Vicky is a 40yr old married woman who was diagnosed with Primary Progressive Multiple Sclerosis (PPMS) 5 years ago, following the birth of her second child.
http://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS
Vicky has two boys, Ben and Alfie, aged 10 and 6.
Vicky has experienced no relief or remissions from her condition, which continues to deteriorate rapidly. She is on multiple disease modifying and symptom management medication with very little effect. Vicky suffers many side effects from these drugs, especially from the pain and muscle spasm drugs she takes. She has increasingly severe spasticity, loss of mobility and dexterity.
Vicky has been using a wheelchair for the last year and has moved into a bungalow with her family.
Vicky also suffers from depression and insomnia, which has worsened in the last few months. She takes an anti-depressant and receives visits from the Community Mental Health Team and other health professionals in the Multi Disciplinary Team (MDT), including a Social Worker, a M.S. Specialist Nurse, a Neurologist, a Physiotherapist, a Speech Therapist and a long-term carer.
Her Neurologist wrote to her GP a few weeks ago stating that it might be beneficial for Vicky to trial the drug Sativex (trade mane Nabixmols):http://en.wikipedia.org/wiki/Nabiximols; http://www.mstrust.org.uk/information/publications/factsheets/sativex.jsp
Sativex is an oral spray medication that derives from the cannabis plant. Studies have been mixed but approximately half the patients who have trialed this drug against a placebo have reported a reduction in spasticity, along with other unexpected symptom improvement such as less insomnia. Some clinicians believe that not only does this drug help symptoms but it can hold back progression in patients like Vicky.
A private prescription for the drug costs about £600 and will only last about a month. Vicky cannot afford this amount of money as the family struggles already to meet everyday bills. However, despite the recommendation from the neurologist, the G.P. has said he is unwilling to prescribe the oral spray as an NHS prescription. He explained that the local Clinical Commissioning Group refuses to fund this medication in the area where Vicky lives, as they feel the cost outweighs the potential benefits: http://www.ms-uk.org/sativex
On recent visits Vicky has been very upset and frustrated at what she perceives to be a 'post-code lottery'. Some patients are allowed an NHS prescription but others are not due to where they live. Sativex is currently prescribed and funded through out Wales for MS sufferers. Decision-making still happens at local level instead of nationally through N.I.C.E guidelines.
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You are visiting Vicky, as a member of the Community Mental Health Care Team. Vicky's husband, Brian, is at work. Brian is very supportive of Vicky but works full- time. The children are out at school until 5pm each day, when Brian picks them up from the after- school club. The children are very loved and well cared for.
You have come to know Vicky and her family well over the previous 2 years. You have been visiting monthly, to provide emotional support for Vicky. You are aware that Vicky feels very frustrated and upset that she is no longer able take part in physical play with her children and husband. She is also feels guilty that her children have to help care for her sometimes. Vicky feels this is a role reversal.
You have not visited Vicky for a month, and on this visit you are surprised to find, when you let yourself in the back door, that Vicky appears to be in positive spirits and is not in her wheel chair as usual, but sat at the dining room table, engrossed in writing a letter. She asks if you would like a cup of tea. You offer to make it and go into the kitchen while Vicky finishes writing her letter.
In the kitchen you notice a bag containing what you recognise as cannabis resin. You are a little shocked by this. You quickly put two and two together and, knowing Vicky as you do, suspect she is using the cannabis as symptom relief.
You decide to ask her about the cannabis, since you are concerned it has been left on the worktop. Vicky says it is always locked up when the children are at home and it’s not a concern. Vicky begins to tell you, excitedly, about how she started using the resin a month ago and of how she noticed a quick improvement in a short period of time. Her spasticity has reduced considerably, allowing her to take small steps, write letters and play board games with her boys. She also explains that her insomnia has improved and she feels less depressed as a result of all of this. She attributes her improvement to the cannabis resin, which she has obtained illicitly. She also tells you that she has stopped some of her medications as she feels she no longer requires them.
Vicky begs you not to tell anyone in the MTD, as she doesn’t want to be stopped, or talked out of taking it. She makes it clear that she wishes her confidentiality to be respected in this situation.
What should you do?