Veterans Affairs Committee on March 20th, 2019

[The Chair, Liberal, Neil Ellis]

Good afternoon, everybody.

Mr. McColeman.

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

As the meeting begins, Chair, I'd like to move a motion. We had invited the minister to appear today. Given his busy schedule, I'm sure the notice was too short. I had put on notice last meeting that this motion be put before the committee. The motion now reads:

That the committee invite the Minister of Veterans Affairs, the Hon. Lawrence MacAulay, to appear on the Supplementary Estimates (B) on April 1, 2019.

That is our next scheduled meeting, when we return from a constituency week. There is an amendment to be moved, and I would ask your forbearance to allow that to be added to it. Then we can vote. Do we need to vote on both?

[The Chair, Liberal, Neil Ellis]

What we can do is start with the amendment.

Cathay, go ahead.

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

I have a friendly amendment to the motion.

[The Chair, Liberal, Neil Ellis]

What is it?

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

I simply wanted to add the following after “on April 1, 2019”: “or April 3, 2019, and that the meeting be televised”.

[The Chair, Liberal, Neil Ellis]

Okay. It's just adding another date and “televised”.

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

It's just giving another option for the minister.

[The Chair, Liberal, Neil Ellis]

First, we'll vote on the amending motion.

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

Chair, if I might add this before we vote, I have had a conversation with Minister MacAulay to let him know. It's the second conversation I've had with him saying that we want him to come on estimates, and he said he'd be very happy to attend, as long as he can fit it into his schedule.

[The Chair, Liberal, Neil Ellis]

Okay. That's great.

First, procedure-wise, the amendment is on the table.

Mr. Samson.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Are there two amendments or just one? Because initially—

[The Chair, Liberal, Neil Ellis]

I took it as one. It's another date, for the following meeting, with it being televised.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Okay. But is it one amendment to the motion?

[The Chair, Liberal, Neil Ellis]

Yes.

(Amendment agreed to [See Minutes of Proceedings])

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

I just want to make sure that the amendment was for April 1 or April 3.

[The Chair, Liberal, Neil Ellis]

For the dates, it's adding April 3 and “televised”. Ministers are usually televised.

The amendment was carried. We'll now vote on the motion.

(Motion as amended agreed to [See Minutes of Proceedings])

Thank you.

Now we'll start with the meeting. Thank you, witnesses, for waiting for us.

Pursuant to Standing Order 108(2), on the study of medical cannabis and veterans' well-being, we have two witnesses today: Dr. Shackelford, physician, and Dr. Waisglass, medical director.

We'll start with testimony from Dr. Waisglass, who is on video conference from Toronto.

You have 10 minutes. Thank you.

[Dr. Barry Waisglass, Medical Director, Canadian Cannabis Clinics]

Honourable members of the House of Commons Standing Committee on Veterans Affairs, good afternoon and thank you for inviting me. It's a privilege to be invited to sit before you to share my knowledge and opinions about medical cannabis and the well-being of our veterans.

I'd like to apologize for not being there in person, which would have been better for all of us, but I had a conflict in schedules and I couldn't make it to Ottawa.

My name is Barry Waisglass. I am the medical director of Canadian Cannabis Clinics. I'll reference that as CCC, as we go forward in my introduction.

In the interest of full disclosure, I'd like the committee to know that I also serve as the medical director for Aurora Cannabis, one of Canada's largest licensed cannabis producers.

Prior to shifting my professional life to cannabis medicine five years ago, I worked for 40 years as a family doctor in a number of Ontario communities. Much of my career was focused on the successes my proffered treatments had on my patients, but the failures of conventional treatments and the harms caused by those treatments became increasingly apparent.

With my support, some patients began exploring complementary therapies, such as naturopathy and herbal medicine. For some, those included the use of cannabis to treat a variety of ailments, including chronic pain, asthma, skin conditions and insomnia. Frequently, they reported improvements in quality of life and restoration of function, with some able to reduce and even stop the use of the prescribed drugs, resulting in both cost savings and elimination of unpleasant side effects.

When Health Canada introduced a medical cannabis program, it legitimized the use of cannabis as medicine. CCC was created in 2014 to respond to the growing demand for access to medical cannabis by those with chronic health problems not responding to conventional treatments. We had two goals in mind: to provide improved access to both medical cannabis doctors and educators/counsellors, and to reduce harm from the growing use of opioids.

Prior to that time, medical cannabis doctors typically charged $300 to $500 and the patients who most needed the service could not afford it. Our clinic model offered all doctor and counselling services free to anyone with valid health insurance, but the demand for our services increased and development of new clinics was rapid. In only two years, by mid-2016, Canadian Cannabis Clinics had 17 clinics in Ontario. We now have 36 clinics operating in four provinces: British Columbia, Alberta, Ontario and Quebec. Since our inception four and a half years ago, we've treated over 65,000 patients, and we remain at this time the largest medical cannabis company in Canada.

The clinics are staffed primarily by family doctors, but also by emergency physicians, internists and psychiatrists, who work as independent health professionals responsible only to their patients and to their respective colleges. Most patients are referred by their doctor because of some form of chronic suffering that has not responded to conventional remedies. After a careful assessment, including review of medical records, medical cannabis may be prescribed if that patient has a condition likely to respond to medical cannabis and is without any contraindications. A cannabis counsellor is then assigned to provide the patient with the information needed to access the best available products for that person and to use them safely.

The term “medical cannabis”, as opposed to recreational cannabis, refers to a product recommended by a health care practitioner with expertise in this discipline. In Canada, that would be a doctor or a nurse practitioner. The expertise includes knowledge about jurisdictional laws and professional regulations, background science about cannabis as medicine, including benefits and risks, and the medical cannabis products available to the patient in his geographic area.

The medical cannabis patient then acquires the medicine exclusively from a Canadian licensed producer. In contrast, the recreational cannabis user receives neither prescription nor professional counselling and may acquire cannabis from any source, legal or otherwise, but, almost without exception, without the oversight of Health Canada regulating that growing operation. Experienced medical cannabis doctors will advise caution to cannabis-naive patients and will prescribe low-THC chemotypes. The recreational user is less informed and consequently at greater risk.

We have learned that response to medical cannabis treatment is variable, from little to no improvement at all to dramatic resolution of the presenting complaint. Those with a profound degree of suffering over prolonged duration often seem to respond best. I think that reflects many of our veterans. Science has helped us to understand why there is such a range of response to cannabis. All humans have a unique endocannabinoid system that is responsible for many of our body's complex regulatory functions. When the endocannabinoid receptors are exposed to the many different cannabis plant cannabinoids, it is understandable that there would be a different response in different individuals. It is important to consider that the top scientists in this field of study believe that many of our ailments are likely the result of endocannabinoid system dysfunction. It is particular to the many degenerative processes that affect us as we age.

We currently have, at CCC, 1,026 veterans on our roster and we average about 30 new vet patients each month. Almost all have chronic pain and/or PTSD. Their symptoms include anxiety, sleep impairment, depression, fatigue and headaches. Most also suffer from reductions in quality-of-life metrics, relationship dysfunction and anger issues. As a group, their positive response to medical cannabis has been significant, with reduction of symptoms, improvement in function and reduction in the use of their prescription medication. Further, many reported improvement with medical cannabis compared to illicit cannabis. Our experiential observations have been reinforced by the results of a number of papers: a study by S. Chan and her group, and a literature review by Yarnell.

This committee has already heard from some academics and clinicians—I'm specifically referring to the ones you heard from two days ago—who are entrenched in our health care institutions, most of whom have limited knowledge of cannabis. They have exaggerated to this panel the potential harms of this complex herb, while discounting its many benefits.

Anthropological and historical evidence illustrates the long history of this venerable plant as a medicine over centuries and across much of our planet. Today, although the evidence supporting the use of cannabis as medicine is primarily limited to observational studies and testimonials, the robust clinical research that some academics insist must precede our endorsement of medical cannabis is under way. Moreover, there is evidence from thousands of pre-clinical studies that prove we are on the right track.

We can, and we must, continue to cautiously recommend medical cannabis while awaiting more clinical studies, because of the significant benefits and relatively minimal risks compared to alternative treatment options.

[The Chair, Liberal, Neil Ellis]

Dr. Shackelford, go ahead.

[Dr. Alan Shackelford, Physician, As an Individual]

Mr. Chair, Madam Vice-Chair, Mr. Vice-Chair and esteemed members of the committee, it is a great privilege and honour to speak with you today about veterans and medical cannabis, veterans' well-being, and how medical cannabis might affect and influence that.

In my 35 years of medical practice, I've been privileged to care for a great many military service veterans at veterans administration hospitals in my post-graduate training in the United States and in my practice in Colorado. Although it's always been a privilege, it's also been frustrating at times, especially when the therapies at my disposal have been less effective than hoped. This is in part because military veterans present physicians with a different set of challenges from those presented by civilians. Military service itself presents unique challenges, and can result in a variety of different medical problems that conventional pharmaceuticals and pharmaceutical products are often incapable of addressing adequately.

Furthermore, veterans might present with several different medical problems simultaneously—for instance, with PTSD, anxiety, pain due to wounds and musculoskeletal injuries, and traumatic brain injury caused by explosions, all simultaneously and in the same patient. Such concomitant problems often require that several different prescription medications be provided, and each might have a side effect that, by itself, might not be of any particularly great concern, but the combination of side effects from increasing numbers of prescription drugs can create many additional problems for the patient, alongside the conditions for which they are being treated. It is now known that merely taking a number of different prescription medicines carries elevated risks. Studies have shown that as the number of prescription drugs approaches eight, the likelihood of a serious adverse event, such as hospitalization or even death, rises to nearly 100%. It's therefore essential that other therapeutic approaches be sought and provided, particularly since military veterans are among those most likely to be taking large numbers of prescription drugs.

A more urgent but related problem is that military veterans are much more likely than their civilian counterparts to commit suicide. That includes especially the Canadian veterans of the war in Afghanistan and the American veterans of the wars in Afghanistan and Iraq. One should not forget, either, those who served in Rwanda. It is almost certain that post-traumatic stress disorder, or PTSD, is the underlying cause of this epidemic, really, of suicide among military veterans, but as with so many other medical problems related to military service, identifying the problem is only the first step in developing and providing effective treatment.

Now, it's been my experience that many conditions, including PTSD, that have defied effective treatment with conventional medications will often respond remarkably well to medical cannabis. Many of my patients were able to reduce their doses of prescription drugs significantly, and many others were able to stop using them altogether, when medical cannabis was added to their treatment regimens. In the last 10 years, I myself have seen a total of about 30,000 patients and have accumulated a body of experience that is supported by the research that has been done in this arena. As Dr. Waisglass said, clearly more research is needed, but it is quite clear that cannabis is an effective treatment modality when appropriately used.

This is because each of the 110 or so different substances called “cannabinoids”, which are unique to the plant, has a different effect that is somewhat variable from the other cannabinoids. Taken as a whole, cannabinoid therapies can address a number of different medical problems with fewer side effects than single compound prescription drugs when administered in combinations. Clearly, if the need for certain drugs can be eliminated or the required doses can be significantly reduced without compromising efficacy, then such novel interventions as cannabinoid medicine should be considered. They are certainly worthy of serious consideration.

Now this doesn't mean that medical cannabis products are perfect. The dosing forms that are currently approved by Health Canada, such as tinctures, oils and smoked or vaporized cannabis, leave much to be desired. That is true not only in Canada but everywhere that medical cannabis has been approved and is in use.

I'm working with a retired deputy surgeon general of the Canadian Forces and a drug development expert, who established the equivalent of Health Canada and the FDA in Israel, on studies that, we are confident, will result in properly formulated, innovative, pharmaceutical-grade cannabis-derived products, which we think will be far superior to anything that's currently available.

For the veteran and also for the active service member, cannabis can offer effective treatment when conventional therapies fail or, in other cases, may provide comparable efficacy with reduced overall side effects, thereby improving the risk-benefit profile of many therapeutic regimens in military medicine.

We look forward to being able to make these advanced products available to patients in Canada and to military veterans, whose resilience in the face of physical and psychological illness is really quite remarkable, and whose willingness to embrace new and novel treatment approaches is both courageous and inspiring. I think we owe Canada's military veterans, and those everywhere, nothing less.

It has been an honour to speak with you thus far. I appreciate the opportunity and look forward to answering your questions.

[The Chair, Liberal, Neil Ellis]

Mr. McColeman, you have six minutes.

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

Chair, just as a quick favour, can you give me a signal when I have one minute left, please?

Thank you both for being here today. It's delightful to hear your points of view. We've obviously been talking to other medical professionals about their views.

Dr. Shackelford, are you practising currently and, if so, where?

[Dr. Alan Shackelford]

Yes. I'm in practice in Colorado.

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

So you've come in from Colorado. Thank you so much for doing that.

[Dr. Alan Shackelford]

It's a pleasure.