Illness no excuse for abuse

The life span of people with Ehlers-Danlos syndrome (EDS) averages just 48 years.

The syndrome is characterised by thin, translucent skin, easy bruising as well as fragile internal organs and blood vessels. Patients can also experience tears in their gastric lining, or have their organs haemorrhaging.

Still, taking marijuana, or cannabis, to deal with the genetic disorder is not the solution, said doctors.

And lawyers add that claiming to have a medical condition so you can take banned substances could get you into more trouble.

Last Wednesday, Leon Russel Francis, 22, a vascular EDS sufferer, appealed successfully against his eight-month jail term for taking cannabis. Francis, who claimed to have used cannabis to relieve him of the pain caused by his disorder, was put on probation for two years.

While cannabis, also known as marijuana and weed, is legal in places such as Amsterdam and some states in the US, it is banned here. This is due to Singapore's commitment to a 1961 international agreement to control the cultivation of the cannabis plant and their products, among other narcotic drugs.

Dr Chia Kok Hoong, a vascular surgeon in private practice, said chronic pain is a symptom that could come with EDS.

Dr Chia, who has 28 years' experience, said medication is available to relieve pain without the use of drugs and hallucinogens.

"If cannabis were the solution, then those suffering from congenital diseases would be smoking marijuana," he added.

While he does not wish to comment specifically on Francis' case, Dr Chia said patients he has encountered usually resort to drugs not just to alleviate the pain.

"When you take cannabis, you are not just getting rid of the pain. You are on a high," he said.

SEEK HELP

Dr Sivathasan Cumaraswamy of The Heart Lung and Vascular Centre agreed.

"There is no excuse. There are many EDS patients who don't need cannabis to alleviate their discomfort," said the doctor, who has experience in cardiac, thoracic and vascular surgery.

"If the patient is really suffering from discomfort and anxiety from the condition, he should see the right doctors and seek proper treatment," he added.

Dr Chia said what is sad about this disorder is that sufferers are unable to lead a normal life.

"The very act of grabbing a patient will leave him with bruises. For serious cases, every single blood vessel can be affected, and will rupture following a simple injury.

"These patients are very fragile. You need to treat them with kid gloves," Dr Chia said.

This fragility was also what led criminal lawyer Gloria James-Civetta to agree with Judge of Appeal Chao Hick Tin's decision to give Francis a two-year probation.

The appeal judge "did right by looking further into the matter", she said.

Lawyer Sunil Sudheesan also pointed out that while Singapore takes a strong stand on drug abuse, there will always be exceptions. "This case by no means signals that anyone with medical conditions can get away with abusing drugs."

Rather than be concerned that Francis' case can become a dangerous precedent for drug abusers, he said he got an "enlightened message" from Justice Chao's verdict.

"I am happy the High Court took the effort to look into Francis' special circumstances," he said.

Citing a case in which a 17-year-old drug abuser's appeal for probation was dismissed, Ms James said: "Generally, the message sent to offenders, be they below or above 21 years of age, is that a jail term is usually warranted when drug offences are committed."

Lawyer Ravinderpal Singh, who said it is rare for adult drug offenders to be put on probation, added: "I think (the law) will be applied very strictly and each case will be determined on its own facts."

ABOUT THE COURT CASE

Leon Russel Francis, 22, a convicted drug offender, was originally jailed eight months but got a two-year probationary sentence on appeal. He had been suffering from a genetic disorder known as Ehlers-Danlos Syndrome Type 4.

Judge of Appeal Chao Hick Tin said there were special circumstances in his case that allowed it to be viewed with compassion.

Justice Chao sympathised with Francis' condition and said it set him apart from other drug offenders. He said it was understandable Francis continued to use the drugs because he felt better each time, reported Chinese newspaper Lianhe Wanbao.

When Francis was 17 years old, his lungs failed and doctors had to remove half of his left lung. At the age of 18, his intestines were punctured and he has since relied on stoma bags to collect waste.

Francis was convicted of two charges of consuming and possessing cannabis last October. Another charge of drug trafficking was taken into consideration.

His home was raided by the police and he was arrested two years ago. A packet of cannabis was seized from his home.

Francis was first introduced to the drug by a friend at a house party in 2011 and he continued to smoke it twice a week after he found it helped him relax and eased his discomfort.

In February, District Judge Siva Shanmugam sentenced him to eight months' jail due to the gravity of his offence and the need for general deterrence.

But Francis, who was represented by lawyer Eugene Thuraisingam, appealed to ask for a probationary sentence instead of a jail term.

WHAT IS EHLERS-DANLOS SYNDROME

Ehlers-Danlos syndrome (EDS) is a group of inherited disorders that affect your connective tissues, mainly your skin, joints and blood vessel walls.

Those with this genetic disorder typically do not live beyond their 40s, doctors told TNP. Francis suffers from EDS Type 4, also known as vascular EDS, in which blood vessels in one's body is formed with defective collagen. The defective collagen, which is very fragile, can cause the walls of your blood vessels, intestines or uterus to rupture.

This results in easy bruising, said Dr Chia Kok Hoong of Dr Chia KH Vein Vascular & General Surgery Centre.

Those born with this genetic disorder are usually skinny and small in build, and have very pale translucent skin.

While he was unable to provide statistics, Dr Chia said he has only seen three patients with this genetic disorder in 28 years of experience.

According to the US National Library of Medicine, EDS Type 4 is very rare and is estimated to affect about 1 in 250,000 people globally.

fjieying@sph.com.sg

This article was first published on July 05, 2014.
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