Issue link: https://maltatoday.uberflip.com/i/1530615
maltatoday | SUNDAY • 15 DECEMBER 2024 6 OPINION Harm reduction in Malta: A bumpy road ahead THE devastating effects of high HIV in- fections across the EU in the late 1980's, and the increased grass-roots move- ments 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 intro- duced substantial legal, social, and educa- tional changes to ensure drug policy ful- filled its overarching purpose to 'prevent harm', both from the chemical composi- tion of the drug, but also from out-dated policies and broader societal and institu- tional discrimination. In these countries one finds different levels of decriminalisation (no criminal consequences for drug possession), the es- tablishment 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 ba- sic 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 de- spite prohibitionist pressure to rekindle a war on drugs and a war on people who use drugs, at the 67th session of the Com- mission 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 commu- nity prioritised the fulfilment of human rights for all people who use drugs. Most significantly, by recognising the validity of comprehensive and inclusive harm re- duction principles and practices, includ- ing the benefits of a regulated framework to access drugs, diplomatic discussions in Vienna highlighted the centrality of a par- adigm 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 thor- oughly at drug policy changes in Canada, Portugal and Switzerland and compared them to the local context. My disserta- tion, 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 devel- opment and practitioners' perception of harm reduction implementation in Mal- ta. Through several qualitative interviews with leading experts in the fields of public health, human rights, and addiction stud- ies, my research findings, identified ten- sion in the perceived applicability of broad harm reduction tools and future develop- ments 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 suspi- cion of trafficking or other foul play is in- volved, 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 resi- dents 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 infor- mation depicting all drug use as abuse, and as a chronic relapsing disease. This, togeth- er with continued criminalisation of para- phernalia, and criminalisation of gifting and sharing of drugs, and the continued per- ceived role of the police to address drug use, have in no small part contributed to push- ing people who use drugs to the margins of society, and directly endangering their lives. The importance of inclusive, non-judg- mental and evidence-based educational tools was identified by participants as piv- otal to reduce risks. Participants called for an urgent introduction of naloxone spray and the need for a low-threshold facili- ty. 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 treat- ment programme. Furthermore, the unsci- entific narrative depicting all drug use as abuse, and the so-called hocus-pocus gate- way hypothesis repeated ad nausea by pro- hibitionists, continues to instil increased animosity and distrust of people using ille- gal 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. Sad- ly, drug consumption rooms remain a dis- tant dream, so much so that even Canna- bis 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 Mal- ta fall short from fulfilling their human rights purpose and thus holistically ad- dress broader social, legal and economic injustices faced by people who use drugs. Despite the legislative changes to depenal- ise small amounts of drugs in 2015, and the more recent cannabis reform in 2021, Malta continues to face a serious short- age of human rights tools, policy meas- ures, 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 chang- es, including the urgent need to introduce basic rights and services such as access to low-threshold services, availability of cannabis consumption spaces, and an- onymised and affordable drug checking services for all people who use drugs. Mark Farrugia holds a B.A in Social Work and works in the field of children's rights. Since 2019 he has advanced the human rights of people who use drugs and is collaborating with Harm Reduction Malta Mark Farrugia