As of July 2018, herbal medical cannabis products have been legally available to Maltese patients who have been prescribed it, and come with a price tag of 17 EUR per gram. At the time of writing, two local pharmacies currently provide three types of medical cannabis products with high THC levels. To get a better idea of the situation on the ground, TalkingDrugs approached a local doctor and five Maltese patients.
Local authorities, including Malta’s Medicines Authority, have been praising the new approach to medical cannabis as efficient. However, various media reports are bringing to light a number of discrepancies and structural hurdles that are turning access to medical cannabis into a long and tortuous bureaucratic process.
Dr Andrew Agius – a family doctor specialising in chronic pain – was instrumental in the introduction of medical cannabis in Malta and greatly welcomed legal developments giving doctors the possibility to prescribe the drug. Nonetheless, speaking to TalkingDrugs, he expressed grave concern at the modus operandi and restrictions employed by the current system.
He lamented that rules on prescribing and accessing medical cannabis remain more stringent than those relating to opioid medication, including morphine. In particular, he warned that the rigid rules on prescribing CBD products clash with recommendations issued by the World Health Organisation – which state that CBD poses no risk of misuse.
Other repressive elements remain within Malta’s approach to medical cannabis. Doctors are currently obliged to inform the Commissioner of Police that a patient is using cannabis. As required by the Maltese Motor Vehicle (Driving Licences) Regulation, the police have the duty to revoke the driving licence and stop the person from driving. Dr Agius explained that these same parameters are not used for other medicines that could affect one’s driving, including pain-relief medication.
While the ability of Maltese doctors to now prescribe cannabis is undoubtedly an improvement, Dr Agius insisted that it is vital for health professionals to be better educated on the use of cannabis.
Patients speaking to TalkingDrugs expressed positive remarks at the introduction of medical cannabis in Malta and explained that the medicine was instrumental in helping them manage their pain and reintegrate into family and social life. The patients we spoke to said that consuming medical cannabis with high THC levels could pose a risk when driving or operating machinery, but they insisted this risk could be reduced if the state educated patients on their responsibilities – rather than barring them from driving which can negatively impact their lives. Patients also expressed concern at the lack of strain diversification and products, high prices, and the general lack of evidence-based information on the topic.
Ms S (teacher, 49 years old, suffering from fibromyalgia) expressed frustration at the fact that doctors did not propose the use of cannabis beforehand, and said she feels cheated by a legal system that in some cases continues to consider the use of the medicine as a crime. She said that she felt like a wooden mannequin struggling to get around before using cannabis, whereas today she leads a very active and happy life.
Expressing similar views, Ms H (self-employed, 36 years old, suffering from fibromyalgia) emphasised that the provision of more information, especially expert training for doctors and pharmacists, is urgently needed. Furthermore, she lamented that local prices are very high when compared to other countries with legal medical cannabis, and questioned why only very few strains have been made available.
Ms N (chef, 31 years old, suffering from chronic pain) feels that the lengthy process required to obtain permission to use medical cannabis, and the high prices involved, continue to negatively impinge on her well-being. Ms N underlined the need for comprehensive education on the properties of medical cannabis, and the importance of eliminating the stigma attached to people who use cannabis.
Ms D (chef, 30 years old, currently battling stage 4 cancer) expressed dismay at the fact that doctors so easily prescribe high doses of morphine but have not yet given her permission to use medical cannabis. She explained that the use of morphine comes with many risks, and that she hoped that doctors would recognise the benefits of complementing cancer treatment with medical cannabis.
Another medical cannabis patient, Mr G (retired waiter, 59 years old, suffering from asthma and fibromyalgia) highlighted that the Medicines Authority is not knowledgeable on the properties of cannabis and should therefore not doubt doctors’ professional assessments. Mr G emphasised that patients should be provided with a more diversified market and be allowed to grow a number of plants for medical purposes.
Whilst recognising that these are the initial steps for a country that is slowly but surely moving towards a more just and inclusive society, it is imperative to keep the interest and well-being of the patient at the forefront. Our conversations with those affected suggests that local authorities must speak with patients and provide a safe space for them to raise questions and concerns about the system of medical cannabis regulation in Malta.
*Karen Mamo is a Maltese citizen, with a master’s degree in Conflict Resolution and Mediterranean Security and a keen interest in drug policy reform.