The National Health Plan 2009-20 and its implementation plans define the main objectives in the area of drug treatment. Treatment in the public sector is funded by the state budget allocated by the Ministry of Social Affairs; almost half of the budget funds opioid substitution treatment (OST), while the remaining budget is allocated for detoxification and drug-free programmes. Some larger municipalities also fund drug treatment.
Traditionally, drug treatment in Estonia is provided through hospitals, which need to obtain a licence for mental health services in order to provide inpatient and outpatient treatment for dependency. According to the Mental Health Act (RT I 1997, 16, 260), only psychiatrists can provide drug treatment, although they are not required to specialise in drug treatment. In general, drug treatment is primarily provided in outpatient treatment units, and inpatient treatment services remain limited.
OST is the most widely available treatment option in Estonia. The other available treatment interventions include detoxification, drug-free treatment and inpatient rehabilitation programmes. Special drug treatment programmes for children, adolescents and people with a dual diagnosis are also available, although treatment options for those groups and for people who inject amphetamines remain limited.
OST with methadone was officially introduced in 2001, but it has been used on a significant scale only since 2003, following the opening of a specialised centre. In 2017, methadone maintenance treatment was offered at eight treatment sites in five regions.
In 2016, most clients who entered treatment in Estonia were treated in outpatient settings.
Among clients entering treatment, 9 out of 10 reported opioids as the primary drug of use (mostly fentanyl, but also methadone or heroin).
Most of those who entered treatment in 2016 received OST, with methadone the most commonly prescribed OST medication in Estonia. Although the coverage of OST is not known, it is assumed to be relatively low.