannabis has not always been the best for me or my social life.

I will actually slightly disagree with Dr. Hurd on the smoking or vaporizing portion, as I've seen that it does help a lot of veterans with sudden onset PTSD symptoms. With oils or edible forms, it can take anywhere between 45 minutes and two hours to actually calm the patient down. If somebody is in a mall and has a flashback and he or she is freaking out and needs to step outside, I find that actually vaporizing cannabis is a much better immediate symptom reliever than an edible. It's going to vary from patient to patient.

[The Chair, Liberal, Neil Ellis]

Ms. Blaney, you have three minutes.

[Rachel Blaney]

Today we've heard just how complex this issue is. I'm new to the study, so I want to get back to the data and the research. I want to get clarity.

In Canada, are we doing any specific research that touches on military veterans, PTSD and the interaction with cannabis? Are we actually looking at that specifically, so that there's more information that really helps support veterans?

What's being heard today is the complexity of this issue—the challenge for veterans who are just trying to get their lives back and right now are looking for any solution that will allow them to stay in their marriages, to be with their children, and keep their families as they once were. Are we really seeing research that is looking at this specifically?

[Dr. Didier Jutras-Aswad]

There was a specific call by the CIHR, the Canadian Institutes of Health Research, for research projects around the issue of cannabis and PTSD for veterans specifically. There is research being conducted, yes.

[Rachel Blaney]

Are you saying this research is in progress right now?

[Dr. Didier Jutras-Aswad]

The approval and all that is confidential, so I don't have the information, but I'm pretty sure if you addressed that question to CIHR to see what was funded and—

[Rachel Blaney]

—when that is going to happen.

When we do this research, which is so important, we need to look at rural and remote communities. When you look at the reality of being diagnosed in those communities, getting the medication that you need, all of these things have multiple barriers that need to be addressed in a meaningful way.

Does anybody have any information on research that really talks about the challenges those rural and remote communities face? It is true. I have a riding where many veterans come simply because they want that pace of lifestyle. They want to be somewhere quiet where they're not in circumstances where they're going to feel overwhelmed. I just don't know whether we're looking at this in the way we should be in this country.

[Dr. Didier Jutras-Aswad]

For a number of conditions in medicine, we have a number of technology-assisted methods to support rural communities and health care providers in these communities. They would be able to provide the best evidence-based treatment in these communities. That could certainly apply for all issues related to cannabis.

We should be careful about the idea of really centralizing knowledge on medical cannabis with specific clinics that are usually in big cities. That's certainly not a good way to make sure that everyone across the country, including rural communities, will have access to treatment.

To go back to my colleague, one key thing is to improve the training in medical schools, so that all physicians, including those who will go and work in these rural communities, will be well trained regarding cannabis, and not only these very specific clinics that usually just provide that kind of treatment in larger cities in Canada

[Rachel Blaney]

Yes, it is a big issue. Many health professionals don't even know how to diagnose or prescribe, and so they don't, which leaves people in these communities really struggling.

Thank you so much.

[The Chair, Liberal, Neil Ellis]

That ends our committee meeting today.

On behalf of our committee, I'd like to thank all of the witnesses for their excellent testimony today. Witnesses, thank you for all that you've done to help the men and women who have served.

The meeting is adjourned.