Country overview: Estonia
- Situation summary
- Data sheet
- Barometer
Contents
- Drug use among the general population and young people
- Prevention
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-related offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Drug-related research
| Year | Estonia | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 1 340 935 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 15.2% | 12.6 % 1 | Eurostat |
| 25–49 | 34.8 % | 36.3 % 1 | |||
| 50–64 | 18 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 68 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 12.4 % | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 6 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 14.2 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 321.6 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 18 % | 16 % 7 | SILC, 2007 | |
p Eurostat provisional value.
1 2007 figures.
2 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
3 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
4 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
5 Situation of penal institutions on 1 September, 2006.
6 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold in the current year and in at least two of the preceding three years.
7 EU-25 countries.
Drug use among the general population and young people
The most recent data on drug use in the general population is based on a survey ‘Health behaviour among the Estonian adult population’, conducted in 2006 by the National Institute for Health Development among persons aged 16–64. Results indicate that respectively 22 % of males and 14 % of females used cannabis at least once. Last month cannabis use was reported by 2.5 % of males and 1.3 % females. The 2004 results indicated a lifetime prevalence of cannabis use of 18 % among males and 13 % among females.
The ESPAD study has been regularly conducted in Estonia since 1995, the latest was done in 2007, based on a nationwide sample of high school students. The results for the 15–16-year-old age group in time period 1995–2007 has revealed an increase in prevalence rates for illegal drug use. Lifetime experience with any illegal drug other than marijuana and hashish more than tripled between 1995 (2 %) and 1999 (9 %) and reached 10 % in 2003. While 7 % reported lifetime use of marijuana/hashish in 1995, 23 % in 2003 and in 2007, 26 % admitted to have experimented at least once with marijuana/hashish in their lives. A further increase was also observed for lifetime use of ecstasy which increased from 3 % in 1999 to 6 % in 2007. In 2003, the lifetime prevalence of amphetamine use was 7 % and in 2007 it decreased to 4 %. In the most recent survey, results indicate a last year prevalence of cannabis use of 19 % and 6 % for the last month prevalence.
Prevention
Prevention is part of the National Strategy on the Prevention of Drug Dependency 2004–12, and is under the shared responsibility of the Ministry of Social Affairs and the Ministry of Education.
National prevention is mostly based on county-specific HIV and drug prevention action plans and nationwide prevention campaigns. Those local action plans mostly contain youth activities (leisure, sport), activities related to raising students’ awareness and enhancing the competence of schoolteachers and county specialists. In 2008, there were no common-ground and materials-based drug prevention classes integrated into the national education system. Based on the school initiative, drug prevention was to some extent included into the subject syllabi of human and family studies of the national study programme.
Selective and indicated prevention projects in Estonia are presently unavailable.
Problem drug use
So far, there is no estimate for problem drug use in Estonia, but as a minimum approximation, the existing injecting drug use estimate may be used. In 2004, the prevalence of IDU was estimated at 15 cases per 1 000 inhabitants aged 15–64 (13 886 users) (1). This result is exceptionally high compared with EU Member State norms.
(1) The original age group considered in the study was 15–44 years; this estimation is just a recalculation made for the purpose of comparability with other EU countries.
The EMCDDA, as well as Estonia, defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates (e.g. fentanyl), cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
Treatment demand
Treatment demand data has not been available since 2002 for Estonia. In May 2005, the draft Narcotic Drugs and Psychotropic Substances Act Amendment Act was approved, which provides the legal basis to set up a drug treatment database. In 2006, the database was adopted and amendments to relevant legal acts were made. Since 1 January 2008, the Estonian Drug Monitoring Centre (EDMC) has collected data on persons receiving drug treatment, and the first data will become available in 2009.
Drug-related infectious diseases
National data on drug-related infectious diseases is collected at the Health Protection Inspectorate, which receives information from various sources including drug treatment services, low-threshold services, hospitals/clinics and HIV testing centres and laboratories.
In 2001, the Health Protection Inspectorate registered the highest number (1 340) of newly-diagnosed HIV infections among IDUs. This number subsequently decreased between 2002 and 2005 (from 702 to 192). Although, in 2007 the number of newly-registered HIV cases increased compared to the previous years (497.1 cases for a million inhabitants). In 2007, over half of newly-diagnosed HIV infections among IDUs was found in Ida-Viru County (north-east of Estonia). By region, HIV incidence is the highest in Kohtla-Järve and Narva. However, due to limited HIV surveillance data, the HIV epidemic among IDUs is probably underestimated, as data show that less than one third of the new HIV cases registered are IDUs.
According to the statistics of the Health Protection Inspectorate (HPI), the number of registered cases of acute antibodies against the hepatitis C virus (HCV) and hepatitis B virus (HBV) shows a falling trend. In 2007, 36 acute HCB cases were registered in Estonia compared to 45 acute HBV cases registered in 2006 and to 78 acute HBV cases registered in 2005.
Drug-related deaths
In Estonia, data on drug-related deaths are only available for deaths caused by an acute intoxication of drugs. A total of 68 cases of direct drug-related deaths were recorded in Estonia in 2006, which represents a more-or-less stable situation compared to previous years (57 in 2005, 98 in 2004). 55 cases were reported as deaths due to ‘other’ or unknown substances, 10 cases were attributed to opioids and three due to psychostimulants. This distribution of codes suggests that a toxicological test had either not been done in the majority of cases, or its results were not available to the Mortality Registry. As regards the distribution of drug-related deaths by age and gender, the majority were young men (43 cases) aged 20–29, and only nine cases out of 68 occurred among females. In 2005–06, total of 117 death cases related with the injection of 3-methylfentanyl were recorded in Estonia.
Treatment responses
In Estonia, the Ministry of Social Affairs is responsible for the overall administration and coordination of the National Strategy on the Prevention on Drug Dependency including treatment. Furthermore, the National Institute for Health Development is responsible for the implementation and funding of drug treatment.
Traditionally, drug treatment in Estonia is for the most part provided through hospitals, which obtain a licence for psychiatric 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 specialised in drug treatment. In recent years, treatment provision has gradually been taken over by specialised drug agencies, thus an increased availability of outpatient treatment as well as of counselling and treatment options outside the psychiatric hospitals was noted. Moreover, drug service provision by NGOs has recently shown an increase. Since 2004, the Tallinn City Government supports provision of substitution treatment for IDUs living in Tallinn. A new treatment centre for minors was opened in 2004 at Jõhvi Hospital in Ida Viru County, to provide drug-free treatment for children and young people aged 19 and younger.
In 2007, an estimated total of 1 044 clients received methadone maintenance treatment through six treatment centres funded by the state (through the HIV/AIDS prevention strategy) and the Global Fund.
Harm reduction responses
Harm reduction responses have increased in Estonia in recent years. This is illustrated by the fact that harm reduction measures were specifically mentioned in the new national drug strategy (2004–12). NGOs are the most active institutions providing services for drug users, and they aim to reduce drug-related harm via activities such as counselling, HIV testing and syringe and needle exchange. In 2002, the spread of HIV/AIDS was recognised in Estonia as a serious health problem and in 2003 the Government began to fund syringe exchange within the framework of the national HIV/AIDS prevention programme. As a consequence, the coverage and quality of syringe exchange programmes has improved.
In 2007, nearly 2 million syringes were distributed through a total of 26 syringe exchange points (seven stationary, 19 mobile, all operated by NGOs). These facilities, managed by five institutions and financed by the Global Fund, registered 193 503 visits in 2007 Three low-threshold centres also provide syringes for IDUs but to a smaller extent. Seminars for pharmacists about pharmacy-based syringe schemes took place in 2007 to promote the adoption of such programmes, which so far do not exist in Estonia. Free testing and counselling is offered, amongst others at AIDS prevention centres in five Estonian cities. According to data from the Merimetsa Hospital Reference Laboratory in Tallinn, since the first reports of an HIV epidemic in Estonia in 2001, the number of tests carried out has increased continuously. In addition, 17 youth counselling centres offer free testing and counselling for people under the age of 18. The prison population, sex workers and men who have sex with men are also seen as target groups and are provided with specific harm reduction services. In 2004, the NIHD drafted guidelines for HIV testing in order to improve the quality of services. In 2005, the Estonian Government approved the National HIV/AIDS Strategy 2006–15.
Drug markets and drug-related offences
The most significant trends in terms of drug production and trafficking in Estonia over recent years concern synthetic drugs. These have been reflected in the significant increase in the number of seizures of amphetamines and ecstasy since 1998, and also the detection of clandestine laboratories. In 2006, three clandestine laboratories were discovered by the police: two for the illicit manufacture of amphetamine, and one for the illicit manufacture of GHB (gammahydroxybutyrate). These synthetic drugs were intended for Nordic countries, but it seems that smuggling to Russia also increased.
In comparison to 2006 the number and quantity of drug seizures increased in 2007. In 2007, the most commonly seized illicit drug was amphetamine with a total of 808 amphetamine seizures. In terms of quantities 56 kg of amphetamine and 45 223 ecstasy tablets were seized in 2007. Furthermore, the most seized opiate in 2007 was mixed fentanyl and 3-methylfentanyl with a total of 1.1 kg of mixed fentanyl and 3-methylfentanyl. In 2007, the quantity of seized heroine increased with a total of 6 kg of seized heroin in 2007, despite the fact that in previous years it had started to disappear from the market. Moreover, in 2007, the price of amphetamine ranged between EUR 9.5 to EUR 16 per gram and the price of ecstasy ranged between EUR 3.8 to EUR 6.3 per tablet.
National drug laws
Since 1 September 2002, the new Penal Code removed repeated use of illicit drugs or possession of a small amount of illicit drugs for personal use from the list of criminal offences, and reclassified them as misdemeanours. Unauthorised consumption of narcotic drugs or psychotropic substances without a prescription, or illegal manufacture, acquisition or possession of small quantities of any narcotic drugs or psychotropic substances are punishable by a fine (usually by the police) or by detention of up to 30 days. However, proceedings for misdemeanours may be suspended for reasons of expediency.
Any act of illegal possession or dealing with drugs not aimed at personal use only, is considered as a criminal offence, regardless of the type and the amount of illicit drug. Activities such as illegal manufacture, acquisition, theft or robbery, storage, transport or delivery of narcotic drugs or psychotropic substances with the intent of trafficking is punishable by three to 12 years’ imprisonment, depending on the quantities involved and aggravating circumstances. An amendment at the beginning of 2004 provides even stricter penalties with respect to drug-related crimes, particularly with aggravating circumstances. These crimes are punishable by over 10 years’ imprisonment, up to life in some cases. Due to limited treatment capacity, alternatives to prison are not widely implemented.
National drug strategy
The Estonian ‘National strategy on the prevention on drug dependency (NSPDD) 2004–12’ came into force in 2005 and replaced the former ‘Alcohol and drug abuse strategy’ of 1997. The new strategy is complemented by triennial action plans for the implementation of the strategy for the periods 2007–09 and 2010–12. It is a comprehensive strategy covering six pillars: prevention; treatment and rehabilitation; harm reduction; drug use in prison; drug supply; and monitoring and evaluation. Each chapter of the strategy includes a long-term objective for 2012 and mid-term objectives for 2007.
Coordination mechanism in the field of drugs
The Government Committee on Drug Prevention was established in April 2006, and its tasks are: revising the national drugs strategy and updating if the need arises; drafting the action plans for the implementation of the strategy; reviewing annual reports; evaluating the implementation of the drug strategy; and drafting an implementation report of the drug strategy for the Government.
The Minister of Social Affairs is responsible for the work of the committee. It is chaired by the Deputy Secretary-General on Health of the Ministry of Social Affairs and it has 11 members from the Ministry of Social Affairs, the Ministry of Internal Affairs, the Ministry of Justice, the Ministry of Finances, the Estonian Drug Monitoring Centre, the Estonian Psychiatrists Union, the Estonian Cities Union, Police Board, and the Board of the Border Guard.
The Department of Public Health within the Ministry of Social Affairs is the permanent coordination unit in the drugs field. The Minister of Social Affairs informs the government on the progress of the implementation of the national drugs strategy. The EDMC (Estonian Drug Monitoring Centre — the Estonian national focal point) is a member of the Government Committee for Drug Prevention and is responsible for drafting twice-yearly reports on the drug situation for this committee.
Drug-related research
Drug-related research is organised through the current national strategies for the prevention on the drug dependency and for HIV/AIDS prevention. The state research funds are mainly managed by the Ministry of Education and Research, but most research projects in the field of drugs and HIV/AIDS were funded by different foreign sources (e.g. the Global Fund to fight AIDS, malaria and tuberculosis, the UNODC, NIH, ILO) or through the national strategy for the prevention of HIV/AIDS. The main research institutions in the field of drugs are universities (e.g. the University of Tartu, Department of Public Health; the Institute of International and Social Studies), together with research and development institutes, such as the National Institute for Health Development. Recent drug-related studies mentioned in the 2008 Estonian National report mainly focused on aspects related to consequences of drug use. Dissemination of research findings is mainly carried out through the national focal point, universities, scientific journals and the media.