For a long time, Malta had a repressive approach to drugs, but there is an increasing understanding and acceptance of harm reduction measures now. We interviewed Karen Mamo, a researcher and harm reduction professional.
Drugreporter: Can you please speak about your personal background – what made you interested in drug policy and harm reduction as a researcher? What harm reduction activities do you do beside your academic work?
Karen Mamo: I am 32 years old and my academic background is quite a varied one. In fact, at University I studied Italian language and literature. I later moved into the world of conflict resolution and Mediterranean security, and last October I enrolled for a Master of Science in Addiction studies. I was always intrigued by substance use, and considering that Malta introduced legislative changes in 2015 (small amounts of drugs depenalised), during the same time I started doing personal research about cannabis and policy. In reality, it was Prof. David Nutt’s book, Drugs without the Hot Air that encouraged me to question what I have been taught till now and to re-configured my view about substances and people who use substances. During these years I was also reaching out to foreign NGOs working in the field of harm reduction and trying to explore how Malta too could introduce this important public health concept. I am very grateful to collaborate with UK-based Talking Drugs and Drugs & Me, but also had the opportunity to participate in the general assembly meeting of the ENCOD in 2019. (Links to these organisations can be found here!). To further expand my outreach, in September 2019 I set up the first harm reduction stand at the Bubble Festival and earlier this year a harm reduction page on facebook. I also held a number of meetings with the University of Malta’s administration and Student Council. Unfortunately, I had to scale back my work due to Covid-19. However, I look forward to revamping my harm reduction advocacy in the coming months.
Most people in Europe know very little about drug use and drug policies in Malta. Could you please describe the scene? What are the main trends in drug use and related harms?
Like any other country, drug use in Malta is very much prevalent. Particularly popular are alcohol, tobacco, and cannabis. However, other substances such as cocaine, xtc, and ketamine are also widely used. Drug policy in Malta has always treated drugs with a strict moralistic and criminal approach, however in the late 2000s Malta adopted harm reduction measures linked to intravenous heroin use (OST, clean syringes). Nonetheless, no other harm reduction guidelines are available. The amendments introduced in 2015 (depenalising small quantities of drugs – 3.5 grams for cannabis, 2 pills or grams for xtc and cocaine), were a promising development as it managed to remove from the criminal justice system people using substances for personal use. Nonetheless, the quantity is very low, and the police retained the right to arrest the person and proceed with interrogation. The person is then asked to appear in front of a board and asked to pay a fine. This type of approach continues to stigmatise people who use substances, and many have been questioning how realistically functional the low threshold is for local realities. Cultivation of cannabis, and the sharing and consumption of substances near school areas are usually viewed as in need of harsher penalties and jail time.
Recent media reports highlighted that the emergence of legal highs, particularly synthetic cannabis, is causing grave health and mental issues. Media reports also speak of increased admission into rehabilitation services by people using cocaine, stimulants, and cannabis. The EMCCDA country report of 2019 is an interesting outlook about substance use in Malta.
The greatest harms related to drug use are usually linked to intravenous administration and related illnesses. In Malta, heroin remains the illicit drug that is linked to the most severe health and social consequences. In 2017, there were an estimated 1,425 high-risk opioid users (4.51 per 1000 population aged 15-64 years.
Unfortunately, information gathered by EMCDDA does not differentiate between substance use and problematic substance use, and therefore it is very difficult to map local trends. I believe this is a prominent barrier to better policy options and improved public health.
Malta is a popular destination for tourists and it is on the crossroads of migration – has this any effect on the drug market?
I have not encountered any effects caused by migration crossings, however I frequently observe that foreign nationals (particularly people of colour) tend to be picked up more easily by the police, and law courts hand out harsher penalties to foreign nationals. It is interesting to note that more than migration, it was the Arab Spring that shaped the drug scene in Malta. Due to Malta’s close proximity to North Africa, cannabis reaching the country was predominantly in hash form. However, following the Arab Spring and political instability in Libya, Malta started receiving more herbal cannabis from mainland Europe.
Malta has a reputation as having a socially conservative and zero-tolerance approach to illicit drugs. Is this still the situation? Is there an official recognition and support for harm reduction programs?
For a long time, Malta adopted a conservative and zero-tolerance approach to substance use. Nonetheless with a change in government in 2013, a more humane and balanced approach was proposed. Presently there seems to be tension between an emerging human rights-based approach to drug policy and the draconian approach adopted in previous years and to a certain degree still present today. Although harm reduction is being more frequently mentioned, there continues to be a poor understanding of what the main scope of harm reduction is and how best to achieve it. Particularly problematic is the enforcement component and the belief that increased crackdown on substances will result in better public health outcomes. Malta is presently at a cross-roads between recognising that previous approaches failed to reduce the number of problematic substance users, and adopting an holistic approach to policy, thus eliminating completely the criminal component and focussing increased energies on education, health, and harm reduction. But there are many who oppose these measures.
What about the drug laws? Drug use is criminalised by the law – do the authorities strictly enforce it and criminalise drug users?
Yes, the police heavily enforce and criminalise drug users, especially those caught cultivating a number of plants or with more grams than what is prescribed by the law. It is interesting to note that the authorities seem to target specific events and neighbourhoods and ignore others. Sometimes court cases take very long (over 6 years) and the person ends up facing pricey court and lawyer fees, whilst suffering from psychological stress and sometimes negative repercussions from family members, their place of work, and society in general.
Is civil society involved in drug policy making? Are there any formal mechanisms for you to have a say?
From time to time the government opens public consultations with the general public on a number of topics. Civil society is consulted by the government and NGOs working in the field of rehabilitation services are given priority. I am still new and do not have an officially registered NGO, therefore I have not yet sought any formal mechanisms.
Medical cannabis has been legal in Malta since 2018. How does this regulation work in practice? Do you think there is a chance to legalise cannabis for recreational purposes too?
Medicinal cannabis is available, yet approval needs to be given by the Medicines Authority apart from being recommended by a doctor. Presently Malta has 4 types of strains, Bedrocan (22/1 THC:CBD), Pedanios (22/1 THC:CBD), Pedanios (20/1 THC:CBD) and Bediol (6.3/8 THC:CBD). Cannabis is only available in herbal form and no oils have been yet been made available. In fact, technically the use of CBD requires a medical prescription and no pharmacy has yet made CBD available. Nonetheless, this can be purchased from different shops throughout the island.
With regard to the non-medical use of cannabis, in 2019 and the first quarter of 2020 the government spoke about the need to change the current laws to combat stigma and ensure people who use cannabis are provided with a good quality product. However, no legislative changes have been enacted or tabelled in parliament yet.
I suppose the pandemic had a huge impact in Malta where tourism is an important economic factor. How did you manage to cope with the COVID-19 pandemic and quarantine measures, with special regard to drug users and drug services?
Yes, the pandemic is still having negative effects on the economy, particularly the touristic field. Media articles highlighted that the use of substances and bingeing sessions during weekends have decreased, yet people who use substances on a regular basis continue to do so. It is interesting to mention that local enforcement officers continued to crack down on cultivators and traffickers, irrespective of lockdown rules.
Interview by Peter Sarosi