The changes to the law which allows the “responsible use of cannabis” within limits have not normalised cannabis use, nor do they encourage people to start consuming the drug, Policy, Research and Harm Reduction manager Karen Mamo said.

Mamo is among the team in the recently established authority for the Responsible Use of Cannabis (ARUC), after government made amendments to the law, allowing personal possession of up to 7g of cannabis, as well the cultivation of up to four plants for personal use.

The authority, which started its operations last year, is now acting as a regulator for the newly-established Cannabis Harm Reduction Associations, where users can obtain a safe, tested, cannabis product.

Mamo, whose background is in policy and international relations, researches drug policy in her profession, aside from her role in the authority. Her main area within ARUC is to build, from zero, the Harm Reduction Department, something new for Malta.

“Although harm reduction was introduced in the early 90s, it was only applied to heroin. What we tried to organise and establish within the authority at a national level is something very new,” she said.

Mamo’s role is conducting research and explaining to authorities, as well as the general public, how the country is moving away from a strict zero-tolerance approach, to a harm reduction and human rights perspective, matched to the Maltese situation and needs.

The authority’s current work is on harm reduction and defining harm reduction not only in the health aspect, and reducing risks related to health, but also “provide information about risks and dangers associated to the law, and how policy treats the person”, Mamo said.

“A decriminalised model, mostly for a person to be able to possess cannabis without being criminalised, falls under a harm and risk reduction approach, and as a society we are preventing a person from being plagued by the justice system,” Mamo said.

She said that ARUC is not only a regulator, but also acts as an educational hub, as through social media, preventive messages, collaboration with Sedqa and at a later stage, the authority will also be meeting the community, a human rights approach is further adopted.

Mamo said that the authority will dialogue with people who use cannabis, to promote responsible use, without people having to fear being targeted by law enforcement.

 

Listening to the community

“The authority wants to listen to the community, to listen to what is working, what is not, and to learn. At the end of the day, people who use and cultivate cannabis are the experts in this field,” she said.

Asked about the authority’s work once the associations start operating, Mamo said that the authority is currently building the training modules for the founders, key administrators and key officers of the associations.

Around 10 modules will discuss different topics around cannabis, including health, psychology, well-being and more, she said. Mamo continued that the idea is to responsibilise the people within the associations through a strong training system, with a certificate in Harm and Risk Reduction, which needs to be re-stamped each year.

There will also be top-up courses, especially for people working on the ground, Mamo said, adding that while the grower will not need an intensive approach, they will still be invited.

 

Future risks

Mamo was asked about expected future risks which could arise, to which she said that this is a new authority, in a new field.

“There was already lotto, and the lottery, when the Gaming Authority was established, so there was already a social acceptance. We are trying to advance into a human rights approach, in an environment which was stigmatised for so long, so problems will definitely arise,” Mamo said.

She said that there are risks related to the industry getting a hold of the regulatory framework, removing the non-for-profit element. Other risks include people trying to abuse the system.

“The more the authority dialogues with foreign partners, especially countries who have been regulating or are moving to regulate cannabis, the more our operations and guard against any risks are strengthened,” Mamo said.

Mamo was asked if she believes that cannabis use could significantly shoot up once the associations start operating.

She said that there were mixed results in statistics gathered by foreign countries that have adopted different models for cannabis use. Countries, which have a commercial model and allow marketing, have shown different realities and prevalence than those who do not, Mamo said.

“Our national legislation tried to prevent these things, by continuing to invest in preventive services, but also by prohibiting marketing and any form of market capture by the associations, a first of its kind,” Mamo said.

She continued that in fact, for other commodities such as alcohol, tobacco or the gaming industry, one can observe different legislations allowing different levels of marketing.

“A restriction on marketing further strengthens the role of public health before profit and ARUC’s commitment to promote a responsible cannabis environment for both people who use, but also people who will form a Cannabis Harm Reduction Association,” Mamo said.

 

Huge gamechanger

She described it as a “huge gamechanger” from a health perspective taking into consideration different aspects of the law, which will prevent from promoting increased use.

“The law and the authority were not established to attract or encourage more users but are only there to prevent current users from ending up in prison or buying a horrible product from the illicit market,” Mamo said, adding that it also tries to encourage people to shift from the illicit market to the associations.

One argument often raised when cannabis is being discussed, is that by making it acceptable by law, it is inherently still encouraging new users, despite the authority’s intention not to promote it.

Mamo disagreed, explaining that cannabis has been increasing in use not just in Malta, but throughout the world.

“In countries where cannabis is mostly prohibited, you find increased use. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) European Drug Report of 2022 explains that cannabis use is at 44% in France, in Malta it is 4%. Legal changes have not normalised cannabis use, this is a misunderstanding,” she said.

Mamo said that it is important to highlight that Malta has not legalised cannabis and that there is a difference between regulation and legalisation.

‘‘It is very restricted, especially when compared to other commodities such as alcohol; the partial decriminalisation of cannabis has only given basic legal tools to shield people from unnecessary brushes with the law or the purchase of a tampered or synthetic product,” Mamo said.

She explained that a person can walk into a bar and buy an unlimited amount of beer and spirits. Yet, a person who uses cannabis will only be allowed to obtain up to 7g per day and not more than 50g per month.

 

Informed approach

“Yes, growing cannabis plants might seem strange, but it is one of the key tools to effectively disrupt the monopoly of criminal organisations involved in the cross-border trafficking of drugs,” Mamo said, adding that allowing home growing empowers people who use cannabis to take an informed approach to their cannabis consumption.

She said that individuals continue to be decisive to implement drug policy reform founded on harm reduction principles.

Mamo said that hundreds of people continued to end up in prison for cannabis consumption, mentioning the case of Daniel Holmes, a man who was arrested in 2006 at his Gozo flat, where he was growing cannabis plants that he said were for his personal use.

Holmes was given a 10-year sentence for the offence. Mamo said that those are the risks the law tries to tackle.

“I cannot understand why, all of a sudden, there is the perception that people who do not consume cannabis would get interested in consuming by bringing up the argument that it is now okay to start using cannabis because the law permits it,” she said.

Asked if perhaps people were interested in consuming cannabis before, but were afraid they would be persecuted by police, Mamo posed another question.

“Would it be better to have someone facing a court case for 10 to 15 years for the possession and non-violent act of consuming a mild-altering substance which has a lower risk than alcohol and tobacco, than having a law which is not promoting, but protecting you within limits to consume it in a responsible way?” Mamo asked.

She compared the Maltese model to that of other countries adopting a commercialisation approach and emphasised that Malta has a strong regulatory framework with a bottom-up approach.

 

Problematic use of substances

Mamo spoke about Spain, where it tried to implement a strong law including social justice, but was shot down by government.

“In Barcelona, there are hundreds of clubs, some of them have set guidelines adhering to public health, others don’t. When there is no law, it’s a jungle. No testing, no control of what comes in and what comes out. That will not be the case in Malta,” Mamo said.

She added that a member must only be part of one association, register in a centralised database, for government to monitor not the person, but the amount each person is consuming and the type of cannabis.

“This information is missing. We only have the National Report on Drugs as statistics, which only looks at the problematic use of substances, not merely use,” Mamo said.

She continued that if there was a 2% increase of people using cannabis, it did not reflect those who are using, but the people going into treatment within government-established systems, also excluding private clinics.

“Now, the association will have a better picture of who the people using cannabis are, what type of cannabis they are using and at what amounts. Maybe in the weekend they use more, or less, or in different potencies,” she said.

Mamo said that results will help the authority and Sedqa to develop better preventative tools and harm reduction messages.

“Deterrence tools, such as the Zero Tolerance approach, were always presented as something that works, but unfortunately statistics show that this approach does not work – it creates a lot more harm than actually preventing them as it criminalises a large portion of the population for a non-violent victimless crime,” Mamo added.

 

Public health approach

She said that after years of the so-called “war on drugs”, most countries are now taking a public health approach, providing educational tools and health services treatment to help the person without imposing.

Mamo said that education is key when it comes to where people can make use of cannabis and adults should be responsible enough to know not to consume cannabis around children or in the time they need to take care of children.

“The same laws and rules apply for alcohol and tobacco. Yes, we should educate, but we should also be careful not to point fingers and continue to stigmatise,” Mamo said, adding that educating people to be respectful towards others is important.

She also spoke about a misconception of passive smoking, saying that just because one smells cannabis while walking outdoors in an open space, does not mean that it will affect you passively.

However, one needs to highlight that the law prohibits public consumption and the fine is heftier if consumption is done in front of a minor, Mamo continued.

“We need to be more respectful towards each other and understand each other more. Cannabis-users are not criminals,” Mamo said.

Mamo said that the education campaigns will be trying to change how people perceive and approach cannabis, with the authority focusing on a purely harm reduction approach, which includes the preventative side, the risks, why people use cannabis, what to do if feeling unwell and other recommendations.

She said that nowadays, there are alternatives to the predominant ill-practice of mixing tobacco, such as the use of vapes and bongs, paraphernalia which were criminalised beforehand.

 

Packaging of cannabis

Asked about the packaging of cannabis to be distributed by the prospective associations, Mamo said that it will include what the product consists of, such as the levels of THC, as well as health warnings.

Additionally, the associations will need to establish several talks, workshops or events for the members to talk about harm reduction, through information on health, sustainability and how to prevent harm.

“These associations will be encouraged to take the lead and engage their members,” Mamo said, adding that forceful participation would scare people away.

Asked whether there is a risk of more fatal accidents caused by people driving under the influence of cannabis, Mamo said that driving under the influence of cannabis would be similar to the issue of driving under the influence of alcohol and one must not assume that changes in the law would increase people taking this risk.

She also raised an interesting point, being that nobody thinks twice about conducting breathalyser tests for anyone who attends the Wine Festival or the Beer Festival, both family-oriented events.

“Cannabis is not the only thing which could impair drivers’ attention,” Mamo said.

Questioned about a drug breathalyser test, which is to be implemented soon by the drug squad within the police force, Mamo said that the apparatus must be scientifically accurate, to avoid the risk of criminalising people for nothing.

“Detecting a presence of cannabis is not the same as impairment, and it works different with alcohol. Cannabis stays in your system and to conduct a breathalyser test the police needs to have an indication of impairment,” Mamo said.

She also said that police officers will need to recognise when someone is impaired under the influence of cannabis.

“There is no current internationally agreed minimum levels for cannabis use, like there is with alcohol,” Mamo said.

Dialogue and cooperation with the drug squad, including cooperation with Sedqa have been identified as pivotal to further ensure a multi-disciplinary and inter-institutional approach, Mamo added.

She said that the authority will have a list available on their website, for people to know which association was given a license.

Mamo emphasised that the associations will not be able to market so as not to attract new members, deeming the not-for-profit model as a courageous step by government.

Mamo highlighted the importance of keeping the associations, and its members, at a limited capacity, to maintain one-to-one relationships and a smaller pool of people.

“Members can feel represented by the founders of the association and they can participate in decision-making. If we move away from that, it will just be a dispensary outlet,” Mamo said.