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Drug treatment overview for Estonia

Map of Estonia

1. National context

Until 2012 drug treatment was part of the National Strategy for the Prevention of Drug Dependency. Following its completion, the treatment of drug addiction is now covered by the National Health Plan 2009–20 (RTA) and the implementation plan for 2013–16. Treatment is through the state budget, allocated according to the RTA implementation plan, and almost half of the budget goes to the implementation of opioid substitution treatment (OST). Some larger municipalities also allocate funding for drug treatment. The Estonian Health Insurance Fund does not finance drug addiction treatment.

Traditionally, drug treatment in Estonia is mostly provided through hospitals, which obtain a licence for mental health services in order to provide inpatient and outpatient treatment for problem drug users. According to the Mental Health Act (RT I 1997, 16, 260), only a psychiatrist can provide drug treatment, although they are not required to be specialists in drug treatment. In general, outpatient treatment dominates and inpatient treatment services remain limited. The available treatment methods covered by state or local funding include detoxification, methadone maintenance treatment (MMT), medication-free treatment and 12-steps programme-based rehabilitation (treatment communities, outpatient and inpatient rehabilitation programmes), although OST prevails among the available treatment options. Special drug treatment programmes for children and adolescents and persons with dual diagnosis are also available, although treatment options for those groups and for amphetamine injectors, whose prevalence among drug users seems to be on the increase, remain limited.

Methadone detoxification has been available in Estonia since 1998, but although MMT was officially introduced in 2001 it has only been used on a significant scale since 2003 with the opening of a specialist centre. In 2013, MMT was available in eight treatment centres and also in one police detention centre. However, treatment capacities still seem to be unable to meet the growing number of treatment demands in recent years.

In 2013 an estimated 1 166 clients received MMT through seven service providers funded by the national HIV/AIDS prevention strategy and the Tallinn Social Welfare and Health Care Department. The number of clients in substitution treatment is slowly increasing from year to year. Although the coverage of OST is not known due to the lack of an estimate of the size of the opioid-using population, it is assumed to be relatively low (<20 %).

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2. Treatment registries and monitoring systems

Data on clients on substitution treatment are collected in the framework of the GF programme 'The Drug Treatment Registry' from 1 January 2006.

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3. Treatment demand

Table 1: Number of clients entering treatment in Estonia by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 665 532 546 434
Number of all clients entering treatment with known primary drug 665 532 546 434
of which for opioids misuse 94.6 91.4 93 92.9
of which for cocaine misuse 0.0 N. Av. N.Av. 0.0
of which for cannabis misuse 0.5 5.3 3 3.7
of which for stimulants misuse 4.2 2.4 2 3.0
Number of new clients entering treatment 176 163 125 126
Number of new clients entering treatment with known primary drug 176 163 125 126
of which for opioids misuse 86.4 80.4 86 81.0
of which for cocaine misuse 0 N. Av. 0 0.0
of which for cannabis misuse 1.7 11.7 N.Av. 12.7
of which for stimulants misuse 10.8 4.9 2 5.6

Notes:
The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2014 and TDI tables.
EMCDDA Statistical Bulletin 2015.

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4. Treatment provision

Table 2: Opioid substitution treatment provision in Estonia
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 1064 1076 1157 1166
of which with methadone 1064 1076 1157 1166
of which with buprenorphine 0 0 0 0
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in Estonia
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 2001
Buprenorphine (HDBT) 2003
Heroin assisted treatment N.App.
Slow-release morphine N.App.
Buprenorphine/naloxone combination N.av.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. App.’ stands for ‘Not applicable’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.
Table 4: Legal framework of opioid substitution treatment in Estonia
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment?    
Do specialised medical doctors have the right to initiate the prescription of substitution treatment?    
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section)
For an explanation of terms used, see the definitions of terms.
'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors.
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2014.

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5. References and links

Related EMCDDA resources

 

External links

Please note that the EMCDDA is not responsible for the content of external sites.

Treatment inventories

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About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 22 May 2015