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New psychoactive substances in Estonia: fentanyl, alpha-PVP and harm reduction

Estonia has historically had an extremely high number of drug-related deaths per capita. However, over the past 3 years, according to the authors of the country report on the use of new psychoactive substances (NPS), there has been a sharp decline in this figure. In 2018, the number of drug overdose related deaths dropped significantly to 39 cases, down from 110 cases in 2017.  This was possible due to effective policing and increased coverage of Naloxone programmes, as well as the emergence of various programmes to help people with drug addiction.

In 2019, there were eight organisations in Estonia that were involved in harm reduction from NPS. At the end of 2019, harm reduction services were provided in 35 locations: 14 fixed centres, 19 outreach programmes and 2 mobile sites.

In addition to this positive trend, the authors of the report also pointed to an increase in lifetime drug use compared to 2008 data. Experts say that substance use has increased most among older age groups (over 16-24 years old). This means that it is necessary to develop programmes that meet the needs of a wide range of age groups.

According to the Estonian Drug Use Survey 2018, 43, 25 per cent of people aged 16-64 have tried illicit psychoactive substances at least once in their lifetime, 7 per cent in the last year and 3 per cent in the last month.

The share of injecting drug use in Estonia is also higher than in other European countries. Among the most popular substances injected are the synthetic opioid fentanyl (although its use has decreased in recent years), as well as NPS such as alpha-PVP and isotonitazene (street name “dog”).

It is noteworthy that the main drug used by PWID in Tallinn is fentanyl, while in the city of Narva the most common drug is alpha-PVP. This situation is likely due to the close proximity to the Russian border, where drug users and police believe most of the alpha-PVP enters Estonia. Most often, NPS in Estonia are purchased through dealers, and the darknet is used mainly by young people 18-20 years old.

In the context of the use of synthetic opioids, Estonia is in a special position due to the recent dramatic history of the fentanyl epidemic in the country.

Back in 2012, the BBC wrote about the widespread use of fentanyl in Estonia and the huge number of overdoses: “In Estonia, a synthetic drug from the fentanyl group, which addicts call China white or “white Chinese,” is claiming more and more young lives. Today, more people in the country die from this drug than from car accidents. Fentanyl is produced in clandestine laboratories in Russia. It has almost completely replaced heroin on the Estonian black market. Although he is much more dangerous.”

Fentanyl became widespread in Estonia back in 2002–2003. due to a heroin shortage and quickly took his place. In 2016, the government changed legislation to make substances with a chemical structure similar to opioids illegal. Thus, due to the limited availability of fentanyl, many drug users were forced to switch to alpha-PVP and other new psychoactive substances. Recently, cases of a newer drug from the fentanyl group, isotonitazene, appearing on the market. However, in 2020, due to the COVID-19 pandemic and border closures, the situation on the Estonian drug market changed again. As Postimees writes, drugs that replaced fentanyl disappeared from the underground market due to border closures, and fentanyl began to appear on the streets again.

According to a survey of NPS users conducted as part of the study, experts found that most NPS users are familiar with the symptoms of a fentanyl overdose because they are similar to those of an opioid overdose. The survey also showed a high level of awareness about Naloxone, however, the majority of respondents responded that in case of an overdose they did not dare to call an ambulance because they were afraid that they might have problems.

One of the key problems is the lack of special rehabilitation and treatment programs for NPS users, due to the lack of general knowledge and clear empirical data. Treatment for alpha-PVP use is particularly challenging, according to medical professionals. Because there are no specific guidelines or drug programs for treating alpha-PVP addiction, health care providers find these cases particularly challenging due to the high level of unpredictability and erratic behavior among regular alpha-PVP users.


Legal basis

Estonia’s drug policy is regulated by the Law on Narcotic Drugs, Psychotropic Substances and Their Precursors. According to this law, unauthorized use of narcotic drugs or psychotropic substances without a prescription or illegal manufacture, acquisition or possession in small quantities of any narcotic drugs or psychotropic substances without the intent to distribute them is punishable by a fine of up to 1200 euros (usually determined by the police) or administrative detention for up to 30 days. Any act of illegal possession or sale of drugs, not solely for personal use, is considered a criminal offense, regardless of the type and quantity of illegal drugs; this issue is regulated by the Criminal Code.

Since 2002, the use, possession, illegal manufacture and purchase of small amounts of narcotic substances without the intention of their illegal circulation or sale is considered an administrative offense and is not a criminal offense, while the maximum possible penalty is a fine of up to 300 fine units, of which one fine unit is 4 euros.

In 2019, 1,536 new drug-related criminal offenses were registered in Estonia, and experts note an upward trend in the number of crimes related to the illegal circulation of small amounts of drugs. In Estonia, the average sentence is 3 years.

The country report on the use of new psychoactive substances in Estonia was jointly prepared by experts from the Eurasian Harm Reduction Association (EHRA) and Swansea University School of Law. The full text of the report in Russian is available here.

Earlier, the portal TalkingDrugs wrote about the situation with the use of new psychoactive substances in Belarus and Moldova here. All previous reports on the use of NPS in Moldova, Belarus, Georgia, Kazakhstan and other countries in the CEECA region are also available on the EHRA website.


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