National addiction services and NGOs are failing to provide alternative treatments for cocaine dependence, such as cannabis-based approaches and supervised psychedelic therapy, which people who can afford private care can access. This creates inequality in the right to health.
Karen Mamo, Drug researcher
Some private providers do offer alternative therapies that Malta's national addiction services do not routinely provide. But the scientific evidence does not establish these approaches as effective, standard treatments for cocaine dependence, so their absence from public healthcare does not by itself show that patients are being denied appropriate treatment.How we reached this verdict ↓
Analysis and evaluation
Some private providers offer treatments for cocaine dependence that national services do not. The research behind them is uneven: cannabis has shown no benefit in controlled trials, and psychedelic-assisted therapy is promising but still experimental.
Cannabis: no benefit in controlled trials
Cannabis has been studied as an "exit drug" that could help people cut down on more harmful substances. A 2017 Canadian observational study of 122 people found that those who used cannabis intentionally to cut down went on to use less crack cocaine. It could not show that cannabis caused the drop.
Randomised trials point the other way. A systematic review published in The Lancet Psychiatry in 2026 pooled trials of cannabinoids for mental health and substance-use disorders. It found no benefit for cocaine dependence, and participants given cannabinoids reported stronger cocaine cravings than those given a placebo.
Psychedelics: promising, still experimental
A randomised trial published in JAMA Network Open in May 2026 gave 40 adults with cocaine dependence either psilocybin or a placebo, alongside psychotherapy. Those given psilocybin had significantly more cocaine-free days and a lower risk of relapse. A 2019 trial of 55 people found that a ketamine infusion combined with behavioural therapy also reduced the risk of relapse.
Both trials were small. Larger trials are needed to establish long-term effectiveness and safety, and neither treatment is yet routinely recommended for cocaine dependence.
| Study | Design | People | Finding for cocaine |
|---|---|---|---|
| Cannabis substitution (2017) | Observational | 122 | Less crack use; cause not shown |
| Cannabinoids review (2026) | Review of randomised trials | Pooled | No benefit; more craving |
| Ketamine (2019) | Randomised trial | 55 | Lower relapse risk |
| Psilocybin (2026) | Randomised trial | 40 | More cocaine-free days, lower relapse risk |
Sources: Socías et al. (2017); Wilson et al., The Lancet Psychiatry (2026); Dakwar et al. (2019); Hendricks et al., JAMA Network Open (2026).
What national services offer
Sedqa provides medical, psychological and rehabilitation programmes, and the Government's mental health services run a clinic focused on stimulant use. Their published programmes do not list cannabis substitution or psychedelic-assisted therapy as routine treatments for cocaine dependence.
A treatment being sold privately does not show that it is effective or safe enough for routine public provision. Public services have to weigh evidence of benefit, patient safety and regulatory approval. Unequal access to proven, medically necessary treatment would raise a serious right-to-health concern. Unequal access to experimental treatment is a different question.
Evaluation
Mamo is right that some private providers offer treatments that national services do not. Her claim that national services are failing patients by not offering them implies these treatments are established enough to belong in public care. The evidence does not support that. Cannabis has shown no benefit for cocaine dependence in controlled trials, and psychedelic-assisted therapy remains investigational. Whether Malta should support clinical research into these therapies is a separate argument. The claim is rated Misleading.
Editorial note
How we assessed this claim
We assessed the factual premise of Mamo's argument: whether the alternative treatments available privately have enough clinical evidence to justify routine provision through national addiction services.
Limitations
- Mamo's references to individual private practices have not been independently confirmed.
- Published descriptions of national services may not cover every treatment offered in specific clinical circumstances.
- Evidence on psychedelic-assisted treatment is evolving, and future research could justify wider clinical use.
- The overall adequacy of Malta's addiction-treatment system would need a wider assessment of access, outcomes and patients' experiences.
Sources
- Wilson et al. (2026), Efficacy and safety of cannabinoids for mental and substance use disorders, The Lancet Psychiatry
- Socías et al. (2017), Intentional cannabis use to reduce crack cocaine use
- Hendricks et al. (2026), Psilocybin in the treatment of cocaine use disorder, JAMA Network Open
- Dakwar et al. (2019), Ketamine and behavioural treatment for cocaine dependence
- Aġenzija Sedqa, Substance Misuse Outpatient Unit
- Mental Health Services Malta, Addiction Service
- Malta Medicines Authority, Medicinal cannabis