NEWS | Wednesday, 15 April 2009

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In January, the government of Malta published its first-ever National Drugs Policy. Raphael Vassallo leafs through the strategy document, and asks if it was really what the doctor ordered

In Steven Soderbergh’s Traffic (2000), Michael Douglas’ character at one point utters: “If there is a war on drugs, then many of our family members are the enemy. And I don’t know how you wage war on your own family.”
The film focuses almost entirely on the United State’s “war on drugs” – a term first coined by President Richard Nixon in 1969, though it reached a world audience arguably in the first half of the 1990s under George Bush Sr.
Malta’s own war on drugs may not cover quite the same terrasin, or even use similar overall tactics. But the South American coca lords featured in Traffic are ultimately behind the networks that bring cocaine into Europe as much as America; while most of the heroin that winds up in Europe tends to originate from the same opium fields of Afghanistan.
Indeed there are few international industries as thoroughly globalised as the world drugs trade. Crime, after all, recognises no international frontiers, and drug trafficking in particular has proved remarkably resilient to even the most concerted international law enforcement efforts.
But for all these similarities, the reality at street level appears to differ vastly from country to country – even within international blocs that share the same data and resources, such as the European Union.

Know your enemy
EU membership has affected Malta in many ways: not least in its approach to the so-called “war on drugs”.
Malta is now anchored within an information-sharing network that has greatly facilitated local law enforcement efforts (evidenced, among other things, by increases in the quantity of illicit drugs seized). More to the point, it was to conform to the Union’s generally accepted norms and policy directions that Malta started seriously collating its drug-related data and information in the first half of this decade.
The first step in any war is to “know your enemy”, and this task falls to The National Commission on the Abuse of Drugs, Alcohol and Other Dependencies: an entity answerable to the education, justice and social policy ministers.
This multi-pronged task-force produces regular reports on the drug situation in Malta, which in turn from the local basis for international data collecting initiatives such as The State of the Drugs Problem in Europe 2007 – a report compiled by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
The results of these studies are almost invariably the subject of controversy, especially insofar as the media are concerned. In their efforts to distil the largely technical reports for juicy titbits, newspapers are often guilty of oversimplifying the results: focusing only on individual details, such as apparent increases in heroin fatalities, or more recently (see full report on p6) misinterpreting statistics to suggest increases in marijuana use among specific age-groups.
So much so, that reactions to the NCADAD 2005 National Report on Drugs prompted the Social Policy Ministry to issue a statement in defence of Malta’s drug policy at the time.
“Regarding heroin problem drug use, Malta falls within the group of countries that include Italy, Portugal, Luxembourg, Denmark and the United Kingdom,” the Ministry stressed, adding that the lowest rates for heroin problem drug use are reported by Holland, Germany, Finland, Greece and Poland.
“Although Malta appears to be in the top group as far as heroin drug use is concerned, the problem has been addressed to date by having an easily accessible treatment centre, namely Detox, subsequent rehabilitation and other programmes.”

Shifting strategies
With hindsight, it is understandable that the Ministry would be concerned about possible interpretations of these statistics.
Since EU accession in 2004, the picture of Malta’s drug use landscape began to unfold in a much clearer way than ever before. But at the same time, the National Commission was also in the process of preparing the country’s first-ever National Drugs Policy issued in January 2009. Any perception of a progressive worsening of Malta’s drug problem would automatically entail a rethink of this strategy before it was even published.

Heroin up, hash down?
The 2007 EMCDDA report, in conjunction with the more recent NCADAD report and last year’s ESPAD survey, certainly appears at a glance to cement perceptions of a gradual worsening of the local heroin problem... though the figures are open to some interpretation on account of economies of scale.
Malta weighs in among the EU countries with the highest rates of problem heroin use and heroin-related deaths, with an estimated 5.8-6.7 cases per 1,000 persons aged 15 to 64. Owing to differences in the methods of information gathering, it is not possible to make direct comparisons between individual countries: but the mean average for the rest of Europe was only between 2.2 and 2.8 cases, making Malta’s heroin dependency rate considerably the highest in Europe. (Having said that, the same study also observes that figures have been relatively stable since 2004.)
More worryingly, a comparison between statistics for recent years shows that in 2005, the number of individual heroin users receiving drug treatment was 12% higher than that of 2004, and 19% higher than 2003. Likewise, 38% of first treatment clients in 2005 were aged 15-19. This latter statistic in particular suggests that heroin enjoys continued popularity among young users; contrasting starkly with the trend for most of Western Europe, where the Ministry’s own 2005 view was that “heroin is no longer considered to be the ‘in’ drug and these countries are now shifting to other drugs of choice, such as stimulants, cocaine, amphetamine and ecstasy.”
Conversely, the scenario for cannabis – classified in many European countries as a “softer” drug – appears to be opposite in three separate indicators: those who report having used the drug once in a lifetime; those who reported using the drug once last year, and those who used cannabis once in the last four weeks.
In all sectors, Malta’s reported use of cannabis (total average: 13%) was considerably lower than the EU average.
On the other hand, both the use of inhalants (16%) and the use of pills in combination with alcohol (11%) are almost double the European average, while the non-prescription use of tranquillisers or sedatives (5%) is about the same as in many other ESPAD countries.

Treatment triumph
In this context, it is unsurprising that the results would fuel wildly speculative media reports. But while the EMCDDA report appears to suggest that local drug trends are diametrically opposed to those of the rest of Europe, it says little about the success or otherwise of Malta’s drug strategy.
One little-known fact that also emerges from these studies is that Malta has registered far more encouraging results from its drug addiction therapy programmes than other EU countries.
Our rate of treatment of heroin users is much higher than the EU average, with drug rehabilitation agencies estimating that two thirds of heroin users are currently in treatment. More significantly, the average time between first use and seeking treatment is around four years: twice as low as that the European average of eight years.
But this must be counterbalanced against the relatively high incidence of relapsers, especially in prison. Recent PQs reveal astonishing high levels of return inmates with drug problems (some registering more than 18 prison sentences), suggesting that while rehab appears to be working, problems quickly surface upon re-integration with society.
Charles Miceli, who runs the Dar Sant’ Anna rehabilitation centre in Bahar ic-Caghaq, explained that addiction treatment in itself may be ineffective without parallel structures to accommodate successful candidates back into society.
“It’s like preparing fish for life in an aquarium, but then throwing them back into a polluted sea,” he said.

Co-ordinating resources
It was within this overall framework that the National Drugs Strategy was launched earlier this year. Purporting to contain 48 “actions”, the policy document represents the clearest and most comprehensive collation of the various consultation processes with stakeholders to date.
Generally, its scope and purpose falls within the declared aims and objectives of the European Union. On closer inspection, however, most of the proposed “actions” turn out to be largely continuations of past policies – including the same policies which have led to the prevailing status quo – together with a general refining of administrative procedures.
For instance, Action 7 stipulates that “the National Focal Point for Drugs and Drug addiction shall continue to monitor the drug situation in Malta”. This does not represent any new strategy direction at all: in fact is such a self-evident statement that it scarcely needed to be included in the first place.
The same could be said for Action 10: “(Government shall) continue to supply its National Law Enforcement Body with the necessary to develop its technical and human resources”... although to be fair, the “National Law Enforcement Body” itself represents a step away from the current regime, which divides its efforts to combat illicit drug trade among several separate agencies, which currently include the Malta Police forces, The Armed Forces of Malta, and also the Customs Department, among others.

High time for a rethink
Elsewhere, the National Drugs Policy identifies a number of shortcomings, though it remains to be seen whether the proposed realignments will actually make any difference.
One example involves the Dangerous Drugs Ordinance – the main article law governing illegal drugs – which has long been criticised for being too vague in its definitions. The new strategy acknowledges the need for an update, but the proposals aim only to change the annexed schedule to include ‘newer drugs’ which are now available on the market.
There appears to be no corresponding revision to address the issue, made apparent by the above reports, of a flawed perception of the social and health risks posed by individual drugs.
However, it seems the three ministries involved in the so-called “war on drugs” now recognise the need to overhaul individual areas of their previous approach. Among the actions to strengthen the juridical framework, for instance, the policy contemplates setting up a “Drugs Court” – an idea first suggested by NGOs involved in rehabilitation.
Drug courts are highly specialised courts which, according to agencies, have been scientifically proven to significantly reduce drug use and crime.
At present the juridical system offers few reliable distinctions of relevance to the issue, and it generally falls to individual magistrates to interpret the law accordingly. The establishment of a Drugs Court therefore represents an entirely new direction in Malta’s national drugs strategy: however, it remains to be seen how effectively it can be implemented. Social workers who spoke to Midweek about the idea all concurred on the need for a Drugs Court, but some were openly sceptical.
“Talking about something that in reality does not have a chance to get off the ground is a waste of time and distracts people from thinking of alternative solutions,” was psychotherapist Mariella Dimech’s reaction.
Perhaps of greater long-term significance, however, is an apparent corresponding change in law enforcement policy. For the first time in any public document on the subject, Malta’s National Drug Policy gives equal importance to Supply and Demand Reduction - marking a clear departure from the Malta Police Force’s previously declared strategy that by adopting a “zero tolerance’ attitude to the supply issue, the demand would automatically be
curtailed.
Instead, the government now envisages awareness campaigns and programmes at schools.
This is admittedly not an entirely new strategy, as efforts to reduce demand have been undertaken before. But the idea of incorporating prevention and cure as two equally important facets of the same strategy is nonetheless innovative in local policy-making. It seems that enforcement agencies have taken on board the message, so often relayed by other stakeholders, that their previous “zero tolerance” approach is no longer sufficient on its own.
Perhaps, like Michael Douglas, we have realised that “war” is inevitably more complex than it at first appears.

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