Veterans Affairs Committee on May 6th, 2019

[Shaun Chen, Liberal, Scarborough North, ON]

Then, essentially, with respect to last year, are you aware of the reasons that those three individuals opted for this particular drug?

[BGen Andrew Downes]

I don't know what their individual reasons were, but in order to be able to prescribe mefloquine on request, people have to have taken it before and not had significant symptoms associated with it. Basically, they've demonstrated their tolerance for mefloquine is good. It's under those circumstances that we provide it, assuming there are no other contraindications.

[Shaun Chen, Liberal, Scarborough North, ON]

Correct. So somebody might request it if they've taken the drug before and they're able to use it without any adverse side affects. There are other medications that are available. Given this information you've just shared, that so far this year nobody has requested it, and last year there were only three servicemen and servicewomen who requested it, and given the concerns that have been raised around this particular drug, what is the rationale? Although I hear from you that the research is possibly not entirely definitive, what is the rationale to continue to offer this particular drug? Is it because the other options are not suitable for the people who might opt in for this drug? Can you speak more about that?

[BGen Andrew Downes]

We wanted to have it still in our formulary for cases where the other drugs were contraindicated. If somebody was allergic to the other medications, for example, we still wanted to have this as a possibility. We do prefer to prescribe the others should they not be contraindicated.

[Shaun Chen, Liberal, Scarborough North, ON]

In the U.S. there have been veterans who have been compensated for medical conditions that were directly linked to the use of mefloquine. Do you know of any cases in Canada where that has occurred or possible cases moving forward where that might be the same situation?

[BGen Andrew Downes]

When you say “compensated”, are you referring to Veterans Affairs compensation?

[Shaun Chen, Liberal, Scarborough North, ON]

I'm not aware. I just understand that in the U.S., some folks have been compensated, veterans specifically.

[BGen Andrew Downes]

Right. There would be different ways people could be compensated for that. One would be through litigation, but there would be the other way, which is through Veterans Affairs.

I'll invite Dr. Courchesne to speak to that.

[Dr. Cyd Courchesne, Director General, Health Professionals Division, Chief Medical Officer, Department of Veterans Affairs]

Thank you.

At Veterans Affairs the message has been consistent: Any service member who has developed any illness or injury as a result of their service can apply. That includes if they believe that mefloquine is a cause of their illness or injury.

We don't compensate for cause, however. We compensate for a diagnosed medical condition. It is possible that some veterans have applied for a disability award for PTSD, but we don't track what the cause of their PTSD is. If you serve and you have a diagnosis of PTSD, you get your disability award and treatment and benefits that go along with that. Every case is looked at on a case-by-case basis, and we have repeatedly invited veterans to come forward.

[Shaun Chen, Liberal, Scarborough North, ON]

With respect to the types of compensation that we may have provided to veterans, it's more in terms of dealing with the conditions they currently are in and to assist them. In any of those cases, have we linked specifically the cause of those conditions to the use of mefloquine?

[Dr. Cyd Courchesne]

Again, we don't award for cause. It could be any cause. Again, these veterans served in a special duty area, and all they need is a record of having deployed and a confirmed diagnosis by their treating physician, and that's enough for us to give them a disability award.

[Shaun Chen, Liberal, Scarborough North, ON]

Has there been any litigation—

[The Chair, Liberal, Neil Ellis]

Sorry, you're out of time.

Ms. Wagantall.

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

Thank you.

In theatre there are a lot of dynamics that the average Canadian wouldn't experience when they're taking this drug. At the same time, the monograph says very clearly that, if you are experiencing anxiety, feeling that people are trying to harm you, depression, seeing or hearing hallucinations—hallucinations that come with this drug—feelings of restlessness.... All these things are common already to a military setting.

You're in a state of fight or flight the whole time you're there, from what I understand. Yet, if this drug is being used, it says that you must stop using it at the onset of anxiety.

My question on this one is: Why are we even continuing to consider it? I know you've said that you encourage them to use the other two first, but they still have the freedom to make that other choice. Do you inform them of the permanent disabilities that can happen with the onset of the first dose of this particular drug, even when they've used it in the past? Are they made aware of how seriously this drug can impact them permanently, for the rest of their lives?

[BGen Andrew Downes]

I'd just like to clarify a point, and that is that, when we prescribe it to somebody now, it's either because the other anti-malarials are contraindicated or it's because they have chosen to and have taken it before without having significant symptoms. It has sort of been tested, if you will.

There is disagreement amongst experts about whether one pill can cause long-term adverse health effects. We don't say “and one pill”; we say there is a risk. What we tell patients is what's in the drug monograph.

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

Okay, thank you.

You mentioned the work that's going on among our allies. Is Canada actively involved in any research going on internationally or within Canada in regard to mefloquine?

[BGen Andrew Downes]

The Canadian Forces is not actively involved in research regarding mefloquine. We are engaged in all sorts of mental health research projects that would certainly be of benefit to all patients who may have—

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

Okay, so are you aware that in Australia, as part of that research that came up with a definitive list of 14 conditions that an individual can end up with as a result of using mefloquine, they had an entire year where any member of their armed forces or veterans had the opportunity to come forward, as they did to our committee, and testify to what they experienced or felt that they experienced in relation to this drug? I assume that's part of it. The more people you have who can have that conversation, the more you're going to come up with some clearer identifiers. With that testimony, they immediately put into place 24-7 psychological care available to those veterans at any time due to the trauma that they experienced in having to present this testimony.

Does that not say to you that we, as Canadians, in regard to our own veterans, should be taking an active role to determine for ourselves exactly what this drug has done historically to our veterans who are suffering and continue to suffer today the results of having used this drug in a circumstance where they were ordered to take it?

[BGen Andrew Downes]

I'm not aware of the information that you provided from Australia. I've never read in any report anything about 14 conditions being diagnosed down there.

I don't know, Colonel Jetly, if you've heard of that, but this is—

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

Gentlemen, you just told me you're totally aware of what is going on internationally, and this was announced weeks ago, the end of their study and what they had determined from it. Can we get a copy of that? It's from the Australian veterans affairs.

[BGen Andrew Downes]

We'd certainly be very interested to see that.

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

Okay. I bet you could google it.

[The Chair, Liberal, Neil Ellis]

Ms. Blaney.

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

Thank you again for this. It's been a very interesting discussion.

I heard loud and clear that, after January 2018, only three people have taken it. At this point you only take it if you've taken it in the past. When somebody who is currently serving or who is now a veteran believes that they may have had a physical reaction to mefloquine, what happens next? What is the process for them to come forward, and how does that work? Is it different? I want to know if it's different for people who are still serving and people who are now veterans.

[BGen Andrew Downes]

The process is a little bit different for veterans versus serving members because the Canadian Forces runs its own health system, whereas veterans get their care through the civilian health system.