John never tried marijuana as a young man, but at 46 the Canadian military veteran says he turned to medicinal cannabis for his chronic pain and post-traumatic stress disorder.

“It’s been fantastic,” he said, noting that since starting medicinal cannabis in the spring he’s been able to cut his prescription pain medication in half and can finally sleep at night.

John, who asked his last name not be used over concerns about travelling to the United States, said he had always wanted to be a police officer. He joined the reserves at 17 and had a 20-year career, largely as a military police officer.

That work would take him to Bosnia and expose him to unforgettable suffering that he’s still not ready to talk about. He’s had four knee surgeries for torn meniscus in both knees. Unable to work, veteran friends told him about their experience with medicinal cannabis.

But he was reluctant.

“I was a police officer … I went from arresting people with drugs to using medical marijuana,” he said. That reluctance lasted a year before he would try cannabis.

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Canadian veterans, like John, are among the highest users of medical cannabis, with Veterans Affairs currently reimbursing more than 8,000 people for daily cannabis consumption.

“Veterans are in a crucible of risk factors,” says James MacKillop, a professor of psychiatry and neuroscience at McMaster University.

“Their service can lead to pain … trauma … other risk factors around substance use disorders and other psychiatric conditions.”

MacKillop and Jason Busse, an associate professor of anesthesiology at McMaster, are the co-directors of the Michael G. DeGroote Centre for Medicinal Cannabis Research. They are the co-authors of an editorial published in the Journal of Military, Veteran and Family Health calling for research on cannabis use among Canadian veterans to be prioritized.

A recent survey cited in the editorial found 41 per cent of Canadian veterans reported constant chronic pain and rates of PTSD range from 7.5 to 13 per cent — more than tenfold higher than the general population.

“There is an urgent need for a comprehensive research program on cannabis use, both medicinal and nonmedicinal, in veterans,” they write.

So pressing is the need that the medical cannabis centre is making veterans a partial focus of its second annual scientific conference on April 12 and 13, 2019.

There simply hasn’t been enough studies done into medical cannabis, something the Centre for Medicinal Cannabis Research at McMaster and St. Joseph’s Healthcare Hamilton is hoping to change. Yet anecdotally, stories like John’s, are promising.

John has four kids and managed to take them to Canada’s Wonderland amusement park on a recent weekend. Walking around all day would have been impossible for him before.

He takes CBD (cannabidiol) oil during the day, and an oil with one-to-one ratio of CBD and THC (tetrahydrocannabinol) at night. THC has a psychoactive effect and CBD is believed to reduce pain and inflammation.

Yet there are more than 100 cannabinoids that have not been studied, along with a need to better understand the human body’s own endocannabinoid system.

During the month of September, John, who lives in London, did a pain management course at the Michael G. DeGroote Pain Clinic at McMaster. He learned about physiotherapy, relaxation, nutrition and other helpful tips.

He also took a course on medicinal cannabis that helped him better understand the benefits and potential risks. That course, taught by pharmacists who work at the pain centre, is mandatory for any patients at the centre to access medical cannabis.

Since 2015, the clinic has grown from about 7,000 patients annually, to 22,000 expected by the end of this year, said Dr. Ramesh Zacharias. The team includes not just doctors, but physiotherapists, dietitians, psychologists, nurse practitioners and pharmacists.

Many of the patients they see are veterans, who are twice as likely as the general population to have chronic pain, along with increased psychological trauma.

“They’ve done a great job serving our country ... now it’s our time to serve them,” Zacharias said.

He’s also very interested in better cannabis research. After attending a conference on the topic in Japan two years ago, he instituted the cannabis course for patients about a year and a half ago.

The centre has five doctors who authorize cannabis use and he says they are working to better understand what works for some patients and not for others, including recommending particular strains.

“Cannabis is an option and a good option for some patients, but the evidence on cannabis is very, very early,” Zacharias said. “It’s not right for every patient and every condition.”

Zacharias wants to know why cannabis appears to work for some and not for others.

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“It’s a very complex, but fascinating area of research,” he said.

He is working on a research study (DATACANN) that has a goal of tracking 1,000 patients over the next two years or longer. These patients, registered through 17 clinics across Canada, will be followed to see what impact medical cannabis has on their health, mental health, and medication usage.

Zacharias also works as a regional coroner where he regularly sees overdose deaths from opioids. He said this type of study should have been done with opioids years ago and could have potentially heralded earlier changes to how the highly addictive and potentially deadly narcotics were prescribed.

Within DATACANN, Zacharias said there are two distinct groups they are pulling out to follow for unique challenges — Indigenous people and veterans.

Veterans Affairs Canada is keenly aware that more research is needed to better understand why so many are turning to cannabis, the benefits and risks.

Michel Doiron, associate deputy minister, said Veterans Affairs Canada have “been practically trail blazers” when it comes to medical cannabis, learning as they go.

Research would be “really, really welcome,” he said.

They do not prescribe cannabis, but simply cover the cost for veterans whose pain or PTSD is related to their service. When this began in 2011-12 they had just 37 veterans asking to be reimbursed, but that has steadily grown.

The first request came from a palliative patient, he said.

But after changes to medical marijuana regulations a few years ago there was a huge influx in patient requests that caught doctors and Veterans Affairs off guard, Doiron said.

“Everyone was caught by the change in regulation ... but what is lacking is true, honest-to-God research,” he said.

That is why Veterans Affairs is work to fund a research grant through the Royal’s Institute of Mental Health Research. Doiron said he couldn’t yet say the dollar amount, but notes the grant for cannabis research will be “a fair amount.”

He hears from veterans who couldn’t function before turning to medical cannabis. But Veterans Affairs is also aware of concerns about addiction (known clinically as cannabis use disorder), psychosis and questions around self-harm. Many veterans are also young adults, perhaps complicating the impact of cannabis because their brains are still growing.

Because veterans have been using cannabis for a long time, in some tolerance has gone up and so has the amount of grams per day they’re using.

At its height in 2016-17 Veterans Affairs paid more than $63.7 million.

So last year the government cut the daily limit of medical cannabis it pays. Now the general limit is up to 3 grams a day, at a price of $8.50 per gram. But Doiron said they do allow up to 10 grams a day if it’s signed off by a specialist.

Of the more than 8,000 being compensated, most (nearly 5,000) are getting 3 grams a day, but there are 606 veterans approved to consume 10 grams per day, according to Veterans Affairs.

“We have a responsibility to the health of our veterans, but at the end of the day that’s between doctor and patient,” Doiron said.

For John, he said he had no problem accessing medical cannabis or seeing it covered by Veterans Affairs. His only wish was that he had turned to it sooner.