Thousands in Malta suffering over extreme restrictions on medical cannabis, says family doctor

The 2015 reform of Malta’s drug laws saw medical cannabis partially legalised as a last resort for chronic pain sufferers. However, two years down the line, not a single patient has yet been treated with medical cannabis because the only form of it which can be prescribed – the mouth spray Sativex – cannot be found on the Maltese market.

Meanwhile, a doctor who had started treating his patients with a hemp-based oil has now been banned from doing so.

Andrew Agius, a family doctor who runs the Pain Clinic in Paola, told MaltaToday of his frustration at the authorities’ lethargy in updating the law and at the reluctance of other doctors to join his cause. 

“There are around 80,000 people suffering from chronic pain in Malta and without this medicine they are being forced to live in pain,” he said. “Unfortunately, there’s still a stigma on marijuana as a gateway drug that can lead to people into taking cocaine, which is rubbish,” he said.

The 2015 drug law reform had allowed pharmacies to start stocking and selling Sativex – a cannabis-based mouth spray medicine that costs around €500 per 10ml. 

To access the drug, patients must be prescribed it by either an oncologist, a neurologist, a psychologist or an anaesthesiologist, and must also obtain permission from the Superintendence of Public Health. 

Agius said that the problems with this restricted legalisation are twofold. Sativex is a very expensive medicine, particularly considering that an average patient requires three or four puffs of it every day. Worse, no pharmacy on the island even stocks the spray to begin with.

“I have been pressuring pharmacies to start stocking it for months now, but they have told me that they tried to acquire it but didn’t manage to.”

Of course, Sativex isn’t the only form of medical marijuana out there – it can also be taken in liquid or edible form and the cannabis buds themselves can be vaporised or smoked. Yet these other versions are so far banned in Malta.

Agius recounted how in November last year, his research on a patient with fibromyalgia had led him to a type of oil that had been used as a herbal remedy, that contains cannabidiol (CBD) – one of the two main active ingredients derived from cannabis. 

He said that the oil had worked wonders on his patients and many ended up dropping their daily cocktails of pills in return for a few daily drops of the oil. 

“One specific patient was bedbound and had to take up to 15 pills a day. The CBD treatment helped her so much that she ended up opening her own business.” 

Agius said he had asked the authorities whether the oil was legal or not but received no response until six months later, when the Superintendent of Public Health Charmaine Gauci informed him that it was illegal by virtue of an old law that bans all products containing hemp.

“Now patients are coming back to me and want more oil but I cannot give it to them,” he said. “Some of them are now buying it off the internet anyway, while others are buying unreliable products off the streets. I know of a case where a patient spent €1,000 on CBD oil that turned out to be Bovril.”

He said that he has been informing the authorities about the problem for months, writing directly to Prime Minister Joseph Muscat, health minister Chris Fearne, and the new parliamentary secretary for reforms, Julia Farrugia, who has been entrusted with revamping marijuana legislation. 

However, the only response so far has been a brief e-mail from Fearne, shortly before the election, saying that “we are looking into it”. 

Agius is frustrated that he is so far fighting this battle solo, with other doctors baulking at the prospect of publicly pressuring for the loosening of marijuana legislation despite agreeing with it in private.

“Other doctors are scared that coming out in favour of this will risk damaging their reputation. Some have told me in private of the need for education on medical marijuana, but when it comes to the crunch they stayed away from the debate.

“Even though it is 2017, some people are still too shy to even like a Facebook page about medical cannabis because there’s the word ‘cannabis’ inside it…”