Country overview: Estonia
- Drug use among the general population and young people
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-law offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Public expenditure
- Drug-related research
|Year||EU (27 countries)||Source|
|Population||2012||1 339 662 p ||503 663 601 b p||Eurostat|
|Population by age classes||15–24||2012||12.8 % p||11.7 % b p||Eurostat|
|25–49||35.0 % p||35.4 % b p|
|50–64||19.5 % p||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||67||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||18.1 %p||29.4 %||Eurostat|
|Unemployment rate 3||2012||10.2 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012||20.9 %||22.8 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2011||252.6||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2011||17.5 %||16.9 % e||SILC |
b Break in series.
p Eurostat provisional value.
1 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.
2 Expenditure on social protection includes: 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.
3 Unemployment rates represent unemployed people as a percentage of the labour force. Unemployed people comprise those aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
4 Situation of penal institutions on 1 September, 2011.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
The most recent data on drug use in the general population are based on a survey conducted in 2008 among people aged 15–69. Whilst a 2003 survey found that 15 % of people aged 15–64 had tried drugs at some point in their lives, the 2008 survey found that 21 % of people in the same age group had tried drugs. Lifetime prevalence of drug use had increased in both the older and the younger age groups, but it was considerably higher in the younger age groups. The increase was particularly significant in the 25–34 age group, where 36 % of people had already tried an illicit drug at least once in their lifetime (16 % in 2003).
The European School Survey Project on Alcohol and Other Drugs (ESPAD) has been conducted regularly in Estonia since 1995. The latest survey was in 2011, based on a nationwide sample of schoolchildren aged 15−16. The results for the 15- to 16-year-old age group for 1995–2007 revealed an increase in prevalence rates for illicit drug use, with some stabilisation signs in the latest available study. Lifetime experience of any illicit drug other than marijuana and hashish more than tripled between 1995 (2 %) and 1999 (9 %), and reached 10 % in 2003, but declined to 8 % in 2011. In 1995 some 7 % reported lifetime use of marijuana/hashish, 23 % in 2003, 26 % in 2007 and 24 % in 2011. Lifetime use of ecstasy, which increased from 3 % in 1999 to 6 % in 2007, had dropped to 3 % in 2009. In 2003, the lifetime prevalence of amphetamine use was 7 % and in 2011 it had decreased to 3 %. The most recent survey indicates a last year prevalence of cannabis use of 17 %, and last month prevalence of 6 %. In terms of gender distribution, boys reported use of illicit substances more frequently than girls; however, prevalence rates among boys remained stable in 2011 compared to the results of 2007 study, while among girls there was an increase in prevalence in the same time period.
In Estonia, prevention is part of the National Strategy for the Prevention of Drug Dependency 2004–12 and is under the responsibility of the Ministry of Social Affairs, while the main implementing parties are the National Institute of Health Development (NIHD) and the Ministry of Education and Research.
Universal prevention activities are mainly implemented in school settings; drug prevention is included in the national study programme within ‘human studies’, as a subtheme in the ‘health study’ course. A new textbook was developed in 2011 to assist implementation of the course in 5th, 7th and 8th grades. In 2010–11, following a comprehensive assessment of school-based drug prevention activities, new visual aids, a film and informative leaflets were prepared for use by teachers in classroom settings. In 2010, the NIHD published guidelines on drug prevention. These guidelines are aimed at youth workers and provide them with common-ground information on how to conduct drug prevention initiatives. Preparation of the guidelines was accompanied by several training seminars in 2010–11.
Eighteen youth information and counselling centres across Estonia, funded by the Ministry of Education and Research, also provide drug prevention information and counselling to young people, and new instructional material (terviseinfo.ee) on health issues, including drugs, was published in 2011 for professionals working in the centres. Several local initiatives, such as early interventions for use with children showing evidence of problems in school settings, counselling interventions for young people and a game promoting an addiction-free lifestyle have been implemented.
Selective prevention activities target children who are at risk and their parents, as well as young people in specialised educational settings. These include activities to promote the adoption of healthy behaviour and to strengthen coping skills.
Indicated prevention projects in Estonia are presently unavailable.
View ‘Prevention profile’ for additional information.
There is no new estimate for problem drug use in Estonia, but as a minimum approximation the latest existing estimate may be used. In 2004, the prevalence of injecting drug use (IDU)s was estimated at 15 cases per 1 000 inhabitants aged 15–64 (13 886 users). (1) This result is exceptionally high when compared with EU Member States.
Up to 2012, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. Details are available here.
(1) The original age group considered in the study was 15–44 years (Uusküla et al., 2007); this estimation is just a recalculation made for the purpose of comparability with other EU countries.
The amendment to the Narcotic Drugs and Psychotropic Substances Act was approved in May 2005. This provided the legal basis to set up a drug treatment database. The database was adopted in 2006 and amendments to relevant legal acts were made. From 1 January 2008 the Estonian Drug Monitoring Centre (EDMC) of the National Institute for Health Development has collected data on individuals receiving drug treatment, and the data are available from 2008.
The drug treatment demand data in Estonia for 2011 were based on 13 outpatient and inpatient centres (including two prisons).
In 2011, a total of 532 clients entered treatment, of which 163 were new treatment clients.
Of those who sought treatment for the first time, 80.4 % were opiate users (mainly fentanyl or 3-methylfentanyl), 11.7 % were cannabis users and 4.9 % were amphetamine users. The figures for all individuals entering treatment show the same distribution: 91.4 % were opiate users (mainly fentanyl or 3-methylfentanyl), 5.3 % were cannabis users and 2.4 % were amphetamines users. Most drug treatment clients were in substitution treatment due to their opiate use, and other forms of treatment remain limited.
In 2011, some 18 % of all clients entering treatment were under the age of 25. For new clients entering treatment the proportion of younger clients was considerably higher, with 37 % under the age of 25. With regards to gender distribution among all clients entering treatment, 74.8 % were male and 25.2 % female. Similar distribution was noted also among new treatment clients, with 73.6 % male and 26.4 % female.
National data on drug-related infectious diseases is collected by the Health Board, which receives information from various sources including hospitals, clinics, and HIV testing centres and laboratories.
In 2001, the Health Board 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 2008 there was a sharp decline in the number of newly registered HIV cases compared to previous years (26.8 cases per million population), in 2009 the rate increased to 63.4. In 2010 and 2011 the rate decrease to 46.3 and 51.5. The actual number of new IDU-related cases in 2011 also went down to 69, compared to 85 cases in 2009. In recent years, the transmission route was unknown in almost two-thirds of newly registered HIV cases, therefore the data should be interpreted with caution. In 2010, the number of people infected with HIV registered in the Health Board continued to decline (370 in 2011; 372 in 2010; 411 in 2009; 545 in 2008; 633 in 2007). Sero-behavioural studies carried out between 2005 and 2009 among injecting drug users indicated that more than half of those tested were HIV positive; however, some indications exist that the infection rates are declining among new injectors (34 % in 2005; 16 % in 2009, p = 0.046). The cross-sectional study among injecting drug users in Narva implemented in 2010 indicated HIV prevalence rates of 52.4 %.
Statistics from the Health Board indicate that in 2011 there were four cases of acute hepatitis C virus (HCV) and five cases of hepatitis B virus (HBV) registered as linked to injecting drug use. Between 2002 and 2011 there was a significant drop in the acute cases of hepatitis B virus, which is attributed to the widespread availability of immunisation against hepatitis B among infants and children aged 13.
Tuberculosis is a common co-infection among HIV-positive injecting drug users. In 2011 there were 41 case of tuberculosis and HIV co-infection cases registered, of which 40.5 % were drug users.
Data on drug-related deaths are only available for deaths caused by an acute intoxication of drugs. A total of 123 cases of direct drug-related deaths were recorded in 2011, fewer than in 2009 when 133 cases were recorded, but still exceeding the levels in previous years (101 in 2010; 67 in 2008; 68 in 2006; 57 in 2005; 98 in 2004). Opioids, 3-methylfentanyl in particular, were present in 95.9 % of all deaths with known toxicological results, and in many instances other psychoactive substances were also present. With regards to the distribution of drug-related deaths by age and gender, the majority were men (87.8 % cases), and the deceased were on average 30.1 years old at the time of death.
In Estonia, the Ministry of Social Affairs is responsible for the overall administration and coordination of the National Strategy for the Prevention of Drug Dependency, including treatment. The National Institute for Health Development is responsible for the implementation and funding of drug treatment. Treatment is also funded through the national HIV/AIDS prevention strategy and by some larger municipalities. It is worth noting that, despite the financial difficulties experienced in 2010–11, the amount of funding allocated for drug treatment services has remained stable.
Traditionally, drug treatment in Estonia is for the most part 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 recent years, treatment provision has gradually been taken over by specialist drug agencies, and an increased availability of outpatient treatment, counselling and treatment options outside the psychiatric hospitals was noted. Service provision by non-government organisations (NGOs) has also shown an appreciable increase. The available treatment methods covered by state or local funding include detoxification, methadone maintenance treatment, medication-free treatment and 12-steps programme-based rehabilitation (treatment communities, outpatient and inpatient rehabilitation programmes), although opiate substitution treatment prevails among the available treatment options. Special drug treatment programmes for women and children 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 methadone maintenance treatment was officially introduced in 2001 it has only been used on a significant scale since 2003 with the opening of a specialist centre. However, treatment capacities still seem to be unable to meet the growing number of treatment demands in recent years. The Drug Strategy for the Prevention of Drug Dependency 2004–12 aims to develop the professional capacities among staff and to improve the availability and quality of treatment services.
In 2011, an estimated 1 076 clients received methadone maintenance treatment through seven service providers funded by the state (through the national HIV/AIDS prevention strategy and Tallinn Social Welfare and Health Care Department).
View ‘Treatment profile’ for additional information.
The Government started funding syringe exchange in 2003, within the framework of the national HIV/AIDS prevention programme. In addition, harm reduction measures were specifically mentioned in the National Strategy for the Prevention of Drug Dependency 2004–12 and are continuously funded by the National HIV/AIDS Strategy 2006–15. As a consequence, the coverage and quality of syringe exchange programmes has improved over the years. 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.
More than 2.1 million syringes were distributed in 2011 through a total of 36 syringe exchange sites (13 stationary and 23 outreach programmes, all operated by NGOs).
Free testing and counselling is offered, at AIDS prevention centres in nine Estonian cities, and at other locations. 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.
A total of 3 821 initial reports on drug-law offences were reported in 2011, more than in 2010 but still fewer than the number reported between 2001–09. A vast majority of the reports are on use-related offences.
The general trends in terms of drug production and trafficking in Estonia over recent years have not changed significantly. Heroin is mainly smuggled through eastern borders and in very small quantities. Synthetic drugs, i.e. amphetamine, are mainly smuggled to Estonia from Latvia or western Europe for domestic use, as well as for other Scandinavian countries. In 2011, domestic production of amphetamine and GHB was reported. Although in recent years Estonia has been used as an entry point to the EU for large quantities of cocaine coming from South America (which was illustrated by a record 21 kg of cocaine seized in 2010), in the following year 34 seizures resulted in only 0.83 kg of cocaine being seized. At the same time, the Police and Border Guard Board indicates increased availability of cocaine in the domestic market. In 2011, an increase in the seized amounts of cannabis products, ecstasy, methamphetamine, heroin and fentanyl were noted. In 2011, seized amounts of GHB dropped further to 13 kg when compared to 16.1 kg seized in 2010 and 25.1 kg in 2009. Synthetic cathinones were the main new psychoactive substances seized in Estonia in 2011.
From 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 in 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, and up to life imprisonment in some cases.
In 2011, Parliament adopted a legal basis for the implementation of treatment for addiction as an alternative punishment for drug addicts. The treatment can be applied only in cases when a person is sentenced to imprisonment for a period of six months to two years and he/she agrees to undergo the treatment course.
In 2011, eleven new psychoactive substances were put under control in Estonia.
View ‘Legal profile’ for additional information.
The Estonian National Strategy for the Prevention of Drug Dependency (NSPDD) 2004–12 came into force in 2005 and replaced the Alcoholism and Drug Abuse Prevention Programme 1997–2007. The strategy was complemented by triennial action plans for the implementation of the strategy for the periods 2007–09 and 2010–12. Taking a comprehensive approach, its six pillars address: 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. Following the completion of the national drugs strategy in 2013, drug prevention issues were subsumed within the National Health Plan 2009–20 and its Action Plan 2013–16. Within the Health Plan specific objectives cover the two domains of demand and supply reduction, and the crosscutting issues of coordination, cooperation, and monitoring and evaluation, reflecting the balanced approach of the EU Drugs Strategy. This change reflects adjustments to objective setting and strategy development in other policy areas, where overarching crosscutting strategies such as the National Health Plan 2009–20 have replaced individual strategies in some areas. While the Minister for Social Affairs holds overall responsibility for the National Health Plan 2009–20, the Minister of Interior is responsible for drugs issues within the plan and its action plans.
View ‘National drug strategies’ for additional information.
The Government Committee on Drug Prevention was established in April 2006, and is responsible for coordination at the inter-ministerial level. Its tasks are: revising and updating the national drugs strategy if needed; drafting 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 and Police and the Border Guard Board.
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 once a year reports on the drug situation for this committee.
The 2007–09 and 2011 action plans both had annual associated budgets. Estimates of ‘labelled’ drug-related public expenditures (1) have also been published every year since 2007. The methodology used to collect and estimate these expenditures cannot be fully assessed, but the results appear to be comparable over time.
The latest data, from 2011, show that labelled drug-related expenditures represent 0.023 % of GDP. Between 2007–11, these labelled expenditures were classified as demand reduction activities (76.4 %) and supply reduction activities (23.6 %).
Based on the available data, trend analysis shows that between 2007 and 2010 labelled expenditures fell, from 0.027 % of GDP in 2007 to 0.021 % in 2010. This decrease was probably associated with the public austerity measures following the economic recession of 2008. The largest reduction was reported in supply reduction until 2009. In 2010, labelled expenditures in supply reduction registered a nominal increase, while expenditures in demand reduction activities declined further. In 2011, labelled expenditures recovered partially to 0.023 % of GDP.
A new estimate for drug-related public expenditures is foreseen for 2013.
(1) Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling.
View ‘Public expenditure profile’ for additional information.
Drug-related research is organised through the current national strategies for the prevention of drug dependency and for HIV/AIDS prevention. The state research funds are primarily managed by the Ministry of Education and Research, but most research projects in the field of drugs and HIV/AIDS are funded through the national strategy for the prevention of HIV/AIDS and foreign (mainly US) or EU research funds. 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) and research and development institutes such as the National Institute for Health Development. Recent drug-related studies mentioned in the 2012 Estonian National report mainly focused on aspects related to the health-related consequences of drug use and on drug prevalence surveys. Dissemination of research findings is mainly carried out through the national focal point, universities, scientific journals and the media.
View ‘Drug-related research’ for additional information.