Situation: Rosa Pound has multiple sclerosis. She suffers from severe pain, particularly in her back. Although she visits her local pain clinic for painkilling injections every four months and takes 150mg Dothiepin, 150mg Tramadol, and 25mg Atenolol daily, she remains in chronic pain. She has been refused beta interferon on grounds of cost. She had been cared for by her partner but he left their eight-year relationship two months ago. Her sister lives nearby and she has assumed the main caring role, although because of her own health this can only be temporary.
Problem: Rosa now has support from a personal assistant from a voluntary agency contracted by social services. But a recent incident has caused concern. Rosa’s sister has for some years been taking cannabis which she claims helps her breathing and alleviates her asthma. She introduced a sceptical Rosa to the drug to help ease her pain. Surprisingly (but gratifyingly) for Rosa – it worked. She now uses it daily. She has begun to grow her own in the conservatory. Not realising what the plants were in the eight pots, the personal assistant happily watered and tended them. One morning the agency manager arrived to see Rosa smoking cannabis. She returned to her agency without carrying out her duties, refusing to work for a “drug addict”. She is demanding that social services call the police – and will go to them herself if they don’t.
Like some other people with multiple sclerosis, Rosa has discovered that cannabis appears to help relieve her symptoms. Opinion has been divided among health professional about the validity of the use of cannabis in symptomatic relief. Therefore the government has commissioned the largest single study of symptom treatment in multiple sclerosis, which is being independently funded by the Medical Research Council. Results are expected later this year. The study will look particularly at the effect that cannabis has upon the relief of muscle stiffness and spasms that people with multiple sclerosis experience. Workers in local authorities are increasingly being met with this dilemma where service users claim the beneficial effect of cannabis but workers, being accountable to their organisation, have to work within the legal framework.
However, using and growing cannabis continues to be illegal under the Misuse of Drugs Act 1971. If Rosa is found in possession of a small amount of cannabis she might, as a first offender, just receive an informal warning. However, the cultivation of the drug would be viewed much more seriously as it could be considered that she had intent to supply.
Workers will be mindful of the Wintercomfort Hostel case in 1999, where staff were given a custodial sentence after it was found that clients they were working with at the hostel had been trading drugs on the premises.
The agency has a right to refuse to withdraw their carers. However, under the NHS and Community Care Act 1990, the local authority would be obliged to provide a service to meet Rosa’s assessed needs. Within current human rights law, there is no moral case for withdrawing the service. Public interest exceptions within the Human Rights Act 1998 include the protection of health or morals. Being witness to drug use would not be viewed in the courts in the same way as, for example, a carer working in someone’s house where pornographic pictures were displayed. In this case, as an extreme example, the service could continue as a carer’s health could be protected by using a mask to prevent smoke inhalation. Many carers and service users may not find this an acceptable solution and may prefer to refrain from smoking cannabis in the presence of carers.
The worker would need to be clear that they have a valid reason for breaking confidentiality if the decision is taken to go to the police. The General Social Care Council code of practice states that a social care worker must respect confidential information and explain agency policies about confidentiality to service users and carers.
There could be an initial call to the local authority legal department to gain advice about the legal position of the organisation.
Advice could also be sought from the local authority drug and alcohol team to obtain information for Rosa. For instance, they could help with information regarding health issues linked to cannabis use and provide advice about the legal implications of growing and using cannabis. Should Rosa wish to seek independent advice she could be given information about Release, which gives guidance in relation to drugs and the law.
The care manager could be active in advising Rosa in managing her own risk in order to ensure that the care package continues successfully. Practical advice might include not smoking cannabis in front of the carers.
Information passed to the police would be regarded as hearsay if the local authority worker had not seen the plants or witnessed Rosa smoking.
There could be a discussion with the agency about the belief that some people hold about the symptomatic relief of multiple sclerosis. This combined with reassurance that Rosa will be informed about the serious nature of both smoking and cultivating cannabis may foster better understanding and cause them to rethink their actions. However, if the agency still felt that it wanted to report this to the police, Rosa should be informed and support offered to her.
Immediate action would need to be taken to ensure that Rosa’s care needs are met. It might be advisable to use in-house home care so that the situation could be monitored. This could provide the additional benefit of more direct communication, with all staff working within the same policy guidelines, thus preventing a similar situation in the future.
Undoubtedly, personal values would play a part. Social workers are part of a society that has an increasingly lenient view of smoking cannabis and this is likely to be reflected in case discussions.
I can sympathise with the position that the care agency finds itself in: it cannot condone illegal activities, and it cannot expect its employees to put themselves at risk by enabling clients to break the law, writes Simon Heng. Also, in an ideal world, members of society have a responsibility to report any sort of crime. The simple solution to this dilemma is to let Rosa know that the police will be informed, probably by the care agency manager, and to let her know that she cannot involve her carers in cultivating cannabis. Rosa and her family then have the opportunity to act on this information.
The other concern for Rosa is the possibility of the mixture of cannabis and prescribed medication endangering her health. She could talk to her GP in confidence (although many doctors might suggest that any illegal drug use is dangerous), or if she has access to the internet, she could go to one of the websites that deal with the medicinal uses of cannabis (for example, www.UK420.com) and post a query on the appropriate forum, although one cannot guarantee the accuracy of any response.
Many people I know who have MS or spinal injuries use cannabis to reduce spasticity and to ease pain, all of them claiming that this is more effective than any prescribed medicine, and with fewer side-effects. Growing plants at home not only guarantees the purity of the product (many drugs sold illegally are contaminated with other, possibly dangerous substances), but also means that people can avoid contact with drug dealers: the lesser of two evils perhaps.
There is an increasing amount of evidence indicating that the use of cannabis can alleviate symptoms associated with a variety of conditions, from glaucoma to spinal injuries and multiple sclerosis. The government recently reported that the first cannabis-based medicines could be on sale by next year. Police and government attitudes towards the recreational and medicinal use of cannabis have, very publicly, relaxed over the last few years. A recent article in The Guardian stated that, in 2002, of about 1,200 people arrested for growing cannabis more than 200 were also given a caution. In this kind of ambiguous and changing legal environment, if people are convinced that they can alleviate their own distress by taking cannabis, who can blame them for “stretching” the letter of the law?
Simon Heng is a disabled service user.