I'll speak to and read the first motion. It is:
That the committee invite the acting minister of Veterans Affairs to appear on the Supplementary Estimates (B) on February 25 or 27, 2019.
This is the 25th, so obviously, we know that our agenda today does not include the coming in as a witness to discuss the estimates, which is the financial appropriations for Veterans Affairs for those of you who are listening in. They amount to $323 million in the supplementary estimates that are requested by Veterans Affairs Canada. This money would be spent on veterans' benefits and they need the scrutiny of this committee, and through this committee to the floor of the House, before they are read into the record as having been deemed approved, which would be this Friday.
I mentioned that this was urgent, when we brought it up during the last committee meeting and asked for the committee to pass what's called a unanimous consent motion for us to be able to table this then, to be able to speak to it and then invite the minister. That did not happen. We were in open session, so it wasn't a closed-door meeting. It wasn't an in camera meeting, but the Liberal members, who have the majority on this committee, all voted in favour of not moving forward with unanimous consent. In fact, that was a barrier to this committee dealing with the spending of government on veterans, essentially saying, “No, we don't need to scrutinize and we don't need to call the chief minister for veterans affairs”.
I might back up a bit first, because I really should give the chronology, so that everyone has the right context here.
When the previous minister, , was in her position, after having been changed from the Attorney General's role to the role of veterans affairs, which was a much discussed issue today on the floor of the House of Commons because many considered it a demotion, with most in the media wondering why she would be demoted. It's been thoroughly talked about publicly that she was removed from her position as Attorney General because of the SNC-Lavalin affair, which was totally relevant today on the floor of the House of Commons.
However, the defence of the government has been to just put up the and say today, on multiple occasions, that this government does not interfere or put up barriers to the work of committees. However, last week, we had the barrier to the convention that we would hear from the minister, whoever that might be at the time, on the appropriations and spending of government. Now they will not be able to come to committee on a timetable that will meet the requirement for this committee to have scrutiny and have input. We were turned down.
We were told, sanctimoniously I might say, over and over again, that somehow the government was going to do business differently, especially business at committee, and not be obstructionist to opposition members when we wanted to follow the conventions of the committee, yet they did that in our last committee meeting. They basically stopped the committee from moving forward with an invitation to the minister to come and be asked questions about the spending of government for veterans. That's what happened. Those are the facts.
Then today, we get this unbelievable repeated line that somehow it's the opposition who are the ones who are responsible for the dysfunction of committee work. The dysfunction occurs when government members, who have the majority, decide to take the route that this committee took. As I shouted across to the minister, she should come to veterans affairs and watch the committee and watch what they did last week.
The issue, going back, is the fact that we had a new minister put into this position, . In January, she took over as minister. In fact, I remember, on social media, watching her transition into the role. She was meeting with veterans within her community, but she also was meeting with the members inside Veterans Affairs Canada and the bureaucracy in Charlottetown.
Frankly, as I said to her personally, both in writing and in person, I was so looking forward to working with her because she is a person of incredible integrity and incredible background, with huge qualifications to take on this role. I was very much looking forward to her and she was very receptive to working....
In fact, I took to her an issue that I considered to be a very non-partisan issue. It was an issue that was brought to me over the holidays by a veteran who wanted to be sure that every World War II veteran who served in the liberation of the Netherlands—and in those days, during World War II, it was Holland—had received the medal that the Netherlands came out with to specifically honour Canadian veterans. His father-in-law, who had recently passed away, had not received the medal. When this veteran found that out, he wanted to make it his project to find out who had received it, which families had and which families had not. He wanted to make sure that every family, whether it was going to the family of a deceased veteran or whether the veteran was still living—and by the way, there are very few of them still living—properly got the medal of the serving veteran.
I thought that this is a great way to start what I would almost call an icebreaker, something for me to suggest to the minister. I went to and said to her, “Here is the situation. Would you like to work on it together so that we can advance this in a very non-partisan way?” She told me verbally, as we met, that, yes, she'd be very interested. I was very much looking forward to that and, in fact, expressed my regrets, as well, because we know what happened.
The story goes on that decided that she was going to resign from her post as veterans affairs minister the day that the tried to vindicate himself on the SNC-Lavalin case by saying that her presence in cabinet speaks volumes and tells the story, really. Then, hours later, she resigned.
With regard to that resignation, we know that she had the best interests of veterans at heart, and the reason for her resignation wasn't about veterans. In fact, she said some very gracious things during the short period of time that she was the minister. In fact, that's when she visited because she had promised—even after she was removed from her position.
I'm making it relevant by giving context to the fact that had said she would be at this committee for scrutiny of the estimates, and she said she would be here on Wednesday of this week, when she was minister. She said that.
An hon. member: To whom?
Mr. Phil McColeman: It was in our schedule that she was going to be here. In fact, the minister had been invited to come to this committee.
That invitation, by the way, Mr. Samson, was declined on the same day The Globe and Mail first reported on the allegation of criminal activity by the Prime Minister's Office, before she resigned. Before she resigned, she declined the invitation on that day. Previous to that, she was scheduled to come.
What we're asking in the motion, and what we had asked for unanimous consent from your side was.... We understand the sequence of events. That's what I'm outlining to the committee. We understand what they were. We would like the .... By the way, the $323 million of spending and appropriations to veterans is the single-largest expenditure in the supplementary estimates. There's no larger expenditure asked for in the supplementary estimates.
However, this committee put its foot down at the last meeting saying, “No, we won't approve the discussion of the motion to get the interim minister here.” We've gone through the procedural way, or the procedural wrangling, because we thought the committee would act in a non-partisan way and say yes. That's been the usual course of action.”
was planning on coming until she declined on the day of The Globe and Mail story, yet we have to come here today with only one day left of committee time—unless the committee wants to choose to hold more meetings this week—with one regular meeting left, without any action or approval from the government side to say, “Yes, we will extend this to the minister and we will make every physical attempt, every attempt we can, to get him here to answer our questions.”
What this tells us in a way, and leads us to, which is part of my second motion—and I'm still speaking to the first motion, Chair—is that if the minister is not prepared to come and discuss the largest spending item in supplementary estimates (B) by the government in a timely fashion to meet the requirements and convention of the House, then really that calls for the appointment of a permanent minister instead of an interim minister. This is what we address in our second motion, when we get to that point in our deliberations here today.
Let me tell you about the kinds of things that are in supplementary estimates (B) that should be scrutinized. These are the very benefits that our veterans rely on, and in some cases, as the PBO has accurately set out for us last week—the PBO, being the Parliamentary Budget Officer, an independent person doing a study—supplementary estimates (B) includes allocations for what the government calls pension for life, and its fulfilment of that promise to veterans.
Let me tell you what the government promised veterans. It promised veterans they would get the equivalent of the pre-2006 new veterans charter pension plan. It was called the veterans pension act. It's relevant, Mr. Chair, because what the PBO reported on last week, as we found out, was that there are veterans, in fact the most seriously injured veterans, who will not receive the amount of money they were getting under the new veterans charter, let alone what they would have received under the Pension Act.
In fact, over the life of their benefits, the average amount that they will not receive from the pension for life is $300,000. There have been several veterans' advocates, one of the most fervent ones being Sean Bruyea, who, by the way, has gone out publicly to say that the pension for life scheme that this government proposes for veterans and will be implemented through the supplementary estimates never did meet the standard of what the Pension Act had provided. It is breaking the promise that this government made to veterans when they campaigned in the last election and said that this is what they would do should they form government.
They failed on that, because when you do the analysis, as the PBO has put forth, it absolutely does not meet that. In fact, in one category, the most seriously injured and multiply disabled veterans, it does not meet the new pension benefits that they were getting. Do you think that we would have questions of the as to how the money is to be allocated and spent after we've found out the new and current relevant information that was provided last week by the Parliamentary Budget Officer? You bet your bottom dollar we will. We would ask him tough questions if he were to come.
I highly suspect today that we will face—if this ultimately comes to a vote—the same barriers and the same open committee acceptance of what we should do to be closed.... By whom? By the majority of the Liberal members on this, because that's what we've been experiencing to this point, so why should it change? I keep rolling over in my mind why it is that the minister would not come and want to be asked about the supplementary estimates. Perhaps he doesn't want to come because he's the interim minister. He already has a portfolio and he has added this to his portfolio. Maybe he thinks he's a part-time , which he may well be.
As the government and the neutral chair decide on what they can do procedurally as they meet on the Liberal side of the room, it appears that again in committee the whole line that we've been given by the government today in the House of Commons, by the , is a total sham. It's totally outright misleading to say that we would have in some ways been able to bring this here to talk about supplementary estimates (B) before this committee on Wednesday.
I know what they're saying. They're asking, “How can we we shut this guy down?” They're saying, “He's just going to continue to talk for the whole committee meeting.” I may well do that, but I'm telling you, this is of the utmost importance, because on this side of the table we have very few tools in our tool box to use when it comes to emphasizing the point of what we think is right for veterans. What we think is right for veterans is that we scrutinize every dollar that goes into Veterans Affairs for one simple reason: to get the best value ending up in the hands of our veterans and to stop the over-administration and the overload of bureaucracy that exists in the system. We know it exists. We've had the people here and have talked to them previously.
I keep hearing from veterans about the type of the money that is spent. Of course, the government continues to use a number and say, “Oh, we've spent $10 million.” It doesn't matter to them. It doesn't matter.
What matters are the principles of what runs this, the principles of fairness and of making sure that there is the proper appropriation going to the various programs. We don't know whether there is or isn't until we ask questions of the minister and he, by the way, brings along his top management people from the ministry, from the Veterans Affairs Canada office, so that we're able to ask them questions as well—and that's typically when the minister comes.
We've been denied this so far. Maybe that will change today. Maybe the will come on Wednesday so that we can ask the right questions. I truly hope that is the case.
The former veterans affairs minister and the person she replaced when she was demoted because of the SNC-Lavalin situation.... came. He came on a timely basis. He took our questions and we appreciated it.
I have no idea why there was resistance put up by the government at our last meeting. This was a motion that was so non-threatening, yet we're told today that this government has the utmost respect for doing the conventions of their committee work in the highest level and highest regard. We heard that over and over again today. It's enough to make someone sick, to hear it as many times as we heard it over and over again.
We know what that's about. That's about the justification for continuing to cover up the real truth of what happened with the SNC-Lavalin affair, the scandal that they find themselves in and the chaos that this government continues to find. Why? Because the previous minister of veterans affairs, , had the best intentions to be a great minister. I think she could have been a great Minister of Veterans Affairs. I truly do. You can see the integrity with which she handles herself. You can see it through the principled approach that she has taken in making sure—to quote her—that she speaks “truth to power”, as she wrote as she departed the justice department. She has had to endure through this period of time. You can tell that's the kind of person who would have been a great minister had she decided that she couldn't speak her truth without taking the actions that she's taken so far. I've said enough about that.
We have an acting minister. We're told by that in Parliament last week, by the way, that the Parliamentary Budget Officer is wrong about the fact that the most injured veterans will receive less under the new pension for life scheme.
Perhaps it shouldn't have been shocking. As I looked across at him and said that's not true, he insisted that it was true. Then the next day—on Friday during question period—he doubled down and said they will receive more. When the is here, it's part of the estimates to show us the numbers that he sees that the Parliamentary Budget Officer got totally wrong. We went back to the budget officer. He's an officer of the House who is completely neutral. We went back to the neutral report and asked if there was something we missed. Is there something he knows that we don't know? Is there something that the people in his ministry can explain to us to say why he would say such a thing to the members of the House when it wasn't true?
When we went back and drilled down and looked at every chart and calculation with all the information that was provided by Veterans Affairs Canada to the Parliamentary Budget Officer, we found the numbers to be the ones that Veterans Affairs Canada had given him. His own senior management had approved those numbers going to the Parliamentary Budget Officer, with which he made his determination that the most seriously injured veterans will receive about $300,000 less under this new pension for life scheme that this government has brought—a clear broken promise for all veterans, but in particular for the ones who need it the most.
I talked about the $323 million in the supplementary estimates that we want the minister to come and examine. I want these other questions answered by his senior management people. I want them to tell us, one way or another, if the minister's correct or the Parliamentary Budget Officer is correct. I would suggest we bring in the Parliamentary Budget Officer as well, at a time when we can query him on his report. His report was broad-ranging. It went through three different regimes. It analyzed each one and compared each one from the time the previous government was in power, previous to 2015, to today. He looked at the cross-section of pretty much everything that's been offered to veterans on the pension issue and on all spending over those periods of time.
I would definitely ask each member to look at that report in detail—in great detail. Spend time looking at that report. This is done by an independent person who's appointed by the House of Commons to make sure that the person is as independent as they possibly can be. It then gives them the latitude to be able to interpret the numbers.
I can remember that when I was on the scrutiny of public spending committee, we were always calling in the Auditor General. The Auditor General would come in and explain how he came up with his numbers when he did Auditor General reports on various parts and operations of government. This is the very same situation we have here. We have deep, deep concerns that the appropriations are being spent in the right direction. This is especially true when we hear from his report—it's explicitly stated, too—that the most injured members of our military, the most hurt from their service who now find themselves veterans in the Liberal pension for life scheme, will receive an average of $300,000 less than they would have under the new veterans charter scheme, the one that existed the day before, let alone going back to the Pension Act they promised they would give veterans the equivalent of.
We need answers to these questions from the minister. Preferably, the would find his way to appointing a full-time minister, treating veterans with more respect than he's currently treating them with an interim minister. They need a full-time minister. They need someone of the quality that was bringing to the table until her abrupt resignation over the SNC-Lavalin affair.
Mr. Speaker, I could carry on with why the accountability, openness and transparency that was promised by this government is reflected in the fact that we experience at this committee the barriers to bringing the interim minister here, yet these are the very tenets they told Canadians they would do differently. I will repeat that they continually mislead in the House of Commons when their House leader gets up and says that they have the utmost respect for committees.
This is one of the areas that this committee has failed tremendously on by not respecting the fact that we have had ministers here on supplementary estimates (B). Every time we've had them in front of us. Right now, there is no respect whatsoever from the interim minister that he would come on a timely basis.
I would ask the members opposite that they give deep consideration to the fact that the Parliamentary Budget Officer's report, in a very neutral and non-partisan way, shot nothing but holes in the future spending through the pension for life scheme. There's an amazingly huge hole for those who are the most injured.
I've met with these veterans. Quite a few of them are in wheelchairs. Quite a few of them don't have their legs. Some don't have their arms. Some don't have mental capacity anymore. These are the ones that the Parliamentary Budget Officer is saying are going to be affected. Money's taken away from them that they would have had under the pension scheme as it existed the day before this new scheme goes into effect.
I want to make that distinction and make it very clear that this is talking about spending supplementary estimates. We're talking about future spending that would go to that, which will ignore the fact that these veterans, the Mark Campbells of the world who are sitting in Edmonton, who know what it's like to have a life without limbs, who know what it's like to deal every day with the mental stress of living a completely new life because he was in a vehicle that got blown up. While most of his comrades did not survive, he survived and he asks himself every day, “Why me?”
Because of the Mark Campbells of the world and others who would say, if you had them here, as they've said to me over and over again, that all they want from their government is the level of respect they earned. To show them respect by taking benefits away through future appropriations to Veterans Affairs Canada is something we cannot allow.
You ask why this is urgent. You ask why we are passionate on this side about this issue. It's because we met with those individuals. We've had them here in Ottawa. We've met them in their own homes and examined how they have to live after their service to this country. Although all things are important to veterans and our study is important to veterans, this is way more important right now because what we're going to have happen is to have it go straight through as though we did study it.
The government members on this committee prevented us from moving forward on this last week, so we procedurally brought it back this week so we could speak to it. They shut down our speaking to it last week, by the way, through a motion of one of their members who said he moved the debate be ended, which is a non-debatable motion called a deleterious motion. You can't debate it. That's the way they got around it last week.
Unfortunately, their scheming can't get around the fact that we can talk to it as long as we bloody well want. And we shall talk to it and we shall be heard on this side. This is our parliamentary prerogative, our parliamentary privilege, we're talking about. This is about doing right for veterans. This is not about figuring out how you shut down the other side, which they so effectively did at our last meeting.
As I said, we have very few ways to do this on this side, when there is a majority on the other side. “Don't worry,” the House leader says. “We want to operate differently. We want to be respecting the committees. They're masters of their own destinies.” Give me a break.
When we talk about the people who will be affected by supplementary estimates (B) in the veterans community, I think about those people hurt the deepest. I also think about the other people who are waiting, who have been waiting or who have sued the government.
Sean Bruyea, by the way, is suing the former minister—two ministers ago now. They're in court together. He's having to sue the minister over his benefits, over something the minister said about him that discredited him.
Do you see a pattern in how this government wants to deal with veterans, with the work of this committee and with what they've been doing of late? Do you see a pattern evolving here of our trying to push the relevant issues of today forward, and of the motion, again, to have the Minister of Veterans Affairs talk about this at our next committee meeting?
I want it to be at the next committee meeting. I think the minister should want it to be at the next committee meeting, not the one after they're deemed read in the House of Commons. That's an option and we may look at that option, but today, we still have time. There are 48 hours before the next committee meeting.
I've seen emergency meetings of various committees where the ministers will drop what they're doing and come, because they know the significance. They recognize the importance. This is how Parliament works. This is how the House of Commons works. We are an extension, as a committee, of the House of Commons.
Maybe members don't take this as seriously as they should. What we are, in essence, is a mini House of Commons, in many ways. We are charged with the responsibility of doing our work and of making sure we scrutinize. In the opposition benches, we hold the government to account on the ways they choose to move forward.
In this case, we have a majority government and we all, ultimately, lose. That's why I will continue to talk. I suspect my colleagues will as well because we know, at the end of the day, that when we give up, when we throw in the towel, they will defeat us. They have the majority vote. That's what they did in the last committee meeting. They defeated us. They can defeat us at any moment. They have to choose, going forward, based on the motion in front of us today, whether or not it's as large, as urgent and as important as we think it is on this side of the table.
I think I'll end my comments there, Mr. Chair. Before I do, can I ask, on a point of order, who is on the speaking list and in what order they're speaking?
Thank you very much, Mr. Chair and members of the House.
My name is Philippe Lucas. I'm vice-president of patient research and access for Tilray. I'm also a graduate researcher with the Canadian Institute of Substance Use Research, and I'm vice-chair of the Cannabis Council of Canada, an industry association representing licensed producers in Canada.
I'm speaking to you today as a long-term patient advocate for medical cannabis patients. I've been working in the space for over 20 years, initially as a patient, then as a patient advocate and provider, and over the last five years in my role at Tilray. Tilray is a global pioneer in medical cannabis research and distribution. Our products are available in 13 countries on five continents right now.
Tilray has done much over the years to work with Canadian veterans to improve the lives of those who might benefit from the use of medical cannabis. We currently serve more than 500 veterans registered with Veterans Affairs Canada. We're the title sponsor of the Wounded Warrior Run B.C. and the Highway of Heroes Bike Ride. Ironically while we're speaking here today, the Wounded Warrior Run B.C. is on its second day, and you will see veterans—police, military and first responder veterans—running from the top of Vancouver Island down to Victoria over the next week, through sleet, snow and rain, to raise attention, awareness and funds for vets who might be affected by PTSD.
Tilray has put in place some very VAC-specific services to aid veterans who might benefit from the use of medical cannabis. Those include putting in VAC limits where we charge all veterans $8.50 per gram—a sort of discount cost on the grams of cannabis they order from Tilray—to ensure they have access to the full selection of products that they need. We have also put in place what we call the VAC bridge program, which allows vets to order cannabis before their VAC approval goes through, to ensure that veterans are not out of pocket when they're ordering medical cannabis. On top of that, we have VAC specialists on staff who can work through approvals, denials and reimbursements with those veterans.
We're a leader in medical cannabis research, and that includes doing a phase two clinical trial at the University of British Columbia on medical cannabis as a treatment for post-traumatic stress disorder. At 42 participants, that's the largest medical cannabis clinical trial to take place in Canada in at least the last four years, and the first medical cannabis clinical trial to examine the use of cannabis in the treatment of a mental health condition. Over the next few weeks, we'll be announcing a second site for that trial in British Columbia.
Today I want to share, very quickly, the results of the Canadian cannabis patient survey from 2017 that we ran. That survey at the time was the largest survey of Canadian patients to date, with 2,032 responses. I took this opportunity to break out the responses of patients who identified post-traumatic stress disorder as their primary condition.
What we see from these patients is that medical cannabis is primarily used in the treatment of chronic pain and mental health, but compared with other patients, those affected by post-traumatic stress disorder are more likely to be disabled. They're more likely than the general population to report use for anxiety, stress and depression rather than simply chronic pain. They're more likely to use cannabis daily, and to use more than the average patient—2.1 grams per day versus the 1.5 gram average of other medical cannabis patients. They're more likely to use cannabis extracts.
Also, perhaps most important to this committee in looking at the health and welfare of veterans, they're also more likely to reduce their use of opioids, antidepressants and benzodiazepines as a result of their use of medical cannabis. According to data from Veterans Affairs Canada, the recent significant increase in the number of veterans using medical cannabis is paralleled by a nearly 43% decrease in the number of veterans using benzodiazepines and a 31% decrease in the number of veterans using opioids.
Tilray has put in place VAC-specific services to assist Canadian veterans, and today we're here to urge you to reassure veterans of the government's commitment to covering the cost of medical cannabis for veterans who might benefit from its use. We're urging you to remove the punitive excise tax as well as the sales tax on medical cannabis that's affecting critically and chronically ill Canadians across the nation, and to increase research funding to examine the therapeutic potential of medical cannabis in the treatment of post-traumatic stress disorder, traumatic brain injury, mental health and chronic pain.
I look forward to your questions, and I really appreciate being invited to speak to the committee today.
First of all I want to thank the chair of the committee for giving me the opportunity to speak today. The subject is very close to my heart.
I am a businessman from Halifax, formerly from Fall River, Nova Scotia. I'm a retired RCAF pilot and a former combat arms officer as well. I had a career in the military spanning 35 years. Since then, I've also worked as a first responder in both search and rescue and firefighting.
Over the course of my military career I saw first-hand the mental and physical implications suffered by comrades from PTSD and chronic pain, so this is first-hand.
The bonds we forge in the military continue long after the uniform comes off, and as such, a business venture I became involved in as a co-founder is a company called GenCanBio. GenCanBio is a Nova Scotia company. We're dedicated to pre-clinical research on the interaction of various cannabinoids and terpenes and the efficacy of these ratios on specific conditions.
GenCanBio has been working on and investing in cannabis-related research into PTSD since 2015. Working with the National Research Council of Canada we've developed a high throughput assay to screen these cannabinoid ratios for conditions such as pain and anxiety. GenCanBio has since partnered with an Ontario-based pharmaceutical company called Ethicann for the development of ethical-based drugs based on botanical extracted cannabinoid oils for symptomatologies including PTSD.
Currently, veterans can purchase various forms of cannabis, but the batch-to-batch purity and potency lack the consistency of an approved pharmaceutical. None of my former comrades wants to get high; they want to get better and they want to be productive. GenCanBio and Ethicann believe strongly that smoked medical marijuana will no longer exist shortly. It will be replaced by a standardized, botanically sourced drug that has been subjected to the regulatory scrutiny of Health Canada, the FDA and other regulatory agencies.
Ethicann is currently working with the U.S. Army to develop a clinical protocol for PTSD. We've reached out to Dr. Cyd Courchesne, chief medical officer of Veterans Affairs. We met with her in early December 2018 to discuss PTSD in Canadian veterans and the need for a well-characterized cannabinoid pharmaceutical to treat them.
Dr. Courchesne facilitated for us the outreach to several Canadian PTSD researchers, including the Canadian Institute of Military and Veteran Health Research and the centre of excellence on PTSD and other related mental health conditions.
In January 2019, we met with Dr. Alice Aiken, who is the VP of research and innovation, and Sherry Stewart, professor of physiology and neuroscience at Dalhousie University in Halifax, both of whom are very excited to work with us on a clinical protocol for PTSD in conjunction with the U.S. and hopefully the Canadian militaries.
We are thus currently working with several Canadian licensed producers and extractors to develop pharmaceutical-grade APIs—an API is an active pharmaceutical ingredient—that can be formulated for clinical studies on veterans with clinically diagnosed PTSD symptoms. Having the support of Veterans Affairs to offset the cost and timelines of these efforts will greatly benefit Canadian veterans.
In closing, I wish to thank the chair and members of the committee for allowing us to express our views today. We believe and have seen that medical cannabis imparts great quality-of-life benefits to our wounded men and women, but I respectfully submit that there's an alternative and better delivery system for this, one that is more effective, more predictable and more cost-efficient. Working together, this is something we can make happen.
As such, I've included in my speaking notes—I'm not sure whether you received these—letters from the presidents of GenCanBio and Ethicann, with requests to continue this dialogue.
Mr. Chairman, good afternoon honourable members of the Standing Committee on Veterans Affairs addressing the issue of cannabis use among veterans and its effect on their well-being.
My name is Dr. Ramesh Zacharias. I am an assistant clinical professor in the department of anaesthesia at McMaster University. I'm also the medical director of the Michael G. DeGroote Pain Clinic. I'm also the co-chair of the physician advisory group for the centre for medicinal cannabis research at McMaster University.
It is truly my honour to address the issue of medicinal cannabis use by veterans and the impact on their well-being.
I'm going to frame my presentation around identifying three of the current challenges and propose three opportunities to ensure the safe and effective prescribing of cannabis.
The first challenge is what I call “the cart before the horse”. Since cannabis was legalized on October 17, 2018, the availability of cannabis for medical purposes was instituted prior to our understanding of the efficacy and safety in a variety of conditions. As a consequence, the medical claims are either overly positive or negative. On the one hand, cannabis is being viewed as a panacea with a cure-all for many medical ailments and at the same time, there are those who see legalization as a Pandora's box, the use of which predisposes the public to unknown harms.
I have been involved in prescribing cannabis for over 10 years. I am of the opinion that with the appropriate patient selection, the use of validated screening tools and informed prescribing, cannabis will be a benefit in a number of conditions.
Although anecdotal evidence has highlighted the potential beneficial role of cannabis for symptom management, such as pain, sleep, nightmares, anxiety and PTSD, the research community is far from having a complete understanding of the mechanisms of cannabis use for common health problems faced by Canadian veterans.
Second, in addition to my work at McMaster University and Hamilton Health Sciences, I have been an investigating coroner in the province of Ontario since 2012. Over that time period, I have either been the investigating coroner or the regional supervising coroner investigating over 1,000 cases. Sadly, a number of those were opioid-related deaths.
The majority of education that was provided to physicians with respect to the prescribing of opioids was provided by the pharmaceutical industry, and unfortunately today, the majority of education for health professionals completing medical documentation is once again being provided by the licensed producers.
The third challenge is the way cannabis is currently being prescribed in Canada. My practice involves looking after veterans. Unfortunately, a number of our veterans have received their medical documentation over Skype without actually being seen by a health practitioner in the office. Once the medical documentation was completed and submitted, they were then scheduled for a follow-up appointment in one year. I find it hard to believe that we as a society would support a process for prescribing any treatment for chronic disease over Skype, with a subsequent monitoring one year later.
Having laid out the challenges that we currently face in Canada, I would like to propose three solutions. I do believe we have a great opportunity to make changes in the way cannabis is currently being prescribed.
In order to address this issue, one year ago we established a data registry called DataCann. The purpose of it was to gather real-time prospective information on patients using medicinal cannabis. We collect information on their diagnosis for which they have been prescribed medicinal cannabis, but equally important, we use validated tools to assess overall functions: sleep, anxiety, depression, PTSD, as well as the early identification of those who could possibly develop cannabis use disorder.
I believe we have a great opportunity to monitor the effectiveness and safety of cannabis among veterans by having them enrolled in this registry voluntarily. This registry has been funded by the Michael G. DeGroote Pain Clinic, the national institute for pain, at McMaster University and the Centre for Medicinal Cannabis Research. We have received no funding from industry.
The second opportunity we have, if we want to learn from some of the mistakes of the opioid crisis, is that we need to develop Canadian guidelines for the prescribing of cannabis. The first Canadian opioid guidelines were developed 15 years after OxyContin was released. It is extremely important that we create evidence-based guidelines for all health practitioners who are prescribing cannabis. I think it would be important for this committee to encourage CIHR to fund the guideline development.
Finally, the federal government can play a significant role by supporting data collection today, as well as funding much-needed research. We have the infrastructure and a network of outstanding researchers in this country that, when funded appropriately, can give Canada a leading role in informing the dialogue about appropriate use of medical cannabis.
Once again, I would like to thank the chair and this committee for the honour you have given me in presenting to you today on this important topic.