The Maltese National Focal Point is based within the Ministry for the Family and Social Solidarity and is part of the National Coordinating Unit on Drugs and Alcohol. It started its operations in June 2004 as a result of a Twinning Light Project with the Netherlands.
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Last updated: Friday, May 20, 2016
The second general population survey on drugs in Malta was conducted among a random sample of 1 869 people aged 18–65 in 2013, while the first dates back to 2001. As was also found in the 2001 study, cannabis use appears to be predominantly experimental in Malta. In 2013 about 4.3 % of respondents used cannabis during their lifetime, which is slightly more than was reported in 2001 (3.5 %). Lifetime use of illicit drugs other than cannabis was 1.4 % (ecstasy, amphetamines, cocaine, heroin, mephedrone, any new psychoactive substance or LSD), with ecstasy being the most popular among this group of substances. Drug use was more prevalent in younger adults, with lifetime prevalence of cannabis reported at 5.1 % among 18- to 24-year-olds.
To date, the European School Survey Project on Alcohol and Other Drugs (ESPAD) has been conducted five times among students aged 15–16. The lifetime prevalence rates of marijuana or hashish use were: 8 % in 1995; 7 % in 1999; 10 % in 2003; 13 % in 2007; and 10 % in 2011. Compared with other European countries, the prevalence rates for the use of cannabis and other illicit drugs were among the lowest, except for lifetime prevalence estimates for the use of inhalants (17 % in 1995; 16 % in 1999, 2003 and 2007; 14 % in 2011), which are high in relation to other European countries. In 2011 the lifetime prevalence rate for other illicit drugs was much lower than for cannabis, at 3 % for ecstasy, 3 % for amphetamines, 4 % for cocaine and 1 % for heroin.
Sedqa, the Maltese government’s executive agency in the drug field, has established a number of prevention interventions. Non-governmental organisations (NGOs) Caritas and the OASI Foundation also run a range of prevention programmes that target specific groups such as schoolchildren, peers, parents, the community and the workplace, while the Anti-Substance Abuse Unit within the Education Division also carries out interventions in the school environment. Few interventions are evaluated.
School-based prevention interventions begin at primary school level, continuing 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. Interventions in secondary schools are designed to develop life skills, self-esteem, decision-making and problem-solving skills, and resistance to peer pressure. The messages focus on reinforcing abstinence from 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. A new nationwide initiative, Leap Project, funded through the European Social Fund, was launched in 2014 and aims to consolidate the community resources and networks to address social exclusion issues. Two online services have been created where children and young people can ask for assistance and report any type of abuse (kellimni.com and Be Smart Online).
Selective prevention interventions are mainly school-based, and focus on students with high levels of absenteeism and those who have dropped out of school. Other interventions include outreach work targeting youths from disadvantaged neighbourhoods. Other target groups are young people in schools in deprived areas, juvenile inmates and young offenders. Interventions for these groups occur mainly as a result of referrals to drug treatment agencies. Appogg and Sedqa have brought together professionals from several fields and developed a project that aims to offer individual guidance and counselling to adolescents who are referred for support. The support offered by this project is also available to parents and partners of the young people referred to the services. The unit also offers crisis intervention where homelessness or abuse is involved. The programme aims to build a network of support by joining forces with other institutions and professionals that are involved with the young person in question.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use or long duration/regular use of opiates, cocaine and/or amphetamines. However, in 2012 a new definition of ‘high-risk drug use’ was adopted. The new definition includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances). Details are available here.
Capture–recapture methodology was used to estimate the prevalence of high-risk opioid users (including people receiving daily opioid substitution treatment) in Malta between 2010–14. The data includes clients registered each year as daily heroin or other opioid users attending the treatment services. It was estimated that there were 1 614 high-risk opioid users in 2014 (range: 1 500–1 759), which translates to a rate of 5.68 (range: 5.28–6.19) per 1 000 residents aged 15–64. This is considered to be an over-estimate by the national experts, mainly owing to the inclusion of high-risk opioid users in long-term opioid substitution treatment, who have a low probability of appearing in other data sources, which leads to the inflation of the resulting capture–recapture estimate.
All drug treatment providers, including five inpatient and six outpatient treatment units, two low-threshold agencies and three treatment units in prison, participate in the treatment data collection system. On the basis of that data collection system the total number of clients entering drug treatment in Malta in 2014 was 1 770, of whom 222 were new clients entering treatment for the first time. More than half of treatment clients entered outpatient specialised treatment units and around 50 % attended low-threshold units. A significant increase in all clients entering treatment has been reported between 2006 and 2013 (from 758 to 1 834); this increase might be related to an improvement in data collection and reporting, and enhanced coordination between services, with an improvement in referrals to treatment from several agencies.
In 2014 around 72 % of all clients entering treatment reported that heroin was their primary drug, followed by 16 % for cocaine and 9 % for cannabis. Among new treatment clients cocaine was the most frequently reported drug (38 %), followed by cannabis (30 %) and opioids (26 %). The share of heroin-using clients entering treatment system has been declining for some years, but 2014 was the first year in which the proportion of new treatment clients using cocaine and cannabis was higher than the proportion using heroin.
In 2014 more than half of all treatment clients, but less than a fifth of new treatment clients, reported injecting their primary drug, with heroin remaining the main drug injected in both groups.
In terms of gender, 83 % of all treatment clients were male and 17 % were female. Among new clients, females represented 18 %.
At present, the National Infectious Disease Surveillance Unit in the Department of Health receives notifications of positive cases from virology departments and prisons. Human immunodeficiency virus (HIV) only became notifiable in 2004. HIV cases linked to injecting drug use were notified in 2008 (two cases) and 2013 (three cases). The 2013 notifications were of particular concern due to the absence of such cases between 2009–12. In 2014, of a total of 40 new HIV cases, none were attributed to injecting drug use.
An additional information source is testing among those seeking treatment at the Sedqa outpatient treatment unit. In 2014 none of the 120 clients tested positive for HIV, 14.7 % of 143 people who inject drugs (PWID) tested positive for hepatitis C virus (HCV) and 1.8 % of 109 PWID tested positive for hepatitis B virus (HBV). In 2014 one acute and seven chronic cases of HCV infection were notified in Malta as linked to injecting drug use. In total, one acute and 13 cases of chronic HCV infection were notified for the year.
Information on drug-induced deaths in Malta is collected by the Department of Health Information in the National Mortality Register (NMR). These records are based on death certificates and toxicology reports. Another source of information on drug-induced deaths is the Police Special Registry, which collects information on all drug-related death cases. Malta complies with the EMCDDA definitions and recommendations to extract and report the cases from these sources. Efforts are under way to cross-validate the data between the two sources.
The annual number of reported drug-induced deaths has ranged from one to 11 over the past 15 years, and in the majority of cases the cause of death was opiates. In 2014 two drug-induced deaths were registered in the Police Special Registry, both of which involved opiates. The mean age of the deceased was 30 years.
The drug-induced mortality rate among adults (aged 15–64) was 6.9 deaths per million in 2014, which is lower than the most recent European average of 19.2 deaths per million.
In Malta there are five main drug treatment providers. Three of these services are provided and funded by the Government: Sedqa, the national agency against drugs and alcohol abuse, which is under the remit of the Ministry for the Family and Social Solidarity; the prison services (under the responsibility of the Ministry of Home Affairs and National Security at the time of the reporting); and the Dual Diagnosis Unit (DDU) within Mount Carmel Hospital, which falls under the responsibility of the Ministry of Health and Energy. Two NGOs, Caritas and the OASI Foundation, which are partially funded by the Government, also provide drug treatment in Malta, with the OASI Foundation active in Gozo.
These treatment providers deliver different types of treatment, which can be classified into several main categories: specialised outpatient services; low-threshold services, inpatient treatment programmes; detoxification treatment; and substitution maintenance treatment. NGO-based outpatient services offer long- or short-term support through social work, counselling, group therapy and psychological interventions, while low-threshold programmes offer day-care services.
There are three main inpatient units: a DDU within Mount Carmel Hospital, which offers help to drug users with mental health issues, including a special unit for females, and non-hospital based residential drug treatment programmes provided by Caritas for males and females. Therapeutic communities are provided by Caritas in San Blas, Sedqa and the OASI Foundation (in Gozo). All programmes offer a holistic, multidisciplinary approach to therapy in a communal living environment and aim to guide clients towards abstinence. Detoxification is offered through an inpatient unit run by Sedqa.
A centralised methadone treatment unit in Malta, the Substance Misuse Outpatient Unit (SMOPU), provides substitution treatment. Methadone maintenance treatment was introduced in 1987. 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. Opioid substitution treatment (OST) is also available in prisons. In 2014 a total of 1 013 clients were in OST, of which the majority (92 %) received exclusively methadone. The remaining patients in substitution treatment switched medication, including buprenorphine-based medications and dihydrocodeine, during the year.
One of the main objectives of the Draft National Drugs Policy 2008 is to achieve a high level of health protection and social cohesion by preventing and reducing drug-related harm to health and society. The policy’s aim is to provide the general public with information on the dangers of drug use and to promote ongoing public health campaigns. Harm reduction responses relate to the prevention of drug-related infectious diseases, and include access to clean injecting equipment, testing and counselling for infectious diseases such as HIV, HBV and HCV, risk awareness and HBV vaccinations. In 2009 a new Female Harm Reduction Centre for females who inject drugs was opened by Caritas to provide short-term intensive therapy to clients who cannot achieve abstinence in the short term; sheltered accommodation and protection from abuse and sex work is also provided.
Syringe distribution started in Malta in 1987 and reached a nationwide geographical coverage in 1994, with seven fixed locations across Malta. Since then, the number of syringes distributed annually increased steadily, from 22 000 in 1994 to 376 000 in 2012. In 2013 this trend changed for the first time, when the number of syringes distributed decreased to 358 000. In 2014 numbers decreased again to 314 000 syringes.
Cannabis is the only illicit substance cultivated locally, as a result of climatic conditions on the island. It is very easy to grow, even without artificial assistance. Home growers are not uncommon and commercial operations are occasionally discovered. Cannabis resin is imported from Tunisia and Libya. Heroin is imported from Turkey, North Africa or western European countries, cocaine is mainly smuggled through Schengen countries, particularly Spain, ecstasy and other amphetamines are imported from other European countries, particularly from the Netherlands. Malta has also become a recipient of new psychoactive substances.
The number of drug seizures almost doubled between 2009 and 2014. Cannabis was the most widely seized drug (176 seizures of herbal cannabis, 39 seizures of resin, and five seizures of cannabis plants), followed by 136 seizures of cocaine, 33 seizures of heroin and 31 seizures of ecstasy. Overall there has been an increasing trend since 2008 in the quantity of cannabis resin seized, with the exception of 2013, when the amounts of cannabis resin seized fell to 0.5 kg. In 2014 a total of 41.77 kg of cannabis resin was seized. With regard to herbal cannabis, the quantity seized rose to 69.5 kg and exceeded those reported between 2010 and 2013. Between 2001 and 2011 the amount of cocaine seized ranged from 0.15 kg to 21 kg; in 2012 a record amount of 143 kg of cocaine was seized, while in 2013 and 2014 a total of 3.6 kg and 5.27 kg of cocaine was seized in Malta. The amount of heroin seized fell sharply between 2008 and 2012 (from 8 kg to 1 kg). Each year between 2012 and 2014 a total of 1 kg of heroin was seized by law enforcement agencies.
In 2013 a total of 30 374 ecstasy tablets were seized, the highest number ever recorded. The previous high-volume seizure report dates back to 2009, after which a sharp decline in number of ecstasy tablets was reported in 2010–12. In 2014 a total of 334 tablets were seized in 31 seizures.
A considerable proportion of the crimes committed in Malta are assumed to be drug-related. This is especially true in cases of petty crime, such as thefts from vehicles, street robbery and other kinds of opportunistic thefts. Crimes that are more violent in nature are not normally associated with drugs. In 2014 the Malta Police Force arrested 537 people for drug-law offences. Of these, 407 were arrested for possession and 130 for supply. Most of the drug-law offences for possession were related to cannabis (213).
The principal pieces of legislation dealing with substance abuse in Malta are the Medical and Kindred Professions Ordinance (Cap. 31) concerning psychotropic drugs, and the Dangerous Drugs Ordinance (Cap. 101) concerning narcotic drugs, combined with the new Drug Dependence (Treatment not Imprisonment) Act 2014.
The illegal use of psychotropic and narcotic drugs is not, per se, recognised in Maltese law, although the use of these substances, if proven 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.
In April 2015 the Drug Dependence (Treatment not Imprisonment) Act 2014 came into force. Under this Act a person found in possession of a small amount of drugs for personal use will be tried in front of the Commissioner of Justice. If found guilty, there will be a fine of EUR 50–100 for cannabis or EUR 75–125 for other drugs. In the case of a second offence within the period of two years, the person will be required to attend the Drug Offenders Rehabilitation Board where they will be assessed for drug dependence and any necessary order may be made accordingly; failure to comply may be punished by a fine or three months in prison. A person found in possession of one cannabis plant, for personal use, will not be liable to a mandatory prison term. For a limited number of offences committed due to drug dependence, the Court may assume the function of a Drug Court, and refer the offender to the Drug Offenders Rehabilitation Board.
For supply offences, the range of punishment that may be awarded by the lower courts is six months to 10 years’ imprisonment, whereas the superior courts may award a maximum punishment of life imprisonment. 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 because these circumstances are deemed to be an aggravation of the offence. However, an amendment to the Dangerous Drugs Ordinance in 2006 allowed the court not to apply the mandatory prison term of six months if the offender intended to consume the drug on the spot with others. In 2014 the laws were further amended to guide the choice of prosecution of trafficking in a lower or superior court considering if the role of the offender was leading, significant or lesser, and defining quantity guidelines for ecstasy, LSD, amphetamine and ketamine. Courts may also opt for the lower punishment range if the higher range is considered disproportionate.
The first Maltese national drug policy document was adopted in February 2008. It aims to streamline the actions of government and non-government bodies responsible for delivering services to drug users. It seeks to: (i) improve the quality and provision of drug-related services; and (ii) provide a more coordinated mechanism to reduce the supply of and demand for drugs in society. The strategy’s main objectives are to ensure a high level of security, health protection, well-being and social cohesion. It is primarily concerned with illicit drugs, but it also considers the abuse of prescription medications. The strategy is built around six main pillars addressing: (i) coordination; (ii) the legal and judicial framework; (iii) supply reduction; (iv) demand reduction, including harm reduction; (v) monitoring evaluation, research, information and training; and (vi) international cooperation and funding. Forty-eight different actions are set out under these six pillars. A first progress review of the strategy was conducted in 2011.
The main body responsible for drug-related matters is the Advisory Board on Drugs and Addiction (part of the Ministry for the Family and Social Solidarity), which was set up when the National Commission on the Abuse of Drugs, Alcohol and other Dependencies became part of the Presidential Office. The seven members are independent experts from fields such as law, youth studies, education, clinical psychology, psychiatry, epidemiology and neuroscience. The National Co-ordinating Unit for Drugs and Alcohol, also within the Ministry, is responsible for the implementation of the National Drug Policy, while the main remit of the National Focal Point for Drugs and Drug Addiction is that of monitoring the situation and the responses, including the effectiveness of the actions put in place as a result of the national drug policy.
In Malta, the financing of drug-related activities is decided annually by the entities in charge of their implementation. The available information is very limited and does not allow the size and trends of drug-related expenditures to be reported.
The most recent estimate, for the year 2012, suggests that drug-related expenditure represented close to 0.08 % of gross domestic product, which means that Malta spent an estimated EUR 5 493 421 on drug reduction activities. However, what proportion this amount represents of the total drug-related expenditure is unknown.
Research is one of the sections of the current national drug policy, which recognises the need for adequate monitoring, collection and dissemination of information, periodical evaluation of policy measures, and ongoing research and training. The Advisory Board on Drugs and Addiction is responsible for all drug-related issues. The National Focal Point for Drugs and Drug Addiction, within the National Coordinating Unit on Drugs and Alcohol, 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. The President’s Foundation for the Wellbeing of Society hosts the National Centre for Freedom from Addictions, which is dedicated to research on drug-related issues. Drug-related research findings are disseminated by the national focal point through regular meetings with its network of partners, direct mailing to interested parties, via the media, and on the national focal point website. Recent drug-related studies focused primarily on prevalence, incidence and patterns of drug use.
|Problem opioid use (rate/1 000)||2014||5.68||0.2||10.7|
|All clients entering treatment (%)||2014||72.8%||4%||90%|
|New clients entering treatment (%)||2014||27.5%||2%||89%|
|Purity — heroin brown (%)||2013||21.0%||7%||52%|
|Price per gram — heroin brown (EUR)||2014||EUR 48||EUR 23||EUR 140|
|Prevalence of drug use — schools (%)||2011||4.0%||1%||5%|
|Prevalence of drug use — young adults (%)||:||:||0%||4%|
|Prevalence of drug use — all adults (%)||:||:||0%||2%|
|All clients entering treatment (%)||2014||15.9%||0%||38%|
|New clients entering treatment (%)||2014||40.3%||0%||40%|
|Price per gram (EUR)||2014||EUR 68||EUR 47||EUR 107|
|Prevalence of drug use — schools (%)||2011||3.0%||1%||7%|
|Prevalence of drug use — young adults (%)||:||:||0%||3%|
|Prevalence of drug use — all adults (%)||:||:||0%||1%|
|All clients entering treatment (%)||2014||0.2%||0%||70%|
|New clients entering treatment (%)||2014||0.0%||0%||75%|
|Price per gram (EUR)||2014||EUR 30||EUR 3||EUR 63|
|Prevalence of drug use — schools (%)||2011||3.0%||1%||4%|
|Prevalence of drug use — young adults (%)||:||:||0%||6%|
|Prevalence of drug use — all adults (%)||:||:||0%||2%|
|All clients entering treatment (%)||2014||0.9%||0%||2%|
|New clients entering treatment (%)||2014||0.0%||0%||2%|
|Purity (mg of MDMA base per unit)||2013||55 mg||27 mg||131 mg|
|Price per tablet (EUR)||2014||EUR 9||EUR 4||EUR 16|
|Prevalence of drug use — schools (%)||2011||10.0%||5%||42%|
|Prevalence of drug use — young adults (%)||:||:||0%||24%|
|Prevalence of drug use — all adults (%)||2013||0.9%||0%||11%|
|All clients entering treatment (%)||2014||9.0%||3%||63%|
|New clients entering treatment (%)||2014||31.8%||7%||77%|
|Potency — herbal (%)||2014||7.0%||3%||15%|
|Potency — resin (%)||2014||7.3%||3%||29%|
|Price per gram — herbal (EUR)||2014||EUR 23||EUR 3||EUR 23|
|Price per gram — resin (EUR)||2014||EUR 22||EUR 3||EUR 22|
|Prevalence of problem drug use|
|Problem drug use (rate/1 000)||:||:||2.7||10.0|
|Injecting drug use (rate/1 000)||:||:||0.2||9.2|
|Drug-related infectious diseases/deaths|
|HIV infections newly diagnosed (cases / million)||2014||0.0||0.0||50.9|
|HIV prevalence (%)||2014||0.0%||0%||31%|
|HCV prevalence (%)||2014||14.7%||15%||84%|
|Drug-related deaths (rate/million)||2014||6.9||2.4||113.2|
|Health and social responses|
|Syringes distributed||2014||314 027||382||7 199 660|
|Clients in substitution treatment||2014||1 013||178||161 388|
|All clients||2014||1 770||271||100 456|
|New clients||2014||222||28||35 007|
|All clients with known primary drug||2014||1 755||271||97 068|
|New clients with known primary drug||2014||211||28||34 088|
|Drug law offences|
|Number of reports of offences||2014||1||537||537||282 177|
|Offences for use/possession||2014||407||13||398 422|
b Break in time series.
p Eurostat provisional value.
: Not available.
1 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
2 Expenditure on social protection contains: benefits, which consist of transfers in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
3 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
4 Situation of penal institutions on 1 September, 2014.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
|Year||EU (27 countries)||Source|
|Population||2014||425 384||506 944 075 bep||Eurostat|
|Population by age classes||15–24||2014||12.9 %||11.3 % bep||Eurostat|
|25–49||33.9 %||34.7 % bep|
|50–64||20.9 %||19.9 % bep|
|GDP per capita in PPS (Purchasing Power Standards) 1||2014||84||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2013||18.7 %||:||Eurostat|
|Unemployment rate 3||2015||5.4 %||9.4 %||Eurostat|
|Unemployment rate of population aged under 25 years||2015||11.8 %||20.3 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2014||134.2||:||Council of Europe, SPACE I-2014.1|
|At risk of poverty rate 5||2014||15.9||17.2 %||SILC|
Ministry for the Family and Social Solidarity
LEAP Community & Resource Centre
72, Melita Street
MT -Valletta, VLT 1120
Tel. +356 2590 3324/86/78
Head of national focal point: Mr Carlo Olivari Demanuele
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