Veterans Affairs Committee on March 20th, 2019

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

When it comes to the distinction between medical cannabis and recreational product, I believe I've heard, and I'd just like to confirm it, that you both believe there is truly a category called “medical” and that everything outside of that category would be recreational product. Is that correct? I'm not talking about the product specifically, but you talk about medical cannabis, and the fact that it is a medicine. Is that your view, that it is a medicine?

[Dr. Alan Shackelford]

Yes. It is clearly a medicine. Cannabis itself can be used in a variety of different ways. When it is formulated as a medical product, to be used for a medical indication, it is clearly a medical product.

It does have recreational uses, historically as well as currently. I think, historically, many people who were using cannabis recreationally were actually treating some underlying medical problem that they may well not have been aware of.

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

Thank you for that.

Dr. Waisglass, would you confirm that it is a medicine?

[Dr. Barry Waisglass]

Cannabis can be used as a medicine, and it can be used for the purpose of leaving our current state of consciousness—our present mindset, if you like. It can be used as a euphoriant, to make people feel happier. So it clearly can be used for people to relax in a social setting. These are some of the ways it's used, as you and I would say, probably not as a medicine.

But Dr. Shackelford is quite correct. People will often say they are using it recreationally, but clearly they're using it for pathological conditions like anxiety disorders.

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

Of course, we're talking about it in the context of veterans, and I want to keep it in that context, if at all possible.

Are there any other types of medicine, other than cannabis, that people smoke?

[Dr. Barry Waisglass]

Are you addressing me on that one?

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

Yes. I'll go to you, doctor. I'd like opinions from both of you.

[Dr. Barry Waisglass]

Okay.

Cannabis is a botanical. It's not a single molecule, which is what we're used to. When we talk about medicine, in the context that I think you're talking about, in the medical and pharmaceutical milieu—now, for almost 100 years or thereabouts—medicine is often thought of as a single-molecule medicine that's usually rigorously screened and checked for indications and risks and so on, and then the doctor, the medic, prescribes it to the patient.

Here we have something different. It requires a bit of a paradigm shift, when traditional medical people and citizens alike look at cannabis in the context of a medicine. It's a botanical. The right person to put this question to would be, say, a naturopath—somebody who deals with botanicals—or an Ayurvedic doctor in India who deals with plants as medicines.

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

I have limited time, so I have to move quickly. If you could keep your answer brief, Dr. Shackelford, that would be appreciated.

[Dr. Alan Shackelford]

I think it has been traditional for people to smoke cannabis for recreational as well as medical purposes, but I don't think that's the only way to use it, nor do I think it's the most effective way to use it. There are ingested cannabis-derived products—pills and other forms—that are more medically appropriate and that I think should be at the forefront. I think the state of development up to this point has limited its uses to the kind of traditional inhaled methods, and there are certain indications for those, such as acute nausea in a patient undergoing chemotherapy. But there are more refined types of products available to address that specific need, such as an extracted oil that can be vaporized in a device made for that purpose.

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

I have one minute left, gentlemen.

I'm going to finish up on one last question, which is this. In this country, there is no distinction between medical and recreational cannabis in terms of how the government is employing the taxation regime. All other pharmaceuticals and medicines in this country are not taxed if they are considered medicine. In this country, we are applying what's called an excise tax, which many people know as the sin tax, the same one that's on alcohol and cigarettes, tobacco products. It's added onto two other taxes, both provincial and federal taxes, plus the final tax on a tax.

Do you agree or disagree that medical cannabis should be taxed with that additional sin tax, that excise tax?

We'll go to Dr. Waisglass in Toronto.

[Dr. Barry Waisglass]

I couldn't be more disturbed by this government's decision to burden medical patients with this additional tax. Skirting that particular item, in my talk I pointed out that the people most in need and the people who most benefit from medical cannabis are often those who are suffering the most financially in their lives, and who are unable to work and unable to participate in society.

So, I'm with you. It sounds like your inference is that this is a horrible thing and mean-spirited as well, and they have to rescind that tax.

[The Chair, Liberal, Neil Ellis]

Dr. Shackelford, if you want to answer, we can give you some time.

[Dr. Alan Shackelford]

Other jurisdictions, such as Colorado, make a very clear distinction between recreational cannabis and medical cannabis, and both products are taxed entirely differently. I think that taxing the medical applications, the medical uses of cannabis as a recreational product is incorrect.

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

Thank you.

[The Chair, Liberal, Neil Ellis]

Mr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you both for coming.

Dr. Waisglass, I noted that in one of your comments you talked about.... I wasn't at the previous meeting, but you were referring to the previous witnesses in medical research and clinicians as being, in your words, “entrenched” in the medical system and over-exaggerating the harms and underestimating the benefit.

Full disclosure: I'm a physician. I also spent five years doing medical research before I was in medical school.

When you look at the levels of evidence that we have to have.... For instance, if there's a new blood pressure drug, you have your basic science research. You then have your animal trials. You have your human trials. You have your gold standard, the randomized clinical trials. Given the backgrounds of people, with these different methods, what evidence is there to counteract what they're saying from their knowledge and experience? What is the level of evidence to say that, no, these high doses are not harmful, or to say that these benefits are there, when others who are performing medical research in clinical medicine don't agree?

[Dr. Barry Waisglass]

If the measuring stick is going to be the same for a botanical as for a single-molecule pharmaceutical drug, we have problems. That's one of the reasons for the delay in getting the evidence we need.

There are two reasons why we do those studies. One is to convince Health Canada, or whoever's going to determine that a new product can come onto the market, that the drug is efficacious—it's going to work for that problem better than a placebo will. Two is that it's safe. Is that not correct?

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

That's correct.

[Dr. Barry Waisglass]

We want to know its safety. We want to know it's not going to kill people or give them cancer.

With medical cannabis, we need to be more patient, because it's very difficult to assess it in the same way. My answer to you is that there is ample preclinical science to make us believe.... There are thousands of studies on animals, and cellular and biological sciences, molecular studies and so on to tell us that cannabis is safe. We have historical evidence that tells us it's safe. It was used as a medicine for hundreds of years throughout Europe and North America and other parts of the world as a drug much as we know it, only in tincture form.

Currently, we have observational studies. We have a variety of smaller studies. New ones are under way, and you can get preliminary reports on those that tell you both that cannabis has relatively few serious side effects, which are easily managed, and that it is very efficacious, very effective, in a great number of treatments and for symptom relief.

The doctors who speak against it are entirely unfamiliar with the observational studies, or they discredit them quickly. A great deal of the negative papers published on cannabis—I know, because I've been through damn near all of them—are rife with bias. Bias permeates our society—bias around cannabis in particular—which is religious, cultural, political or social. We all know that, and you've probably heard from a number of people, officially and unofficially, who have this bias.

In the same way, there are people with biases in favour of cannabis—cannabis can do no wrong and it fixes everything. We have to discount those people too.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Dr. Shackelford, do you have anything to add to that?

[Dr. Alan Shackelford]

I did medical research as an undergraduate medical student at Heidelberg University, and I published five papers—both basic science or animal work and clinical investigations. I was a research fellow at Harvard Medical School in my postgraduate training, which was one of my three fellowships after an internal medicine residency at Harvard. I am extremely familiar with investigations of this nature, and I've been looking into the research evidence that supports the use of cannabis as a treatment.

There are extremely well-done, randomized, placebo-controlled trials, both in Canada and the United States, and in other countries, that support the use of cannabis and its safety and efficacy. One study by Donald Abrams, published in 2011, showed that the use of cannabis—in that particular study it was vaporized—in conjunction with prescription opioid pain medicines allowed a reduction in the dose of the narcotic pain medicines by 25%. In and of itself, that is an important way of decreasing the risk that patients are exposed to in the use of opiates, and the pain control was equally good.

There have been studies in Canada by Dr. Mark Ware, whom you may well know, who showed that inhaled cannabis—smoked, again—was efficacious for the treatment of neuropathic pain.

One of the problems, however, with being able to do these types of studies that we are all familiar with as physicians and scientists is institutional bias—particularly in the United States—against doing studies involving cannabis. There is a very clear disinterest in showing that cannabis may have any medical benefit, and that has limited our ability to carry out appropriate studies. Nonetheless, the study I cited by Dr. Abrams was done with permission by the National Institute on Drug Abuse in the U.S., and there are other studies that are equally demonstrative of benefit.

In terms of risk, other studies have shown poor evidence that using cannabis is linked to any sort of development of psychiatric or physical disease.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

I'm sorry, but could I cut you off there? I think I'm just about out of time.

[The Chair, Liberal, Neil Ellis]

Yes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Sorry about that. Thank you very much.