Yes, exactly.
Evidence of meeting #115 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 symptoms.
A recording is available from Parliament.
Evidence of meeting #115 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 symptoms.
A recording is available from Parliament.
4:35 p.m.
Psychologist, Central Ontario Psychology, As an Individual
Yes, exactly.
4:35 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Your comments about awareness are, I think, appropriate. Not only VAC but other agencies should be notifying not only our physicians but our pharmacists, because ultimately our pharmacists....
4:35 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Are you aware of how much training a pharmacist might be able to get in this area?
4:35 p.m.
Psychologist, Central Ontario Psychology, As an Individual
I have no awareness.
4:35 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
That's something we need to look at, because the pharmacists are the ones giving it out. If all of a sudden it's 100 milligrams that is being asked for and they don't have that pill, do they go to different strengths, different levels?
4:35 p.m.
Psychologist, Central Ontario Psychology, As an Individual
Yes, I agree that this is absolutely an issue that applies to civilians as well.
4:35 p.m.
Liberal
Shaun Chen Liberal Scarborough North, ON
Thank you, Mr. Chair. I want to thank Dr. Douglas and Dr. Suter for joining us today and providing their testimony.
I want to begin by reading from the 2014 report by the European Medicines Agency. It stated, “There is enough evidence from the presented drug safety reports, the submitted literature report and the FDA assessment report supporting a causal relationship between mefloquine and the occurrence of long lasting and even persistent neuropsychiatric side effects.” Certainly, both of our witnesses provided much testimony today.
Within our Canadian Armed Forces, currently, mefloquine is used for less than 5% of malaria prevention prescriptions. From my understanding, since June 2017, it is only prescribed to members of the Canadian Armed Forces when it is specifically requested, or when other options are deemed a contraindication. What is your thinking, what is your assessment of how the armed forces is currently prescribing this drug?
4:35 p.m.
Psychologist, Central Ontario Psychology, As an Individual
It's certainly a good idea to encourage different medications over mefloquine. All of the quinine-based drugs carry at least some risk. Mefloquine's risk, from what I gather, seems to be unique, but none of them are entirely without some risk. I would be concerned about people requesting mefloquine specifically and I'd be curious as to know why. Are people getting the informed consent they need to make a decision about whether or not mefloquine should be the drug of choice here? What's behind someone saying, “I'd like to take mefloquine”? Based on what I know about it, it seems to be a fairly surprising choice.
4:35 p.m.
Liberal
Shaun Chen Liberal Scarborough North, ON
That's an excellent question in terms of why somebody would ask specifically for mefloquine. As far as I can see, there's no literature to look at that question. That would certainly be a good research question to put out there.
You mentioned other drugs, but that they also carry risk. As you mentioned earlier, there could be underlying conditions or a buildup of different events in, for example, a soldier's career where he or she actually hits that point where they break the camel's back and they reach that critical point of PTSD.
With respect to the other drugs, can you speak to the neurological or psychiatric conditions as well as experiences that are potentially traumatic? What are the potential risks with other types of medications that are used for malaria?
4:40 p.m.
Psychologist, Central Ontario Psychology, As an Individual
I'm afraid I simply can't give you an informed answer. I'm the wrong professional for that. I'm not sufficiently aware of other medications and their risks.
4:40 p.m.
Optometrist, As an Individual
I know there are other chloroquines that are used routinely for things like rheumatoid arthritis or autoimmune disorders. What we look at there is macular toxicity. With some of those drugs, you've never heard of psychiatric issues with them. Mefloquine does seem to be somewhat unique. It almost sounds like anything would be safer, truthfully.
4:40 p.m.
Liberal
Shaun Chen Liberal Scarborough North, ON
I know we've talked about the research questions you put out there of how many soldiers have been exposed. What do you think would be some of the broader research questions, because these drugs are used by folks who are outside of the Canadian Armed Forces?
What type of research do you think would be very helpful for us, as a community, to move forward on this issue in the interest of public safety?
4:40 p.m.
Psychologist, Central Ontario Psychology, As an Individual
It's an excellent question. I think it's a much more challenging one to identify people in the community who may have been exposed to the medication.
Perhaps pharmaceutical records might lead to people who have received mefloquine in the past. Again, I think we might be up against the challenge of how long records are kept. I know in my own field it's 10 years for keeping records. I'm not sure if that would apply. That's from my own college of psychologists, so I'm not sure how long pharmaceutical records would be held. I suspect a lot of the people who are exposed to mefloquine probably took it as long as 15 or 20 years ago.
It would be interesting to correlate the rates of psychiatric disability among those who have been so exposed perhaps through census or something like that, where you might ask such research questions. Did you ever take an anti-malarial drug? We could correlate that with the reactions, because it's not simply exposure. It's exposure plus that reaction. Then correlate that with subsequent psychological or psychiatric disability.
4:40 p.m.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
Thank you, Chair.
Dr. Douglas, in your bio it states that you have expertise in sanctuary trauma, which is the psychological mechanism by which invalidation, dismissal and betrayal by authorities not only perpetuates both physical and psychological injuries but actually impedes healing and makes the injury substantially worse.
As we've been studying a lot of issues around veterans, I have sensed over and over again that a great deal of the added stress, illness and trauma is due to having to try to prove that they are ill and this whole question of benefit of the doubt.
Could you speak to that a little as to the issues around mefloquine? There's a lot of information out there. We know it's there. We know we need more study, but in the meantime, what is your sense on this specifically for veterans who were forced to use this drug, had no recourse and are suffering now?
4:40 p.m.
Psychologist, Central Ontario Psychology, As an Individual
The issue of sanctuary trauma are very important to me. I work with Badge of Life Canada, an organization devoted to helping police officers and corrections officers. I often speak on this topic at considerable length. It's almost hard for me to speak on it shortly, but I will do my best.
4:45 p.m.
Conservative
4:45 p.m.
Psychologist, Central Ontario Psychology, As an Individual
It has a great deal of research behind it. Again, it's not a concept that is very well understood, but the idea is that the level of injustice somebody experiences subsequent to an injury predicts very strongly the duration of that disability. It predicts that, independent of the severity of the physical injury that occurs. It applies to both psychological and physical illnesses.
I have absolutely no doubt that it's a very common reaction really in anyone who's up against that system that says, “Prove to me you're sick.” That person's going to experience that at some point. Some people are going to be embittered by that experience and, as a result of that, their injuries are going to get worse.
It's difficult to balance. We need to have good, solid information when we give somebody a disability pension. We don't want to give people disability pensions simply because they ask for them, obviously.
4:45 p.m.
Psychologist, Central Ontario Psychology, As an Individual
But we also have to recognize that putting up too many barriers actually makes the disability worse, which increases the costs to the system, never mind the personal costs to the individual who's suffering.
