Country overview: Malta
- Situation summary
- Data sheet
- Barometer
- Drug use among the general population and young people
- Prevention
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-related offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Drug-related research
| Year | Malta | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2010 | 412 970 | 501 105 661 p | Eurostat | |
| Population by age classes | 15–24 | 2010 | 14.0 % | 12.1 % p | Eurostat |
| 25–49 | 34.2 % | 35.8 % p | |||
| 50–64 | 21.4 % | 19.1 % p | |||
| GDP per capita in PPS (Purchasing Power Standards) 1 | 2009 | 81 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 2 | 2008 | 18.9 % | 26.4 % p | Eurostat | |
| Unemployment rate 3 | 2010 | 6.8 % | 9.6 % | Eurostat | |
| Unemployment rate of population aged under 25 years | 2010 | 12.9 % | 20.9 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 4 | 2009 | 119.4 | Council of Europe, SPACE I-2009 | ||
| At risk of poverty rate 5 | 2009 | 15.1 % | 16.3 % | SILC | |
p Eurostat provisional value.
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, 2009.
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).
Drug use among the general population and young people
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 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).
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. In 2006, a lifestyle survey was conducted among 18–24-year-old full-time students in Malta and Gozo. With regards to the use of any illegal drugs, lifetime prevalence was reported by 24.4 % of respondents. 17.7 % reported use of any drug during the last year and 9.1 % the 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 tranquillisers without medical prescription (9.8 %). The use of tranquillisers 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 neighbourhoods. 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. Appogg and Sedqa have joined teams of professionals and have developed a project which aims to offer individual guidance and counselling to adolescents who are referred for support. The support offered in this project is extended to parents and significant others of the young person referred for services. The unit also deals with Crisis Intervention in situations of homelessness or where abuse is involved. The programme also aims to build a network of support by joining forces with other institutions and professionals who may be involved with the young person in question.
Problem drug use
Using the capture–recapture methodology to estimate the prevalence of problem drug users (as per the EMCDDA definition), the data, based on which problem drug use in Malta was estimated, concerns active clients registered in 2006 as ‘daily heroin users’ attending the centralised detoxification/substitution unit (Sedqa) and two outpatient community services (Caritas and OASI). The estimate is 1 606 problem heroin users (range: 1 541–1 685), resulting in a rate of 5.7 (range: 5.5–6.0) problem drug users per 1 000 persons aged 15–64 years. Since 2004, figures have been relatively stable.
The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
Treatment demand
In 2009, 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 2009, the total number of clients entering treatment was 1 792, out of which 250 were first time treatment clients.
Data regarding treatment clients entering treatment for 2009 indicate that 83.4 % of all clients entering treatment reported that opioids was the primary drug, followed by 10.0 % for cocaine and 5.5 % cannabis.
Among first-time treatment clients, 46.3 % reported opioids as their primary drug, followed by 30.9 % for cocaine and 19.5 % for cannabis.
Furthermore, in 2009, 26 % 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 57 % under the age of 25 years. As far as gender distribution is concerned, 85 % of all clients entering treatment were male whereas 15 % were female. A similar distribution in gender distribution was reported among first time treatment clients with 86 % for male and 14 % 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 are 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). . In 2009, no HIV infections were found among 125 tested IDU. None out of 93 tested IDUs tested positive for hepatitis B virus. However, 30.8 % out of 121 injecting drug users tested positive for HCV.
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 under way to cross-validate the data between the two sources. In 2009, six drug-related deaths were registered. With regards to the distribution by age and sex and the majority of DRD cases were men (five cases out of six).
Treatment responses
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. 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 2009, there were a total of 1 099 clients in opioid substitution treatment, 977 of them receiving methadone, and 42, buprenorphine. 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 2008 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. 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 distributes 30 % of all syringes. In 2009, about 309 000 syringes were distributed in Malta. Although the syringe distribution programme works well, the needle-exchange practice, which 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 that, as a result of 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 Netherlands. 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 2009, approximately 100 seizures were for cannabis and 102 for cocaine, followed by seizures for amphetamine. In comparison with previous years, there is a significant increase in the number and amount of seized herbal cannabis — in 20 seizures, 458 kg of the substance was seized. The number of seizures and quantities of cannabis resin and cannabis plants seized in 2009 are lower than in previous years. In the period from 2001 to 2006, the quantities of seized cocaine remained stable between 3–5 kg seized annually (except in 2004, when a small amount was seized). However, in 2008, the record amount of 21 kg of cocaine was seized. In 2009, the quantities of seized cocaine attenuated to 16 kg. Likewise in 2008, eight kilograms of heroin was seized in 2009. In 2009, in total 21 682 ecstasy tablets were seized, which is the highest amount of ecstasy seized in the country.
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 2009, the Drug Squad of the Malta Police Force made 623 arrests for drug-related offences. Among these arrests, 74.2 % were for possession and 25.8 % for trafficking. Most of the arrests related to cocaine and heroin.
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 10 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. 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
A first ever Maltese national drugs policy document was adopted in February 2008. The policy has no timeframe while its focus is on illicit drugs and the misuse/abuse of licit substances (medication). The goals are the same as in the EU drug strategy: ensure a high level of security 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 appropriately reduced as much as possible. 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 drug-related matters is the National Commission for the Abuse of Drugs, Alcohol and other Dependencies, which resides in the Ministry for Education, Employment and the Family. The seven Commission members are independent experts from various fields such as law, youth studies, education, clinical psychology, psychiatry, epidemiology and neuroscience. The newly set up National Co-ordinating Unit for Drugs and Alcohol within the Ministry is responsible for the implementation of the National Drug Policy while the National Focal Point for Drugs and Drug Addiction main remit is that of monitoring the situation and the responses such as the effectiveness of the actions put in place as a result of the National Drug Policy.
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 Education, Employment and the Family, and is responsible for all drug-related issues. The National Focal Point for Drugs and Drug Addiction 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.
