In Estonia, the Health Board collects national data on drug- related infectious diseases, which are complemented by data from prevalence and behavioural surveillance studies among PWID in three cities. Injecting drug use remains a key driver of the HIV epidemic in Estonia. During the last five years, one out of five new HIV infections notified were linked to injecting drug use and the rate of new HIV infections among PWID in Estonia remains one of the highest in Europe. Nevertheless, the annual number of new HIV infections attributed to injecting has reduced since 2010, when 118 new HIV infections among PWID were reported, compared with 55 new HIV-positive individuals associated with drug injecting in 2015.
Studies carried out among PWID who attend needle and syringe programmes (NSPs) indicate a high prevalence of all drug-related infectious diseases among this group. The prevalence of HIV infection has remained stable over time, around 48 % among NSP clients in Tallinn and 60 % in the eastern parts of Estonia. Among clients attending NSPs in Tallinn, more than 61 % tested positive for HCV antibodies, while this figure was up to 94 % in eastern parts of the country. It is estimated that the prevalence of chronic hepatitis B virus infection (based on HbsAg) ranged from 3 % to 22 % among PWID using NSPs.
No standardised national data collection on drug-related emergencies exists in Estonia, but there are different data collection systems in place at sub-regional levels. Tallinn City Emergency Medical Services report data on overdoses linked to opioid use. In 2015, a total of 861 overdoses were reported, which was fewer than in 2014. The Parnu city ambulance services reported that about 1 % of all emergencies were related to overdose, while in Kohtla- Jarve 68 of the total of 25 217 emergency cases were due to an overdose.
Two emergency departments from hospitals in Tallinn and Parnu participate in the European Drug Emergencies Network (Euro-DEN) project, which was established in 2013 to monitor drug acute toxicity in sentinel centres across Europe.
Newly diagnosed HIV cases attributed to injecting drug use
NBNB: Year of data 2015, or latest available year.
Prevalence of HIV and HCV antibodies among people who inject drugs in Estonia
NBYear of data 2014.
Characteristics of and trends in drug-induced deaths in Estonia
NBYear of data 2015.
Drug-induced deaths are deaths directly attributable to the use of illicit drugs (i.e. poisonings and overdoses).
Following a record 170 drug-induced deaths recorded in 2012, the number of drug-induced deaths reported by the general mortality register declined in the following years. In the past, toxicological results attributed the majority of these deaths to overdose of synthetic opioids — fentanyl and 3-methylfentanyl in particular. In 2015, no detailed information was available, but there are indications that most deaths were related to opioids. Most victims were male and the average age was 33 years, which is younger than the overall average for Europe.
The decline in drug-induced deaths in Estonia may be attributed to the launch of a take-home naloxone pilot programme in 2013, the possible reduction of a number of high-risk opioid users and a reduction in the purity of fentanyl in recent years.
The drug-induced mortality rate among adults aged 15-64 years was 102.7 deaths per million in 2015, considerably higher than the European average of 20.3 deaths per million.
Drug-induced mortality rates among adults (15-64 years)
NBYear of data 2015, or latest available year.