Article by Aaron Beswick, Journal Pioneer
The Department of Veterans Affairs spent $77,794,212.57 last year on marijuana.
That is more than the department spent ($66.2 million) on the 12,000 other drugs approved to be prescribed for veterans.
The Chronicle Herald began an examination of the marijuana industry and government oversight because of revelations in the Desmond Fatality Inquiry.
We dug through corporate filings, lawsuits between companies, government reviews of its ballooning spending on marijuana and research into its effectiveness.
The trauma and physical ailments of those who have served Canada are a big opportunity for big weed. We found companies have established themselves as grower, prescriber and counsellor – all at the same time.
We found a system in which veterans are regularly prescribed marijuana at triple Health Canada’s recommended maximum daily dose.
And we found a government whose attempts to reign in the industry after a damning 2015 auditor general’s report have largely failed.
“In 2014, you know, I was at a place where there were several suicides that year, a few of the guys I knew quite well, and my question simply was, you know, what are we doing for the guys?” Dr. Paul Smith said to a Crown attorney at the Desmond Fatality Inquiry in the Guysborough Municipal Building in February.
“And the answer from the vets was simply if the pills didn’t work, they were, basically, on their own.”
In an ill-fitting suit jacket, Smith described himself as a “family doc.”
He was there because in July 2015, Lionel Desmond walked into his office near CFB Gagetown in New Brunswick. The young man was a month out of the military and had been diagnosed with post-traumatic stress disorder and major depressive disorder. He had a history of concussions.
Desmond had financial and marital difficulties and described a childhood with physical and verbal abuse.
He had served on the front lines in Afghanistan during the height of the war in 2007 and was haunted by nightmares of what he saw there.
“When I hear ’07, I purposely don’t ask too much because I know what went on and it was pretty nasty,” Smith said.
Desmond’s chart was not out of the ordinary in practices like Smith’s, where the home front’s ill-equipped medical system struggled with the Afghan war’s emotional and physical wreckage.
Like the psychiatrists, psychologists and emergency room physicians Desmond would meet before killing his wife, mother and daughter before committing suicide on Jan.3, 2017, Smith found him to be easygoing and pleasant.
Smith had a similar answer to questions asked of all the other mental health professionals who appeared on the stand when asked whether he felt the young man from Upper Big Tracadie was hiding anything.
“Obviously I’ve asked that question many times since then but I can’t remember him presenting that way. It was always so easy to flow, he answered questions very quickly, he talked about his emotions and feelings very easily and he wore his heart on his sleeve sort of thing,” said Smith.
Desmond walked out of Smith’s office with a prescription for 10 grams of medical marijuana per day.
Asked by the Crown attorney whether considering a complex history that included head injuries, Desmond should have been referred for a concussion evaluation before being prescribed medical marijuana, Smith said that would have taken a year-and-a-half to two years.
“(A concussion evaluation) would probably not be approved for benefits that are paid by (Department of Veterans Affairs),” testified Smith.
“It could be six or seven thousand bucks to do that evaluation. So, unless there’s reasonable grounds for a claim, DVA will say, ‘We’re not paying for it.’”
But Veterans Affairs would pay for doses of medical marijuana over triple the maximum recommended by Health Canada (three grams per day).
That recommendation is echoed by the Canadian College of Physicians and Surgeons.
“We expect that the upper level to the safe use of dried cannabis will be on the order of 3.0 g per day, and that even this level of use should be considered only in very circumscribed conditions,” reads the college’s guidelines to doctors on the prescription of medical marijuana.
“This dosing level would apply to experienced users of dried cannabis only, never to cannabis-naïve patients. It must only be arrived at through a careful process of assessing the patient’s response as dosage is slowly increased, weighing analgesic benefit, improvement in function, and presence or absence of adverse effects.”
However, Veterans Affairs data shows that 30 per cent of the approximately 1,600 veterans with a medical marijuana prescription in 2015 were purchasing and being reimbursed for 10 grams a day.
“In September 2013, Health Canada recommended that those who have a serious mental health condition such as schizophrenia, psychosis, depression, or bipolar disorder not utilize marijuana for medical purposes,” reads a 2015 auditor general’s report into the Veteran Affairs’ drug program.
In 2014, 46 per cent of the then-600 veterans using medical marijuana were also taking antidepressants.
The auditor general blasted Veterans Affairs for not monitoring concurrent conditions among those prescribed medical marijuana, for reimbursing for dosages triple Health Canada’s guidelines and for not putting in place price controls on what it pays suppliers.
Veterans Affairs agreed with all the auditor general’s recommendations.
It limited the amount it would reimburse for medical marijuana to $8.50 per gram.
The department restricted dosage to three grams per day. For a veteran to be reimbursed for more, they would need a letter from a medical practitioner explaining why and what other treatments had been tried, and potentially a letter of support from either a psychiatrist or chronic pain specialist.
Yet, last year, the number of veterans receiving over three grams a day had ballooned to 2,186.
The auditor general warned in its 2015 report that medical marijuana spending was projected to reach $25 million in 2016.
In 2019, Veterans Affairs spent nearly $78 million on 10,152,284 grams of marijuana for 13,270 veterans.
What’s in pot
When Fabian Henry lists off the drugs that doctors put him on for post-traumatic stress disorder, it sounds like Johnny Cash listing off the places he had been.
“So I was on Clonazepam, Effexor, Bopropion, Seroquel, Abilify, Trazodone and multiple other ones, Viagra, because you know a lot of things didn’t work because of all the pills I was on,” Henry told The Chronicle Herald in a recent interview.
“As a Canadian Armed Forces sergeant, combat engineer, who did six tours for Canada, I did everything they asked me to do, including taking nine pills a day for three years of my life and losing everything.”
What did work for Henry was smoking marijuana.
He is now off the other drugs.
Henry is the co-founder of Marijuana for Trauma and of Breton Cannafarms, a medical marijuana producer setting up shop in Port Hawkesbury.
Despite a growing chorus of veterans and first responders suffering from post-traumatic stress disorder who claim marijuana has been the only effective treatment for their condition, Health Canada does not recognize it as a therapeutic drug.
“While pointing to some potential therapeutic benefits, the scientific evidence does not establish the safety and efficacy of cannabis, to the extent required by the Food and Drug Regulations for marketed drugs in Canada,” reads a 2016 fact sheet on dosing medical marijuana by the agency.
That fact sheet advises the “low and slow” approach to dosages and that the total THC content be kept to a minimum.
Henry agrees that dosages should be started low and ramped up slowly but adds the following for context.
“Is 10 grams a lot of pot, a lot of medicine? Yes, it is. So is nine pills and 12 pills a day. That’s a lot of medicine too,” said Henry.
“When you understand now that people have had time to explore cannabis, someone who has pain issues, they don’t need to be high. That 10 grams a day could be 10 grams of CBD oil for some elderly veteran who is not getting high but is out dancing and golfing like he never has before. You’d be OK with that, but if a veteran with PTSD is suicidal, who has sleep issues, pain issues, nightmares and he needs a sublingual spray, he needs to vape some product, he needs CBD for his pain, he needs oral Indica for sleep. That quickly adds up. Then he has a bad day and has to burn through a bit more.”
A gram of marijuana is a lot of things.
Different strains have different combinations of up to 140 compounds.
While some of the minor ones like turpenes and flavonoids have been associated by doctors with assisting with depression and anxiety, the primary active compounds are THC and CBD.
“(CBD) makes you comfortable right here and right now, you don’t really care about the past or the future, so you can forget about your past traumas very effectively, if done at a reasonable dose,” explained Smith.
“So, it makes people able to get on with their day without being intruded with all the memories from the past, you know, such as PTSD, as well as control pain at the same time.”
CBD also does not get you high. It is relaxing, relieves pain and is widely used on its own via a capsule that is swallowed.
THC is the more psychoactive component.
In small doses, Smith, the New Brunswick doctor, testified he has found it to have a contributing therapeutic effect for those suffering from PTSD.
“It’s extremely small,” said Smith of the therapeutic dose for THC.
“The instability of THC comes from too much, too fast or doses that are too high, which can cause anger, agitation, anxiety, paranoia, and schizophrenia and bipolar in those specific rare … more rare groups but those things are THC excess symptoms.”
Just like any other drug, many of which are approved for therapeutic use by Health Canada, THC has side effects.
Desmond would later tell Dr. Ian Slayter, a psychiatrist he visited in Antigonish, that he stopped smoking marijuana because it caused him to have nightmares that his wife was cheating on him.
Dr. Faisal Rahman, head of psychiatry for the Nova Scotia Health Authority’s eastern zone, told the Desmond inquiry that emergency rooms have seen an increase in marijuana-induced psychosis since the legalization of its recreational use in 2018.
He also warned that marijuana should never be prescribed in conjunction with other pharmaceutical drugs.
To address the shortage of research into the effectiveness of medical marijuana, Smith ran a retrospective chart review study under the supervision of his provincial college of physicians and surgeons.
The study, Medical cannabis use in military and police veterans diagnosed with post-traumatic stress disorder, was sponsored by MedReleaf Corporation, which was paid $39 million for medical marijuana by Veterans Affairs last year.
“They knew that we were using their products and I think they thought that was a good way for advertising and so on,” testified Smith of the sponsorship.