The Republic of Malta is gradually but steadily pushing forward medicinal cannabis laws, however it is struggling to find equilibrium between patient’s needs, financial interests, and a strict regulatory regime.

Cannabis, known locally as ħaxixa, is one of the most-used illicit drugs in Malta. For the past 50 years, the country has treated people who use cannabis with an iron fist and a harsh criminalisation approach; drug laws in Malta date back to 1939 and are regulated under Chapter 101 Dangerous Drugs Ordinance of the Laws of Malta. However recent reforms, debates, and proposed legislative amendments on medicinal cannabis products, and other drugs, suggest an apparent move towards a more open, humane, and common sense approach.

In 2015, the Drug Dependence (treatment not imprisonment) Act was introduced, meaning that someone found possessing a small quantity of drugs for personal possession would face a fine, rather than criminalisation. This was an important breakthrough and promoted the need to address drug misuse within a human rights approach. The amendment also allowed access to medicinal cannabis; for the first time, a number of specialists were entitled, in very restrictive cases, to prescribe preparations of the plant for medical purposes.

Many welcomed this change, especially long term suffering patients struggling to cope with chronic pain and devastating side-effects caused by their mostly opioid based medication. Nonetheless, as the months went by, no educational campaign for patients or specialists was introduced by the local authorities. This information vacuum, together with high priced synthetic CBD oil (made legal in August 2017), built a wall between what the law was permitting and what the specialist was prescribing. Furthermore, inconsistencies with the law and the restrictive nature (available only for those suffering from Multiple Sclerosis) stalled the developments from the beginning. Patients started to question how come the law was permitting the use of medicinal cannabis but they were still being denied access, with some admitting to resort to illegal market products to control their pain.

As a response, on 27th November 2017, Health Minister Chris Fearne presented the Maltese House of Representatives with a Bill to amend the Drug Dependence Act. As reported by the local newspaper The Malta Independent, the proposed amendments – which are still under debate - include:

A licensed medical practitioner who is duly registered in accordance with the Health Care Professions Act, shall be entitled to prescribe to patients medicinal preparations of the plant cannabis and synthetic cannabinoid products licensed under the Medicines Act or manufactured under good manufacturing practice, if it is considered that there is no viable alternative to such prescription due account being taken of any protocols which may be in force from time to time in respect of the prescription of medicines, of the interests of the patient and of the costs. None of the preparations … may be indicated for smoking or in any form meant for smoking As per directions by the Superintendent of Public Health, medicinal cannabis preparations are only to be prescribed on a named-patient basis All licensed medical practitioners are entitled to prescribe medicinal cannabis; they must send an application for its use to a generic e-mail at the office of the Superintendent of Public Health. The application is then processed and if accepted, the prescriber, pharmaceutical wholesale dealer and the pharmacist receive a copy of the application endorsed by the Superintendent for Public Health

The amendments would allow a larger number of doctors the possibility to prescribe medicinal cannabis, however, they have also attracted criticism for their lack of detail on the different effects and benefits of delta-9-tetrahydrocannabinol (THC) and Cannabidiol (CBD) based products.

While THC is the psychoactive chemical in cannabis and presents usage both for medicinal and recreational purposes, CBD is non-psychoactive and poses no apparent risk. In November 2017, the World Health Organisation declared that “CBD exhibits no effects indicative of any abuse or dependence potential. Furthermore, to date there is no evidence of recreational use of CBD or any public health related problems associated with the use of pure CBD”.

Proponents of CBD access in Malta are frustrated by the proposed amendment’s lack of focus on CBD. Local medicinal cannabis advocates, Dr Andrew Agius, a family doctor with a specialisation in chronic pain management, and Mr Karistu Abela, a medicinal cannabis patient, have on numerous occasions spoke on the importance of specifying that CBD is a safe and non-psychoactive chemical. Mr Abela has explained how his life turned around with the use of natural CBD oil and pleaded with local authorities to recognize that CBD poses no risks to those who use it, and thus should not be heavily restricted or priced. As the House of Representatives continues to debate the proposed amendments, direct input and consultation with patients and key experts in the field of medicinal cannabis is pivotal for ensuring legislation provides the right balance between patient’s needs, financial realities, and strict regulation.

The positive developments in the field of medicinal cannabis are gaining substantial momentum. However, reluctance by local authorities to give patients central stage in the debate, and a clear lack of understanding of how CBD and THC relate to the body, is creating unnecessary legal and administrative hiccups. Ultimately, patients pay the biggest price as they continue to live in a state of uncertainty.

*Karen is a Maltese citizen, with a master’s degree in Conflict Resolution and Mediterranean Security and a keen interest in drug policy reform.