Veterans Affairs Committee on Nov. 20th, 2018

[Dr. Cyd Courchesne]

We will note that, and I will get that information for you.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

It would be much appreciated if we could have that breakdown so that we can see that information. I like to take a null-hypothesis approach to this, and prove one thing wrong in order to prove the theory.

Thank you.

We know that with the epidemiology and acute risk involved with marijuana alone, such as motor impairment, induced delirium, psychoses and adverse effects on cognition, as well as a chronic risk that can result in use disorders, 68% tend to be lifetime and 1.3% are annual. This is from research I've done. There are only roughly 20 papers I can see out there that support that, using roughly 1,800 patients. The research that I'm aware of is scant.

Do you have any research that would be of value to this committee? If so, can you provide that for us?

[Dr. Cyd Courchesne]

If I understand your question, you want to know how many of our veterans have substance-use disorder related—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

No. What I'm looking for actually is more from the research point of view. The reality is, as I pointed out, yes, there are risks involved, and I've been trying to find those risks. I can't find anything more. I'm trying to find out if you have more information to justify whether a dose should be three grams versus 10 grams, etc.

[Dr. Cyd Courchesne]

There's not much research. There is a lot of research on the harmful effects of using cannabis. There has not been much research done on whether cannabis is useful for any medical condition. Part of this was because it was difficult to do clinical research when you were dealing with an illegal substance. To design clinical research, and to do long-term research like this.... Again, this was not a product that was developed to treat medical conditions. This is a product that people use for all sorts of reasons.

The research is scant.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you. I get it. How can you do a proper study, a research study? If I were on a review board a year ago and you brought me a research paper which said that you wanted to study marijuana, I would have said to you that it's illegal, and there's no way we can do that. I understand. How can you do research on that? However, to make decisions without research, to me, is not acceptable.

We seem to be doing that, especially with some of the chronic conditions that you see with it, such as chronic bronchitis, psychosis disorders, self-harm and suicidal tendencies. We're talking about trying to bring veterans off that edge from that suicidal point. With that said, hopefully we will see some answers come from this study.

[The Chair, Liberal, Neil Ellis]

You have 30 seconds.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I have 30 seconds. Okay.

[Dr. Alexandra Heber, Chief of Psychiatry, Health Professionals Division, Department of Veterans Affairs]

By the way, I have some research papers that I can leave.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Very quickly then, when a veteran no longer gets a prescription but gets authorization for it, does that veteran have to renew that monthly, six months or yearly, or is it ever done?

[Dr. Cyd Courchesne]

Authorizations from Health Canada are good for one year. Health Canada has the framework for how often they can get it. They require an authorization, and it's good for a year, with a licensed producer.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Bratina.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Thank you very much.

Another way of asking a similar question is: What is the state of research on the cannabis drug? What do we know for sure about what it is and how it works?

[Dr. Alexandra Heber]

Let me answer that. As Dr. Courchesne said, because of the war on drugs, principally in the U.S., for a very long time it was very hard to get funding to do research. However, there is research available. As she also said, most of it shows the harms associated with cannabis use.

There is actually very little good research showing any positive health effects for the use of cannabis, even though you will see in the popular press that people who tend to use cannabis will talk about how profoundly it has helped them. In fact, the research that is out there, including both reviews and reviews of the research out there on health effects, show overwhelmingly that there are negative effects, certainly on mental health and on physical health as well.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

How would you suggest we're actually going to figure this out in the next few years? All we really hear is anecdotal evidence. How would researchers separate the anecdotal things we all hear about from what is real?

[Dr. Alexandra Heber]

Certainly that's one of the big questions. It's something we've been discussing and trying to look at.

Right now we're putting together some proposals with our research division to look at our own population that is already using cannabis or those who will start using cannabis to perhaps do some kind of a case comparison, at least of matched veterans who are not using cannabis, so that we can look over time and see how these people are actually doing.

One of the concerns in conditions like post-traumatic stress disorder, of course, is that one of the major symptoms that is very hard to treat is the avoidance symptom. One of my concerns is that what veterans and others using cannabis for PTSD are doing is that it becomes a way of avoiding. It is much like when I was in the military and many of my military patients would drink a lot before they came in to see me. One of the first things we needed to do was help them to stop drinking. Again, understandably, they were drinking to mask their really terrible PTSD symptoms. Personally, it's one of the concerns I have.

Again, we don't know. We need good research to be exploring all of these questions.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

How is the information that you have collected, in terms of the anecdotal stuff that we're hearing about? Do you have protocols for talking to veterans?

[Dr. Alexandra Heber]

Right now—

[Dr. Cyd Courchesne]

When we revised the policy we held workshops and we asked them directly. We use our national stakeholder summit to have breakout sessions and we consulted widely.

The minister also has advisory committees, which is another avenue for veterans to provide feedback. We continue to have summits where veterans are more than happy to provide us with feedback.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Is Veterans Affairs Canada capable of undertaking the research that's required? There are certainly lots of other people who must be considering this. Is there any co-operation among groups?

[Dr. Cyd Courchesne]

With the legalization of cannabis in Canada there has been more interest in conducting research—the Canadian Institutes of Health Research and the Canadian Institute for Military and Veteran Health Research. All of these organizations are working together and, of course, they know that we have a population of interest, as well as the military. We're part of big consortiums of people with common interests to look at this. We're not alone because it would be impossible for the department to undertake large studies on their own. We rely a lot on CIMVHR especially, which has access to over 46 universities and organizations to do this.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Is there any data showing up yet that with legalization other veterans will decide to use the product to see if it helps them? Are you seeing anything like that?

[Dr. Cyd Courchesne]

It's really too early.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Okay, thanks.

[The Chair, Liberal, Neil Ellis]

Mr. Johns.