The last population survey among a random sample of 1,755 people between the ages of 18 and 65 years was conducted in Malta in 2001. The response rate was 68.3 %. The survey questionnaire was based on the European Model Questionnaire for surveys on prevalence of drug use in the general population developed by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), to which questions about lifestyle, gambling and service utilisation were added. The reported last year prevalence of cannabis was 0.8 % and of these 0.5 % were current users. The use of cannabis appears to be predominantly experimental. Lifetime experience with other illicit drugs other than cannabis was 1.2 % (including ecstasy, amphetamines, cocaine, heroin and/or LSD).

In 2008, prevalence questions (lifetime use, last year use, last month use and age of first use) on tranquiliser/sedatives, cannabis, ecstasy and cocaine use will be incorporated in the National Health Interview Survey (NHIS), conducted by the Department of Health Information among residents of the Maltese Islands aged 16 years and over.

To date four ESPAD studies have been conducted among students aged 15-16 years in Malta. In 1995 2 % admitted the use of illicit drugs at least once in their lives (lifetime prevalence rate). In 1999 this rate rose to 8 %, and in 2003 to 11 %, while in 2007 it stood at 15 % of students. The lifetime prevalence rates for marijuana or hashish were 8 % in 1995, 7 % in 1999, 10 % in 2003 and 13 % in 2007. The increase of lifetime prevalence of cannabis use over the four surveys is supported by the notion that the perception of ease of availability increased during the same period. Compared with other European countries, the prevalence rates of cannabis use and other illegal drugs are among the lowest, except for lifetime prevalence estimates for the use of inhalants, which are high in relation to other European counterparts. In 1995, 1999, 2003 and 2007 rates were 17 %, 16 %, 16 % and 16 % respectively. The lifetime use of other illegal drugs such as ecstasy, amphetamines, cocaine and heroin are much lower (4 %, 5 %, 4 % and 1 % in 2007) but an increase was also observed between 1995 and 2007. The full results of the ESPAD survey 2007 will be available in December 2008.

In 2006, a lifestyle survey was conducted among 18-24-year-old full time students in Malta and Gozo. As regards the use of any illegal drugs, lifetime prevalence was reported by 24.4 % of the respondents. 17.7 % reported use of any drug during the last year and 9.1 % use of any drug during the last month. Lifetime prevalence of cannabis was reported by 22.4 % of the respondents, last year prevalence was 16.0 % and last month prevalence 7.8 %. After cannabis, highest lifetime prevalence were respectively anabolic steroids (12.4 %), mushrooms (10.8 %) and tranquilisers without medical prescription (9.8 %). The use of tranquilisers during the last year was reported by 6.1 % of the respondents and by 3.4 % during the last month. Lifetime prevalence of cocaine was 5.9 % and last month prevalence for cocaine was 1.5 %.

Prevention

A number of prevention programmes have been established by Sedqa, the Maltese Government's executive agency in the drug field. In addition, the NGOs Caritas and OASI also have a range of prevention programmes in place that address specific target groups such as schoolchildren, peers, parents, the community and the workplace.

School-based prevention programmes commence from primary school level, with continuation into secondary schools. Universal prevention in primary schools focuses on friendship and peer pressure, with some introductory information on the possible problems tobacco and alcohol can cause. In secondary schools, a continuous focus on reinforcing non-use of tobacco, alcohol and drugs, with the aim of preventing the development of long-term harmful use of these substances. Universal family-based prevention programmes in an interactive environment generally tackle topics related to parenthood, such as leadership styles, communication, child development and discussions on drug and alcohol abuse. Community-based prevention programmes primarily target families and youth in different environmental settings, such as local councils, youth organisations, religious societies and social and political clubs. Furthermore, workplace-based programmes are organised with the aim of creating awareness among employees regarding substance misuse, and other social problems that could affect their personal, social lifestyles and their work performance.

Selective prevention interventions are mainly school-based, and focus on students with high levels of absenteeism and school drop-outs. Other interventions include outreach work targeting youths from disadvantaged neighborhoods. A new programme called 'Booster' commenced at the end of 2007. The aims of this programme are to identify students who are experimenting with drugs and to prevent early drug-taking from developing into more intense abuse.

The main target groups for indicated prevention are youth in vulnerable schools, juvenile inmates and young offenders. Interventions with this target group occur mainly as a result of referrals to drug treatment agencies. A new project called 'Budz' is an intensive non-residential programme aimed at treating adolescent drug users aged between 13 and 18 years.

Treatment demand

In 2006, the data collection system for treatment demand was provided by five treatment centres. These included outpatient and inpatient treatment centres, as well as the treatment units in prison. In 2006, the total number of clients entering treatment were 757, out of which 416 were first time treatment clients.

Data regarding treatment clients entering treatment for 2006 indicate that 76.2 % of all clients entering treatment reported that opioids was the primary drug, followed by 11.8 % for cannabis and 8.4 % for cocaine. Among first time treatment clients a similar trend was evident with 63.7 % for opioids followed by 19 % for cannabis and 11.7 % for cocaine.

Furthermore, in 2006, 48 % of all clients entering treatment were aged less than 25 years. A slightly higher percentage in age distribution was reported among new treatment clients, with 49.6 % under the age of 25 years. As far as gender distribution is concerned, 84.6 % of all clients entering treatment were male whereas 15.4 % were female. A similar trend in gender distribution was reported among first time treatment clients with 83.9 % for male and 16.1 % for female.

Drug-related infectious diseases

At present the National Infectious Disease Surveillance Unit in the Department of Health receives notifications of positive cases from virology departments and prison. HIV only became notifiable in 2004, and notifications from the detoxification unit in Malta where the majority of testing for drug users takes place are not included. The data is collected during anonymous testing among those seeking treatment at this detoxification unit. However the data does not provide any prevalence or incidence rate as it includes those who had 'ever been tested'. Considering these biases, the most recent available information on HIV/AIDS, hepatitis C virus (HCV) and hepatitis B virus (HBV) among injecting drug users (IDUs) is derived from the methadone dispensing Substance Misuse Outpatients Unit (SMOPU) and prison unit (CCF). The ratio of IDUs (ever IDUs) to the total number of HIV positive cases registered in Malta for 2006 was 0 % (175 valid tested persons out of 622). The infection rates among IDUs (ever IDUs) were 0.1 % (1 case) for the HBV antigen (151 valid tests out of 622) and 33.1 % for HCV (1151 valid tests out of 622) in 2006. Procedures are underway to improve this data source in the future.

Drug-related deaths

Information on drug-related deaths is collected by the Department of Health Information which constitutes the General Mortality Register in Malta. The department also has a framework for cooperation with the EU and with Eurostat, and thus all deaths are coded based on the ICD-10 and have been recorded in this manner since 1995. The records are based on details from death certificates which are also cross-checked with toxicology reports. The yearly number of drug-related deaths ranges in Malta from one to nine over the last 13 years (five in 2003, six in 2004) and in the majority of cases the cause of deaths was opiates. Another source of information on drug-related deaths is the Police Special Registry, and efforts are underway to cross-validate the data between the two sources. In 2006, seven drug-related deaths were registered. As regards the distribution by age and sex, the majority of DRD cases were men (five cases out of seven) and the mean age was 26.8 years.

Treatment responses

In June 2007, the National Drug Policy was published for consultation purposes, and it is envisaged that it will be launched in the first quarter of 2008. Drug treatment in Malta is delivered by Sedqa, the National Drugs Agency, the Substance Abuse Therapeutic Unit, the Dual diagnosis Unit and the Corradino Correctional Facility. These four services are fully funded by the government. Furthermore, two NGOs, namely Caritas and Oasi Foundation, which are also partially funded by the local government, provide drug treatment in Malta, with the latter being active in Gozo.

These six treatment providers deliver different types of treatment, which can be classified into four main categories: outpatient community services, rehabilitation residential programmes, detoxification treatment and substitution maintenance treatment.

There are seven community outpatient services, which offer long- or short-term support through social work, counselling, group therapy and psychological interventions to persons with a drug problem. In terms of rehabilitation programmes, there are two main residential programmes, a two-year programme provided by Caritas, and an 18-month programme provided by Sedqa. Both programmes offer a holistic, multi-disciplinary approach to therapy in a communal living environment and aim to guide clients towards abstinence. Furthermore, the Oasi Foundation provides a short-term residential programme followed by Continued Care Sessions. The same foundation also offers day programmes.

Substitution treatment is provided by a centralised methadone treatment unit in Malta, the Substance Misuse Outpatient Unit (SMOPU). The Craig Hospital in Gozo also offers methadone treatment. Methadone maintenance treatment was introduced in 1987, and in 2005 there were a total of 671 clients in opioid substitution treatment. Furthermore, in 2005, take-home methadone prescriptions were introduced, and in 2006 treatment with buprenorphine began, in addition to methadone. Buprenorphine is given as a take-home dose, and is available by prescription from either SMOPU or a general practitioner. In Malta, substitution treatment is mainly initiated and administered by treatment centres, and only a few general practitioners offer substitution treatment.

Harm reduction responses

One of the main objectives of the Draft National Drugs Policy 2007 is that of achieving a high level of health protection and social cohesion, by preventing and reducing drug-related harm to health and society. The policy's actions in this sense aim to provide the general public with information on the dangers of drug use and to promote ongoing and public health campaigns. Harm reduction responses as they relate to the prevention of drug-related infectious diseases in Malta include access to clean injecting equipment, testing and counselling for infectious diseases, as well as risk awareness and HBV vaccinations. Since syringe distribution started in Malta in the 1980s, reaching nationwide coverage in 1994, the number of syringes distributed yearly has risen steadily, with an increase of 1.4 % in 2005 compared to 2004, and of 2.5 % in 2006 compared to 2005. Most syringes were distributed from health centres in the Southern and Northern Harbour regions of Malta. One particular health centre in the Southern Harbour Region distributed 30 % of all syringes. In 2006, about 230 000 syringes were distributed in Malta. Although the syringe distribution programme works well, the needle-exchange practice, that existed briefly and failed in 2002, was never re-implemented.

Drug markets and drug-related offences

Cannabis remains the most used illicit drug in Malta, and this is explainable by the fact, as a result of the climatic conditions on the island, it is very easy to grow cannabis even without artificial assistance. Home growers are not uncommon, and commercial operations are discovered from time to time. Cannabis resin on the other hand is imported from Morocco. Heroin is imported from Turkey and from North Africa, while cocaine, ecstasy and other amphetamines are imported from other European Countries, particularly the Nederlands. Furthermore, Malta has also become a recipient for New Psychoactive Substances. In 2006, 1-benzylpiperazine (BZP) and 1-(3-chlorophenyl) piperazine (mCPP) tablets were detected.

In 2006, the majority of drug seizures were for cannabis resin, with a total of 39 % followed by heroin (24 %) and ecstasy tablets (20 %). However, there was a decrease in the total number of seizures in 2006 when compared to 2004 and 2005. The amounts of drugs seized in 2006 were comparatively three times higher than 2005.

A considerable proportion of the crimes committed in Malta are assumed to be drug-related. This is especially true in the case of petty crime such as thefts from vehicles, snatch-and-grabs and other kinds of opportunity thefts. More violent crimes are normally not associated with drugs. In 2006, the Drug Squad of the Malta Police Force made 544 arrests for drug related offences.. Among these arrests 445 persons were charged, 76 % for possession, 15 % for trafficking and 9 % for a combination of trafficking and possession. Most possession cases related to cannabis, with 40.8 % of possession charges and heroin, with 33.4 % of possession charges.

National drug laws

The illegal use of substances is not, per se, recognised in Maltese law, although use of these substances, if proved in court, will lead to a conviction for possession or trafficking. Maltese law recognises two kinds of possession: simple possession, or possession for personal use; and aggravated possession or possession not for the offender's exclusive use.

The Attorney General must, possibly before the initiation of criminal proceedings, decide whether the offender is to be tried before the lower courts or before the superior courts. Punishments vary accordingly. For example, the maximum punishment that may be awarded by the lower courts is ten years' imprisonment, whereas the superior courts may award a maximum punishment of life imprisonment.

Non-criminal sanctions are not contemplated by Maltese law, yet the laws do provide certain non-custodial sanctions in minor cases. For example, the court may order drug addicts to undergo treatment for their addiction by way of punishment. Drug trafficking carries a penalty of life imprisonment unless exceptional circumstances are proved. When certain offences take place within 100 metres of the perimeter of a school, youth club or centre, or such other place where young people habitually meet, the normal punishment is increased in that these circumstances are deemed to be an aggravation of the offence.

National drug strategy

The first Maltese national drugs policy document was adopted in February 2008. The policy has no timeframe, and its focus is on illicit drugs and also the misuse/abuse of licit substances (medication). The goals are in line with the EU drug strategy: to ensure a high level of protection to the general public and a high level of health protection, well-being and social cohesion. Operational objectives are to improve the quality and, where necessary, increase the provision of drug-related services, and to provide for a more coordinated mechanism through which the supply and demand for drugs are reduced. The policy includes 48 actions, and covers coordination, legal and judicial framework, supply reduction, demand reduction, monitoring, evaluation, research, information and training, and international cooperation.

Coordination mechanism in the field of drugs

The main body responsible for coordination of drug related matters is the National Commission for the Abuse of Drugs, Alcohol and other Dependencies, which resides in the Ministry for Social Policy. The seven Commission members are independent experts from various fields such as law, youth studies, education, clinical psychology, psychiatry, epidemiology and neuroscience.

Drug-related research

Research is one of the sections of the current National Drugs Policy which recognises the need for adequate monitoring, collection and dissemination of information, periodical evaluation of policy measures, and ongoing research and training. The National Commission on the Abuse of Drugs, Alcohol and Other Dependencies, which resides in the Ministry for Social Policy, coordinates all drug-related issues. The national focal point is responsible for gathering the necessary information to support the policy cycle, and to monitor the drug situation and the responses. Both governmental and university departments play an important role in undertaking research, which is mainly funded by the state budget. Drug-related research findings are then disseminated by the National Focal Point through regular meetings with its network partners, through the use of a mailing list, the media and the national focal point website.

Note: The full EU-wide annual report by the European Monitoring Centre for Drugs and Drug Addiction may be downloaded by clicking this link.