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 people who inject drugs (PWID) in three cities. Injecting drug use has been a key driver of the human immunodeficiency virus (HIV) epidemic in Estonia, although in recent years the proportion of new HIV cases attributed to injecting drug use has remained fairly stable, with around 1 to 2 in every 10 new HIV cases recorded among PWID. The annual number of new HIV infections attributed to injecting has also reduced since 2010, when 118 new HIV infections among PWID were reported, compared with 30 new HIV infections associated with drug injecting in 2016. Nevertheless, the rate of new HIV infections among PWID in Estonia remains one of the highest in Europe.
|Year of data: HIV 2016, HCV 2014|
Regional studies carried out among PWID indicate a high prevalence of all drug-related infectious diseases among this group, with more than half infected with HIV. The prevalence of HIV infection has remained stable over time, around 58 % in Tallinn and 66 % in the most recent study in Kohtla-Jarve (a city in the eastern part of Estonia). In Tallinn, more than 61 % of PWID tested positive for HCV antibodies, while this figure was as high as 94 % in eastern parts of the country. It is estimated that the prevalence of chronic hepatitis B virus infection (based on HBsAg) ranges from 3 % to 22 % among PWID.
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.
In 2016, Tallinn City Emergency Medical Services reported 1 203 emergency cases due to overdose. North Estonia Medical Centre Ambulance Service reported 30 cases, Narva Hospital Emergency Department reported 66 cases, Karell Ambulance Service, serving eastern parts of Estonia and Harju county, reported 88 cases and Pärnu Hospital Ambulance Service reported 11 cases (mainly caused by cannabis, amphetamine or ecstasy, as well as one case related to LSD). The services in south-east Estonia reported 30 cases of non-fatal drug overdose. In other parts of Estonia, emergencies related to drug overdoses remained rare. In many non-fatal overdose cases, naloxone was used by the emergency services.
Two emergency departments in hospitals in Tallinn and Pärnu participate in the European Drug Emergencies Network (Euro-DEN Plus) project, which was established in 2013 to monitor acute drug toxicity in sentinel centres across Europe. The sentinel centres reported around 100 and 201 cases, respectively, of drug-related acute intoxication per year. Most drug-related acute emergencies in Estonia were related to opioid use. Opioid overdoses are usually treated in a pre-hospital environment (the ambulance) and patients only very rarely attend emergency departments.
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 period 2013-15. In 2016, a total of 114 drug-induced deaths were reported. Toxicological results attributed the majority of these deaths to overdose by synthetic opioids, mainly fentanyls (3-methilfentanyl and other fentanyls, such as carfetanyl, furanylfentanyl and acrylfentanyl). Most victims were male and the average age was 34 years. Although the mean age of victims has increased in recent years, in 2016 the number of deaths among those younger than 25 years more than doubled when compared with 2015.
The increase observed in 2016 is thought to be mainly attributable to the emergence of new and more potent fentanyl derivatives.
The drug-induced mortality rate among adults aged 15-64 years was 132.3 deaths per million in 2017, considerably higher than the European average of 21.8 deaths per million.