Harm reduction in Malta: A bumpy road ahead | Mark Farrugia

The devastating effects of high HIV infections across the EU in the late 1980’s, and the increased grass-roots movements calling for humane drug policies, gave birth to the first peer-led initiatives by People Who Use Drugs [PWUD]. Throughout this time countries such as Canada, Switzerland and Portugal introduced substantial legal, social, and educational changes to ensure drug policy fulfilled its overarching purpose to ‘prevent harm’, both from the chemical composition of the drug, but also from out-dated policies and broader societal and institutional discrimination.

In these countries one finds different levels of decriminalisation (no criminal consequences for drug possession), the establishment of drug consumption rooms (providing safe drug using equipment and space) and drug checking services (testing substances for purity and adulterants), the opening of low threshold services (no need to enrol for treatment to receive basic health services), and a greater focus on social, housing and employment needs.

Despite these siloed national initiatives, drug policy discourse and reform has been stagnant for over 60 years, until this year! Against all political predictions, and despite prohibitionist pressure to rekindle a war on drugs and a war on people who use drugs, at the 67th session of the Commission on Narcotic Drugs (CND), world leaders under the stewardship of Malta, broke the so called ‘Vienna Consensus on Drugs’ and resorted to taking a vote. Like never before, the international community prioritised the fulfilment of human rights for all people who use drugs. Most significantly, by recognising the validity of comprehensive and inclusive harm reduction principles and practices, including the benefits of a regulated framework to access drugs, diplomatic discussions in Vienna highlighted the centrality of a paradigm shift in international cooperation to address drug use in society.

Through my undergraduate dissertation submitted for the B.A in Social Work, with the University of Malta, I looked thoroughly at drug policy changes in Canada, Portugal and Switzerland and compared them to the local context. My dissertation, called Harm Reduction Approach to Addictions; Where Do We Stand in This Regard in Malta? and How This Compares to Other Countries Where This Approach Guides, aimed to better understand the trajectory of harm reduction principles, including possible lacunas in policy development and practitioners’ perception of harm reduction implementation in Malta. Through several qualitative interviews with leading experts in the fields of public health, human rights, and addiction studies, my research findings, identified tension in the perceived applicability of broad harm reduction tools and future developments of human rights for people who use drugs in Malta.

The Drug Dependence: Treatment not imprisonment Act of 2015, introduced basic depenalisation tools whereby people found in possession with less than 2g or two pills, would be arrested by the police, and the drugs confiscated. Unless suspicion of trafficking or other foul play is involved, the person receives a summoning to appear in front of the Commissioner for Justice to pay a fine and if needed be diverted to rehabilitation services. The legislative changes in late 2021 partially decriminalising cannabis for personal use, and the establishment of the Authority for the Responsible use of Cannabis tasked with licensing not-for-profit Cannabis Harm Reduction Associations brought about significant changes for Maltese residents who use cannabis.

My studies highlighted that one of the most pressing issues negatively impacting the human rights of people who use drugs in Malta is the lack of inclusive dialogue between stakeholders and policy makers, in particular the complete absence of the voice and views of people who use drugs in discussions concerning their needs and well-being. Malta is potentially the only EU country with no NGO led by people who use drugs. This is very worrying and directly reflects the decades old perception pushed forward by the war on drugs and stigmatised preventive educational information depicting all drug use as abuse, and as a chronic relapsing disease. This, together with continued criminalisation of paraphernalia, and criminalisation of gifting and sharing of drugs, and the continued perceived role of the police to address drug use, have in no small part contributed to pushing people who use drugs to the margins of society, and directly endangering their lives.

The importance of inclusive, non-judgmental and evidence-based educational tools was identified by participants as pivotal to reduce risks. Participants called for an urgent introduction of naloxone spray and the need for a low-threshold facility. Very worryingly, currently, there are no homeless shelters in Malta that accept and cater for the needs of PWUD. Unless you hail from a rich socio-economic family and afford to travel abroad for tailor-made treatment services, people seeking help in Malta are left out in the cold unless they are ready to go for an abstinence only treatment programme. Furthermore, the unscientific narrative depicting all drug use as abuse, and the so-called hocus-pocus gateway hypothesis repeated ad nausea by prohibitionists, continues to instil increased animosity and distrust of people using illegal drugs. In fact, very disappointingly, till this very day, Malta is one of the few EU countries which has not yet introduced the much-needed opioid overdose reversal kit Naloxone [nasal spray]. Malta is also one of the few EU countries with no low-threshold services for PWUD, and no drug checking services accessible for the community. Sadly, drug consumption rooms remain a distant dream, so much so that even Cannabis Harm Reduction Associations have not been allowed to facilitate for their members access to less risky consumption practices, such as the benefits of non-combusting cannabis via a herb vaporiser.

My research study highlighted that the definition and implementation of harm reduction principles and practices in Malta fall short from fulfilling their human rights purpose and thus holistically address broader social, legal and economic injustices faced by people who use drugs. Despite the legislative changes to depenalise small amounts of drugs in 2015, and the more recent cannabis reform in 2021, Malta continues to face a serious shortage of human rights tools, policy measures, and collective stakeholder efforts to address drug use in society. One augurs policy makers and politicians provide the necessary platform for increased dialogue on human rights and drug policy changes, including the urgent need to introduce basic rights and services such as access to low-threshold services, availability of cannabis consumption spaces, and anonymised and affordable drug checking services for all people who use drugs.