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.
Karen Ludwig New Brunswick Southwest, Lib.
Thank you.
Thank you, all, for your testimony today.
Mr. Baldwin-Brown, thank you so much for your service and to your seven colleagues who are working with you.
We've heard from a number of people regarding the collection of data. In the work you do, are you sharing with Veterans Affairs Canada the information you're collecting and what you're learning?
Co-Founder, Spartan Wellness
We are not at this time. We would love to. We would relish the opportunity to work closely with Veterans Affairs Canada. When we're taking patients in on an initial prescription, we obviously ask them what medications they're currently on and check with the medical staff to make sure there are no contraindications and that the prescription is appropriate for that individual. That's not always the case.
Obviously, on renewal as well, we ask them which medications they've been taking. Have we had any luck in reducing those medications? In almost every instance we have, as I said, with the quality of life improvements and things like that.
Our data gathering is second to none in Canada as it stands right now. We have a vested interest in making sure that we gather everything we can.
Co-Founder, Spartan Wellness
It's online in our own program. It's in a medical program known as EMR, electronic records management.
New Brunswick Southwest, Lib.
Have many of the veterans who are attending Spartan Wellness taken...? You mentioned finances, because however much it costs.... Did many of them receive a one lump sum payment or a pension for life?
Co-Founder, Spartan Wellness
With Spartan it's a mix of both. We found that the average age of our patients is somewhere around the late forties to mid fifties. A lot of those patients will be covered by the Pension Act, as well as received subsequent payments for different ailments. If somebody broke their hip in Cyprus, they got a pension under the Pension Act. For PTSD in Afghanistan they have a lump sum payment that is now going over the pension for life.
New Brunswick Southwest, Lib.
Do you hear from any of the veterans that you're working with about the veterans centres themselves? Are they using the veterans centres?
Co-Founder, Spartan Wellness
Usually not, but some do. I tend not to. Most of the patients that we deal with deal with Veterans Affairs remotely through My VAC Account. The younger generation, usually those under 40 are high users of My VAC Account.
Then again, it's individualized. Someone with severe PTSD and depression may not have the capability to click 82 times to get what they need. Most of them are call-ins or proactive outreaches from the case managers themselves.
New Brunswick Southwest, Lib.
Do you know if any of the veterans are using any of the wraparound services, such as education and training services, family services?
Co-Founder, Spartan Wellness
Some are, yes. I look at a whole bunch of veterans as three big packs. You have the veterans who got out who don't require any assistance from the VA. They're just off work and they're doing their thing and they happen to serve and didn't get injured and got out. A lot of those veterans I dealt with, the people I served with, are using the education and training benefit. I can think of at least two off the top of my head. You have a second group of people who are out and receiving some form of help from Veterans Affairs, whether they're working and receiving a top-up to their income or a permanent impairment allowance. Then we have the third group who usually have diminished earning capacity and rely on the VA as well.
New Brunswick Southwest, Lib.
Thank you very much.
I'm going to jump over to our psychiatrist here in the room.
On the Canadian side, where are you receiving your funding for your current research?
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
Some is being funded within the university and for other research that's been funded, one is through a bequest from a family who lost someone. There are opportunities through CIHR and so on, which are competitive bids.
New Brunswick Southwest, Lib.
Is there a national body that you think could be the overarching centre for the data you're working on in Canada? You mentioned in your testimony, for example—
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
—CIMVHR.
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
Yes, one of the bodies is the CIMVHR, which is the Canadian Institute for Military and Veteran Health Research, based at Queen's University. That has network links with other veteran research organizations around the world in Australia, the U.K. and the U.S.
New Brunswick Southwest, Lib.
Am I looking at this too narrowly if.... I'm just going to make my suggestion.
I think a lot of the work that I hear about at this committee, particularly from the medical profession and psychiatrists, is critical information. Networking and collaboration, as you said, are absolutely important.
Isn't there a crossover from the medical prescriptions to the general population for similar psychiatric challenges? If we keep it just inside Veterans Affairs is that too limited?
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
It's not too limited; however, as I said earlier in evidence, there are some unique skills in working with veterans. Not all clinicians are comfortable with veterans' experiences. Not all have a sufficiently good appreciation of what happens in the theatre of combat and the consequences on the individuals and their families. A veteran said to me just last week that PTSD is that thing he had enough courage to share with me.
It's quite a different approach to civilian health issues. If I liken it medically to a fracture—a person could fracture his femur slipping on ice, in a car crash or being blown up. It's the same broken bone, but the experience and the qualitative nature is considerably different and the impacts are different.
Shaun Chen Scarborough North, Lib.
Thank you, Mr. Chair.
I have a question for the physicians, the doctors here with us today and the researchers.
In 2016, Veterans Affairs Canada reduced the maximum allowable reimbursement limit for medical marijuana from 10 grams to three grams per day. They also established an exceptional approval process for those who require a higher dosage. Some have argued that there is a lack of medical professionals who specialize in treating PTSD and are simultaneously well versed on medical marijuana usage. Many of you have pointed out the lack of research and the need for more data on the effects of using medicinal cannabis.
Can you comment on some of those concerns that have been previously raised?
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
I think one of the challenges for the medical profession also is when we refer to grams, as my colleague Dr. Hurd mentioned earlier, it's predominantly referring to smoked plant product.
Within that weight can be a whole range of differences, mentioned earlier. One of our studies has identified a 65-fold difference in potency within what would be described as a joint. Within that potency, being THC, there's still the ameliorating effects of CBD. A unique experience is needed, just understanding and having the clinical confidence with cannabinoids.
PTSD is a disorder not only in the military population, but a disorder that requires considerably more professional input. I think so many people suffering from PTSD find themselves in addiction services, misusing alcohol, opioids. Marriages and relationships break down, and so on. That requires a whole skill and resource on its own.
Every area of this could certainly do with a lot more resources. I think if we can make this important curricular training for medical students and therapists much earlier, that will go a long way.
It may well be, as mentioned, that veterans have a considerable role in medical education. If you can make a strong impression and raise awareness in a young medical student, nurse, social worker, occupational therapist, that goes a long way for the rest of their careers.
Scarborough North, Lib.
Doctor, thank you for sharing that.
This goes to your earlier comments. You spoke about the development of a national information registry and an information campaign, combined with what you have just raised with respect to medical schools arming the next generation of doctors with the proper knowledge.
Can you talk a bit more about that national information registry that you mentioned at the end of your testimony earlier?
Associate Professor, Department of Psychiatry, Queen's University, As an Individual
Yes, by that I'm referring to actually pooling the experience and the resources within centres, from Montreal to Toronto to all over the country. There's a lot of strength in numbers, and if there's a way of actually bringing together evidence, data, in a secure way and having this used to develop the larger knowledge pool.... There are countries with much larger numbers, but for the population here, if we can pool all of that together in such a way that we have confidential material available, where veterans can seek evidence-based information relevant to them, where veterans' families or kids, who wonder why dad's always angry and so different, or when people say, “Your dad uses pot”, will be able to actually access information that's not going to stigmatize them or cause further difficulty.
Having spoken with veterans, I think it can be a very lonely world. Some of these experiences involve mislabelling. Some people who have given their lives in service to the nation could do with bringing together the information we have.
Scarborough North, Lib.
The data is showing, in fact, that the department spent in the 2016-17 fiscal year, $63.7 million on medicinal cannabis. That amount was triple the amount that it had spent the year before. Simultaneously it reduced the limit from 10 grams per day to three grams per day.
Based on your experiences, and I'm happy to hear from Mr. Baldwin-Brown as well, what are some of the reasons and factors you can share with us as to why there has been such an increase in just one year?
