Last month, I attended the Medical Cannabis Summit in Malta. The country wants to become a leader for European medical cannabis innovation, after several policy changes in recent years. In the first of this three-part article I detail the policy landscape of medical and ‘recreational’ cannabis. For an overview of the key takeaways from the conference, check out Part Two. Part Three explores how the multi-million euro cannabis market seems to exist in a parallel reality to that of communities on the ground.
Malta’s policy landscape – the recreational side
For the past 40 years, Malta’s policies and mentality towards cannabis, cannabis use, cultivation and sharing have been very harsh. Many young people get convicted for minimal amounts of the plant, and sentencing drags on for a long time. Slowly, the public have begun to question the validity of the system, as more stories of injustice are exposed.
In 2013, the Labour government returned to power for the first time in 16 years, and sentiments about cannabis and drug use, in general, began to shift more towards a human rights focussed and a less punitive approach.
In the following three years, personal possession of cannabis was decriminalised, with small amounts – 3.5g or less – no longer leading to a criminal offence. Medical cannabis also became legal. According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), if a person is found guilty of possession, without any link to trafficking, they must pay a fine of 50-100 euros. If caught again within two years, the person is required to attend a Drug Offenders Rehabilitation Board, effectively a drugs tribunal where their dependency is assessed. If necessary, additional non criminal orders can be issued.
So, while decriminalisation is a positive step, Karen Mamo, who is currently pursuing a Master of Science in Addiction Studies, agrees that its current framework still poses a problem. Indeed, police still have the right to arrest and interrogate the person, there are no cannabis quality checks, which perpetuates the presence of synthetic cannabis and “long-standing dogma preaching an abstinence-only approach” hampers harm reduction education across society.
This is echoed by Andrew Bonello, the president of ReLeaf, the leading Maltese NGO advocating for legalisation and regulation of cannabis since 2017. For him, the two main obstacles to legalisation and better regulation in Malta are a lack of research into the long term effects of cannabis on the body and mind, and the continuous taboo and stigma, particularly with professionals who “are reluctant to speak about their cannabis use”.
Malta’s policy landscape – the medical side
In 2017, medical cannabis became legalised, but it remains complicated to prescribe and access medical cannabis and prices are extremely high, with one patient estimating €5,390 for 13 months of treatment with one gram of cannabis a day. Under Maltese law, patients have to be granted a control card by the Superintendent of Public Health, and if they do not abide by the rules, the doctor is responsible, which serves as a deterrent. While patients should be able to buy flower tops by Bedrocan and Pedanios, which are high in THC content and low in CBD, for only three medical conditions, chronic pain, spasticity in multiple sclerosis and side effects of chemotherapy, these can be out of stock for long periods of time.
CBD products, including oils, which are being sold without prescription, have been increasing in price because of the new certification requirements, even in cases where they were available before with patient-focused certification. This means that they are now effectively unapproved, thus illegal, but still available online, at higher prices. As such, patients and their families continue to feel unnecessary suffering, increased economic burdens and an overall lack of clarity on cannabis laws and restrictions in Malta.
The control card policy and CBD restrictions are very harsh in comparison to other European countries, even though the situation in most is not as straightforward as it seems.
Karen Mamo, who has previously written about patients’ perspectives, added that the government has on multiple occasions recognised that the current situation is not conducive to public health and further changes are required. However, they will first push for a national educational campaign warning young people specifically about the dangers of drug use and promoting ‘healthier living’.
The Medical Cannabis Summit
This climate is the backdrop to the Summit, which brought hundreds of specialists on the topic to Malta to discuss the need for research, investment opportunities and more technical debates such as the reluctance of financial institutions to provide reliable banking and support, from the US to Malta, for cannabis businesses.
Everywhere it seems that there is a disconnect between what legislation says is happening and the reality in practice. At the conference, Dr Anne Schlag, Head of Research at Drug Science, remarked that in the UK, “in principle” medical cannabis is available, but “in practice, things have not always worked out”. Prof. Mike Barnes, the Chief Medical Officer at Lyph Group, specialised in the supply of medical cannabis, summarised by saying, “we need education, we need accessibility of the evidence out there, we need better guidelines and we need fewer restrictions on doctors”. In our interview, Andrew Bonello added that Malta must ensure that “medicinal cannabis is made available for all”, including people who might have struggled with “problematic substance use”, but where this medicine is now the best course of action, “if warranted by a doctor”.
As mentioned by MEP Dr Miriam Dalli, there is a hope that the European Union could become the largest medical cannabis market in the world. Before we get there, it is necessary that all citizens have the same rights, that legislation is standardised and money invested into facilitating the creation and access to medical data, which would help to break down economic and stigmatising barriers to the prescription of medical cannabis.
*Massive thank you to Karen Mamo and Andrew Bonello for their contributions to this article series and for the super warm welcome in Malta!