Drugs and Substance Abuse in the Homes of People Receiving Care Policy

Background Information

From time to time, a worker providing care and support to a person in their own home might find or suspect that they are using illegal drugs. Illegal drug use will always be outside the contractual arrangements entered into by the agency or the contents of the care plan that workers will be following.

However, in some cases, the reasons for the person taking the drugs might well have some bearing on the conditions for which {{org_field_name}} is being provided. For example, they might be taking cannabis to relieve pain, which is linked to a disability, which is also requiring an element of personal care. The person might also be showing signs of becoming drug dependent or of being vulnerable to moving from soft to harder drugs. Such situations could create difficulties for an agency which must always be seen to be operating within the law.

Most of the available guidance is directed at the use of drugs and alcohol by employees within the workplace and on the impact drug use has on work performance. It is related to health and safety issues and to employers’ responsibilities for protecting all employees from the possible consequences of anyone using drugs that may affect their work.

There are also organisations that employ people to work directly with people with alcohol- and drug-related problems including housing providers. These organisations clearly need and usually have detailed policies and procedures to guide their workers, practice and to make sure that as organisations they comply with the current legislation and do not expose their staff to prosecution for failing to comply with the law.

There has been less information on the issues addressed in this guidance, which outlines the responsibilities of people who are exposed to drug taking as a by-product of their work, but which could as a result make both employers and employees vulnerable to charges of being involved in illegal acts. Employers could also be accused under health and safety legislation of failing in their duty of care to protect their employees by exposing them to situations which put their personal safety at risk.

Key Points

It will be useful for the agency and its care workers who visit people who might be using illegal drugs and substances to take note of the following key points.

Legislation

The Misuse of Drugs Act 1971 makes it an offence for:

anyone to possess, supply, offer to supply or produce controlled drugs or substances without authorisation
occupiers of premises to permit knowingly the production or supply of any controlled drugs or allow the smoking of cannabis or opium on those premises.

It is also an offence under common law for anyone to “aid and abet” the commission of an offence under the Misuse of Drugs Act.

“Unauthorised” drugs are classified in terms of their dangerousness with penalties for any offences committed being in general proportionate to their classification, ie to possess or supply a Class A drug like heroin is accepted as being more serious and deserving more severe penalties than for Class C drugs, which includes some tranquillisers and ketamine.

Types of unauthorised drug

Care workers in contact with people who use services who might use unauthorised drugs should become aware of the different types of drug, their classification and of any changes of status that are made as a result of government review.

Class A drugs include well-known “hard drugs” such as cocaine, heroin, LSD, methadone, morphine, opium, and ecstasy.
Note:
Class B drugs also become Class A drugs if they are prepared for injection.
Class B drugs include amphetamines and codeine in concentrated forms. Cannabis has been reclassified as a Class B drug since January 2009.
Class C drugs include various tranquillisers such as valium.

Some drugs go under several popular names and it might be important to understand the specific drug that is being referred to such as “uppers” (amphetamines), “skunk” (cannabis), etc. The Internet provides useful sources of information. See, for example, www.talktofrank.com.

Possession

It is important for care workers to understand what is meant by “possession”. Possession means having drugs in one’s physical possession or having control of drugs. If a person says: “I don’t keep drugs in the house, but in a hole dug outside my back gate” they would not necessarily always be keeping the drugs which they use in their “possession”, but they are controlling the drugs and thus be liable to be charged with “possession” if discovered.

Knowledge

Knowledge about possession is important. For example, a drug-user asks someone to fetch a package (ie drugs) buried in the hole outside but does not say what it is and the carrier is caught in possession by the police. If the person can prove that he or she does not know what the package consists of they should not be found guilty of an offence.

Intention

Intention is also important. It is not an offence, for example, to carry an unauthorised drug for someone who is entitled to have it — as when someone gets a prescription for someone else. Neither is taking possession of a drug to destroy it an offence, but holding on to the drug to use it oneself or to sell it would be an offence. Just observing another person use a drug would not be an offence.

Premises

“Premises” can mean a house, boat or caravan, anything which is not moving. (An open field does not count as “premises”.) Responsibility for premises lies with occupiers, not owners. A tenant is an occupier for this purpose. Anyone who invites or excludes visitors, holds the key, or takes responsibility for “premises” will count as an occupier. This puts people sharing houses or flats are in a difficult position. If one person uses cannabis with the knowledge of others, then the co-tenants could be prosecuted for allowing the premises to be used for smoking cannabis. It could also be an offence for an occupier to fail to put a stop to drug use on the premises for which he or she is responsible or jointly responsible.

Drugs and/or Alcohol Abuse/Excessive Use in the Homes of People Using the Services

There might be situations where home care workers encounter difficulties due to excessive drinking or drug abuse taking place in the home of the person using the services which affect their ability to provide a service in accordance with their contractual obligations and to the standards required. The problem could be in the person, an informal carer, other family member, friends or visitors to the home. In these situations, it is important that the agency makes clear its responsibilities and limits to the person who uses services, to its staff and other professionals, and to its service commissioners. The agency should accordingly develop its response in terms of its concerns not only for the person who uses services’ welfare and its contractual obligations to them and to the commissioning service, but also for the health and safety of its staff, who might be put at risk from exposure to the effects of drug and alcohol induced conduct.

The situations that are likely to arise will vary. In some instances, excessive drinking or drug taking on the part of people who use services and/or their immediate carers might make it difficult for home care workers to carry out their agreed tasks. People who use services might also be putting themselves at risk of further harm from their excessive drinking or drug abuse. This then makes it difficult to achieve the outcomes of the care plan. Problems in other family members, friends and visitors too could create difficulties in delivering the agreed service and increase the risks to the person and possibly to the agency’s employees. In some cases, the problems will be progressive and need to be kept under continuous monitoring and review for any increase in risks.

The risks too will vary from situation to situation depending in the source, nature and extent of the alcohol and/or drug abuse and will need to be assessed on a case-by-case basis. For example, there may be increased risks of personal injury to the affected people, to the welfare of the person who uses the services from neglect or inappropriate administration of medication. In some cases, the effects of the misuse of alcohol and/or drugs will conflict or be detrimental to the home care service effort. Accordingly, the agency may need to seek assurance that it will not be held responsible or held liable for any failures or shortfalls in the service that result from such conflicting actions within the home care situation which are not within its control. These should be determined and recorded on the care plan.

Aim of the Policy

This policy aims to provide guidance and procedures for care and support workers employed by a registered domiciliary care agency, who suspect or have evidence that the people to whom they are providing a service are taking illegal drugs or substances.

Drug Misuse Policy

The agency is committed to working within the law. It is equally committed to making sure that its employees are not exposed to unnecessary risks of personal injury and harm.
If the agency’s care workers have evidence or reasonable suspicions that a person for whom they are providing a service is using illegal drugs they should report this immediately to their manager.
The manager will carry out a risk assessment to see if, from this evidence that, the agency’s workers are at risk in any way because of their working with someone who is using illegal drugs. From this assessment, the manager will decide an appropriate set of actions. For example, if the agency’s workers do appear to be vulnerable because of the person’s use of drugs, the manager could decide to suspend or end the service after discussions with the other professionals involved.
If as an outcome of the assessment it is found that other vulnerable adults or children are at risk because of the drug use, then the manager would need to initiate local safeguarding procedures to protect those people. Where there are no risks to other people and the agency’s employees are not being implicated in any ways with the illegal drug use then the manager might decide that the situation should be monitored and kept under review.
Managers will make it clear to care workers that they must not become involved directly or indirectly in any illegal drug taking by the person who uses services. If necessary, such statements will be written into the contract with the person and commissioners. For example, a care worker should not be expected to escort a person who uses services outside of their home whom they know is carrying illegal drugs. The care worker should not be open to accusations that they might be aiding and abetting the person to take illegal drugs or substances say in the event of a “stop and search” police action.
Where it is evident that the person, to whom the agency is providing a service, is at risk of causing further harm to him or herself because of the drug use, the agency will alert other agencies and professionals involved to make sure that a “harm reduction” plan is put into place to which the agency could contribute.

Training

The agency undertakes to provide training and support to any of its employees who need to provide a service to people who might be taking illegal drugs with reference to the key points identified above.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

DS55. Drugs and Substance Abuse in the Homes of People Receiving Care