Estland. Key Lessons from Estonia

Estland. Key Lessons from Estonia

Mikk Oja, Aljona Kurbatova, Katri Abel-Ollo

The National Institute for Health Development, Estonia

So-Prep, 2021, Deliverable D2.3

Executive summary

Over the last two decades, Estonia has witnessed one of the biggest problems with opioid use in Europe and the highest overdose death mortality rate. Based on the risk behaviour and infectious disease prevalence studies among people who inject drugs since 2005, it can be seen that the main opioid injected between 2005-2017 was fentanyl. Estonia is one of the few countries in the world where the drug market has been dominated by illicitly produced fentanyl – a synthetic opioid that is 50 to 100 times more potent than morphine – as well as other fentanyl-analogues such as carfentanil, which can be even more potent.

Fentanyl appeared on the Estonian drug market in 2002 due to a temporary shortage of heroin caused by the war in Afghanistan, leading to several waves of overdose deaths among users. At first the situation was expected to be temporary with heroin soon returning to the market. During the following decade, however, fentanyl and 3-methylfentanyl started to dominate the opioid market. Due to fentanyl’s higher potency, switching back to weaker opioids is difficult and heroin disappeared from the Estonian drug market.

The use of SOs (synthetic opioids) has predominantly occurred among communities in the capital area as well as in the northeast region of the country - regions most affected in the end of 1990s and 2000s by socio-economic problems. As the problem was new throughout the world, there were no recommendations or practices from other countries that Estonia could have adapted at the time and the lack of timely and sufficient action led to an unacceptable loss of human lives. It took years for the seriousness of the situation to reach the political level.

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