Increase in emergency calls by drug users: More abuse or less fear? | Karen Mamo

The Euro-Den Plus reporting network has identified a regional increase in emergency calls predominantly concerning poly drug use, but also noticing increased calls for cocaine and cannabis related health matters. This reality is also being observed locally.

But is an increase in numbers indicative of alarming drug related problems and a free for all mentality, or could it be an indication that people are less fearful to seek emergency services and hence less likely to wait till it is maybe too late?

Key findings from 2022 showed that acute drug toxicity is mostly prevalent for males between the ages of 25 and 45.

Interestingly, half out of the 28 active centres taking part in this monitoring exercise reported that almost 50% of acute drug toxicity emergencies involved the co-ingestion of alcohol. The report explained that cannabis was the second most reported illicit drug effecting EU emergency services with presentations involving acute cannabis intoxication increasing in 10 centres compared to other substances in the previous year.

When looking at cocaine, presentations were reported across all 28 centres, with the emergence of crack cocaine resulting in 12 centres.

When looking at the situation in Malta, one cannot fail to notice that local developments reported in the Euro-DEN Plus report are in great part mirroring broader regional behavioural patterns linked with drug use and the drugs market in the EU. In fact, irrespective of market size or legal status of a particular drug, increased presentations to the emergency services, primarily linked with cocaine and cannabis, are a shared reality across the EU.

The United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health has on multiple occasions recognised that people who use drugs may be deterred from accessing health services owing to the threat of criminal punishment or may be denied access to health care altogether.

More recently, the United Nations High Commissioner for Human Rights through Report A/HRC/54/53 of 2023 called on legislators and policy makers to adopt alternatives to criminalization, “zero tolerance” and elimination of drugs, by considering decriminalization of usage; and take control of illegal drug markets through responsible regulation, thus having an increased possibility to eliminate profits from illegal trafficking, criminality and violence.

In Malta, legal changes depenalising small amounts of drugs (Drug Dependence – Treatment not Imprisonment Act, 2015), and the partial decriminalisation of cannabis (amendments to Dangerous Drugs Ordinance, 2021) could have, in part directly contributed to break historic barriers hindering access to emergency services and the realisation of the highest attainable standard of physical and mental health for all citizens, including people who use drugs.   

This brings to the fore some recommendations.

As attested on various occasions since 2010 by the UN Special Rapporteur for health, and more recently in 2023 the UN Human Rights Commissioner, the criminalisation of drug use, including paraphernalia and stigmatisation of people who use drugs, act as direct barriers to the realisation of the right to health.

Policy makers and legislators should seriously consider the introduction of comprehensive harm reduction approaches for all people who use drugs, thus recognising the importance of facilitating health, legal and social drug policy tools such as broader fully decriminalised models, and anonymous real time drug checking services, further helping people to prevent health risks when consuming an illegal substance.

Develop an accessible and ‘drug user friendly (especially for marginalised communities)’ early warning system for adulterated substances which is not locked away and forgotten within academic quarters, government departments, or abused by the media to sensationalise problematic drug use in society.

Introduce the practice of recording further information on the drug being reported at emergency care settings [not limited to Mater Dei but including also major private hospitals such as St James Hospital] (without adopting invasive and humiliating practices), including analysis for adulterants, and potency.