No more ‘war’: reducing harm is the new language on drugs

A harm reduction information booth at the Earth Garden Festival with academics addressing various themes surrounding responsible drug issue signals a new philosophy on how to treat drug usage

Left to right: Karen Mamo, Giulia Zampini and Fabian Stienmetz
Left to right: Karen Mamo, Giulia Zampini and Fabian Stienmetz

A Harm Reduction information booth within the Healing Fields of Earth Garden festival opened its doors between the 3rd and 5th of June 2022.

Addressing drug use through a non-judgmental, non-stigmatised approach, Harm Reduction Malta, in partnership with Dr Giulia Zampini and Dr Fabian Steinmetz, delivered three workshops addressing drug use in society, focusing on the relationship between drugs and crime, cannabis quality and transparency, and the People and Dancefloors project.

Leaflets produced by the UK-based NGO Drugs and Me offered information on different drugs, with tips on how to minimise harm and maximise pleasure. Visitors had the opportunity to scan a QR code and access detailed information on different substances’ effects, building awareness of potentially dangerous drug combinations. The European Coalition for Effective Drug Policies (ENCOD) supplied a leaflet addressed at parents and caregivers covering drug use, problematic drug use and health guidelines. Dialogue and respect for the views of people who use drugs are at the heart of the work of ENCOD and Drugs and Me.

People visiting the booth were encouraged to practice safe sex and use protection against unwanted consequences. Free condoms were received with jubilation by people who could not access this basic public health device elsewhere on the festival site.

Some visitors spoke at length about the importance of offering education to people who use drugs. Others asked if the booth provided a drug checking service, which would provide information about substances’ contents and potency to prevent unnecessary harm.

The team spoke with MEP Cyrus Engerer and Labour MP Randoph Debattista about the aims of harm reduction and the role of education to address drug use in society. Karen Mamo, of Harm Reduction Malta, explained that the legislative changes enacted in 2021 promise a paradigm shift in the way society perceives and treats people who use cannabis: no longer criminals or pathologised patients, but human beings in need of evidence-based tools to make responsible decisions without fear of criminal and social repercussions.

Mamo also spoke about the mutual relationship between public health and education, highlighting that dialogue and a non-coercive approach remain a priority to promote the well-being of people who use drugs, and by extension that of society.

During the drugs and crime workshop, Dr Zampini discussed some of the evidence around humans’ perennial relationship with drugs, defining such relationship as natural. Conversely, she defined the relationship between drugs and crime as socially constructed, highlighting some examples of the very real consequences that such a relationship has on people’s lives and wellbeing. “The prohibition and criminalisation of drugs has grave social costs and is a significant financial burden to the state,” she said.

Drawing on the theme of healing as integral to the festival, Dr Zampini asked participants to reflect on how we, as a society, can heal the problematic relationship between drugs and crime. Among the solutions proposed by participants were decriminalisation of drug possession, better drug treatment provision, and even legal regulation of drug supply.

Delivering a workshop on cannabis quality and transparency, Dr Steinmetz congratulated Malta for the recent legislative changes partially decriminalising cannabis in late 2021. “Criminalisation increases harms to the person and fuels a culture of stigma and discrimination. Furthermore, criminalisation and prohibition directly impact levels of cannabis quality and hinder the exchange of greatly valuable information about cannabis cultivation.”

Addressing contamination of cannabis and bioburden (presence of microorganisms), Dr Steinmetz highlighted the importance of educating cannabis home growers on how to properly dry and cure cannabis flowers. “This is particularly important in humid and hot climates, such as that of Malta,” Steinmetz said, calling for quality testing services to be made affordable and accessible, with the Authority for the Responsible Use of Cannabis acting as a regulator and an educational hub for growers and associations.

Answering questions about urine testing for employees, Dr Steinmetz explained that such testing is unnecessary from an impairment and health and safety perspective. “In fact, non-psychoactive metabolites produce false positive results even if there is no impairment. The issue of false negative results, whereby the person is impaired when the drug is yet to be metabolised, should be considered when adopting an evidence-based approach to safer working environments.”

Answering a question about the link between Cannabis and psychosis, Dr Steinmetz highlighted that psychosis affects only around 1% of the population, irrespective of the levels of cannabis used by a particular society. “Nonetheless, people with a history of schizophrenia in the family or previous psychotic episodes have a higher potential to experience a psychotic episode or accelerate and worsen symptoms.”

A third workshop delivered by Dr Zampini and Karen Mamo focused on the people and dancefloors project, a qualitative study delving into the role of pleasure, drug use, and dancefloors as spaces of encounter. Reading quotes from the study, participants were invited to guess the quotes’ context, eliciting reflections on personal experiences. The discussion focused on the role of stereotypes and stigma linked with people who take drugs in music spaces.

The interaction with participants provoked interesting observations, particularly around the tension between professional, family, and pleasure-seeking identities and behaviours. The lack of honest conversations about drug experiences for fear of legal, economic, and social repercussions, negatively impacts people’s mental health and self-perception, while hindering the reduction of harm.

Originating in the UK as a documentary-based project and spreading to Brazil and Malta, the people and dancefloors project aims to explore differences and similarities across social and cultural environments. Given that drug use happens within a prohibition policy framework, Dr Zampini highlighted the crucial role of a harm reduction approach to facilitate non-coercive dialogue and positive behavioural change.

Mamo clarified that harm reduction practices range from providing drug checking to other basic services, including the provision of free water and condoms. “The validity of this approach, especially when considering the high temperatures hitting our island, and the increased prevalence of sexually transmitted diseases. By promoting harm reduction, I hope Malta soon will take the leap towards a human rights-based approach for people who use drugs,” Mamo said.

The Harm Reduction Information Booth was sponsored by the University of Greenwich.