Veterans Affairs Committee on April 29th, 2019

[Dr. Jonathan Douglas]

I think when it comes to dealing with mefloquine, what we have to be able to do is to move quickly to a place where we can offer some kind of validation that we get it, we're hearing it, we're paying attention to it and we're listening to it. That's number one.

Number two, it's not really true that this thing is undiagnosable at this point. It really can be diagnosed. If we say they can't be diagnosed with PTSD because of the exclusion in criterion H regarding its being attributable to a medication, if we say that it's not PTSD, then, okay, it's a trauma-related disorder, it's an anxiety disorder or it's a mood disorder. We can come up with other labels. There's always a label for someone who's suffering psychologically and has a significant impairment. That's going to be a diagnosable condition of one form or another.

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

On that note, then, we know that Health Canada quietly upgraded the label to be more visible, to give more attention to the fact that if any of these conditions are happening to you, you must quit using this drug.

[Dr. Jonathan Douglas]

Right.

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

So that's an improvement, but have either of you received any training or literature from Health Canada indicating that mefloquine poisoning is a condition that should be screened for?

[Dr. Jonathan Douglas]

I wouldn't, as I don't prescribe.

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

What about yourself, Dr. Suter?

[Dr. Penelope Suter]

I'm actually from the U.S.

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

Oh, that's right. You can't help me there.

[Dr. Penelope Suter]

No, sorry.

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

As far as our veterans are concerned, I know a lot of them have heard of these upgrades in announcements from the surgeon general and from Health Canada, yet there has been no communication whatsoever to the veterans themselves to try to deal with these issues.

[Dr. Jonathan Douglas]

Correct.

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

From your perspective, again, that causes even greater duress because it creates even more of a wall. Then you talked about suicides.

I'm hearing over and over again from our veterans about the number of suicides taking place in Canada, due to illness and due to—they would say as well—such a heightened level of frustration.

[Dr. Jonathan Douglas]

Absolutely. In fact, this speaks again to the issue of what we should we be researching. Mefloquine exposure with a prodromal reaction and risk of suicide, that's retrospective research that could be done, and it would certainly be very important to understand the potential impact that mefloquine may have had on veteran suicide.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Blaney, you have three minutes.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you for speaking about the informed choice of taking mefloquine. We heard earlier about the 5%, or less than 5%.

What is the process that they're being asked to follow and are they being given the proper information before they make the decision to take mefloquine? Is that something that you would recommend that this committee look into?

[Dr. Jonathan Douglas]

Yes. I think that's a very significant issue and it goes much beyond simply mefloquine. It's the issue of a soldier's right to consent to medical treatment, and it's a challenging one. We're sending people into an area where they may be exposed to certain diseases and we have these medications. We want to protect the soldiers—we have an obligation to protect the soldiers. Are they able to make an informed consent?

I'm not the expert here, but my understanding is that if you get ordered to take that drug, you take that drug. I know that in the United States, from what Dr. Nevin was writing, frequently the drug inserts that say to stop taking it if you're getting certain reactions were not being provided to soldiers, so the information was not being provided. Even if it were being provided, were they actually empowered to say, “I have to stop taking this”? These are very challenging issues when we're dealing with a captive population that may not have the same freedom of consent to a medical treatment as any other citizen would.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you. I think that's a really important part to consider.

You also talked about some veterans not disclosing because their experience is that this feels like what we think PTSD is but they weren't in active combat and they didn't see those things, so they wonder why they are having this reaction. I'm just curious about what you think about the education process to let people know that this could be why they're having that.

I also want to know, in that context, if you've ever worked with someone who was diagnosed with PTSD but later on found out that it was actually mefloquine toxicity, and figured out how to address the issue.

[Dr. Jonathan Douglas]

To date, I believe I've worked with three people who have been mefloquine exposed, two of whom had the prodromal reaction. One of them is a more recent one, so I was able to catch that and say what was going on there. The other one was the one who introduced me to the concept of mefloquine toxicity. In that particular case—I think that's sort of my standard—that fellow had been diagnosed some years before I'd ever heard the word.

In my opinion, the diagnosis of PTSD is not inaccurate in his situation, but we'd have to look at that case by case. We may very well have people out there who have been so identified, who are not actually suffering from PTSD. As I say, I think it's complex.

[Rachel Blaney, NDP, North Island—Powell River, BC]

It is complex and making sure people are getting the correct treatment is something that we should all be concerned about.

[Dr. Jonathan Douglas]

Absolutely. In terms of the treatment, certainly, I think the psychological treatment of anxiety, depression and these kinds of issues that people are presenting with are going to be beneficial. We're going to help people cope more effectively, regardless of the source of the anxiety.

It's not like that treatment is going to be wasted, but we might very well find that certain people are not responding as effectively to treatment as we might otherwise hope, and the mefloquine exposure and the reaction are in fact holding them back. What do we do with those people? I'm going to be sending them to a neuro-optometrist from now on.

What other options are there? We really do have to come up with some good answers for what we do with these people.

[Rachel Blaney, NDP, North Island—Powell River, BC]

That's right. Thank you so much.

[The Chair, Liberal, Neil Ellis]

That ends our time for testimony today.

On behalf of the committee, I'd like to thank both of you for taking time out of your day to testify today.

That's the end of the meeting.

[Dr. Jonathan Douglas]

Thank you very much.

[The Chair, Liberal, Neil Ellis]

We're adjourned.