The National Health Plan 2009-20 defines 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), with the remainder allocated to 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 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. 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. 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 these groups and for people who inject amphetamines remain limited.
In 2017, methadone maintenance treatment was offered at eight treatment sites in five regions.
In 2017, 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 received OST, with methadone being the most commonly prescribed OST medication in Estonia. Although the coverage of OST is not known, it is assumed to be relatively low.