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-related 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||2011||1 340 194
||502 476 606 p||Eurostat|
|Population by age classes||15–24||2011||13.4||:||Eurostat|
|GDP per capita in PPS (Purchasing Power Standards) 1||2010||64||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2009||19.2||29.5 % p||Eurostat|
|Unemployment rate 3||2011||12.5||9.7 %||Eurostat|
|Unemployment rate of population aged under 25 years||2011||22.3||21.4 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2010||258.9||:||Council of Europe, SPACE I-2010|
|At risk of poverty rate 5||2010||15.8||16.4 %||SILC
p Eurostat provisional value.
b Break in series.
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 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.
3 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.
4 Situation of penal institutions on 1 September, 2010.
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 is based on a survey conducted in 2008 among people aged 15–69. Whilst the survey conducted in 2003 showed that 15 % of people aged 15 to 64 had tried drugs at some point in their lives, the survey conducted in 2008 showed that 21 % of people in the same age group had tried drugs. Lifetime prevalence of drug use has increased both in the older and the younger age groups, but it is considerably higher in the younger age groups. The increase has been particularly significant in the 25–34 age group, where 36 % of people have already tried some illicit drug at least once in their lives (16 % in 2003).
The ESPAD study has been regularly conducted in Estonia since 1995, the latest was done in 2011, based on a nationwide sample of schoolchildren aged 15−16. The results for the 15–16-year-old age group in the time period 1995–2007 has revealed an increase in prevalence rates for illegal drug use, with some stabilisation signs in the last available study. 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, but has declined to 8 % in 2011. While 7 % reported lifetime use of marijuana/hashish in 1995, 23 % in 2003, 26 % in 2007 and in 2011, 24 % admitted to have experimented at least once with marijuana/hashish in their lives. Lifetime use of ecstasy which increased from 3 % in 1999 to 6 % in 2007, has dropped to 3 % in 2009. In 2003, the lifetime prevalence of amphetamine use was 7 % and in 2011, it decreased to 3 %. In the most recent survey, results indicate a last-year prevalence of cannabis use of 17 % and 6 % for the last-month prevalence.
Prevention is part of the National Strategy for the Prevention of Drug Addiction 2004–12, and is under the shared responsibility of the Ministry of Social Affairs and the Ministry of Education.
The universal prevention activities are mainly implemented in the school settings, drug prevention is to some extent included into the subject syllabi of human, family and personal studies of the national study programme. In 2010, following a comprehensive assessment of school based drug prevention activities, new visual aids and informative leaflets were prepared to be used by teachers in classroom settings.
In 2010, the National Institute for Health Development (NIHD) published guidelines on drug prevention. These guidelines are aimed for 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. Nineteen youth information and counselling centres funded by the Ministry of Education and Research across country also provide drug prevention information and counselling to young people. Several local initiatives, such as early interventions for problematic children in school settings, counselling interventions for young people and a game promoting a lifestyle free of addiction are implemented in the country.
Selective prevention activities target delinquent young people in specialised educational settings and include activities which promote adoption of healthy behaviour and strengthening coping skills.
Indicated prevention projects in Estonia are presently unavailable.
View ‘Prevention profile’ for additional information.
So far, there is no new estimate for problem drug use in Estonia, but as a minimum approximation, the latest 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 when compared with EU Member States.
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/3-methylfentanyl), cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
(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.
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) of the National Institute for Health Development has collected data on individuals receiving drug treatment, and the data are available since 2008.
The drug treatment demand data in Estonia for 2009 were based on 13 outpatient and inpatient centres (including two prisons).
In 2010, a total of 665 clients entered treatment, out of which 176 were new treatment clients.
86.4 % of those who sought treatment for the first time were opiate users and the rest were amphetamines and cannabis users — 10.8 % and 1.7 %, respectively. The figures for all individuals entering treatment show the same distribution: 94.6 % were opiate users (mainly fentanyl or 3-methylfentanyl), 4.2 % amphetamines users and 0.5 % were cannabis users. Most of drug treatment clients are in substitution treatment due to their opiate use, while other forms of treatment remain limited.
In 2010, 21 % of all clients entering treatment were under the age of 25. On the other hand, first-time treatment clients were considerably younger, with 40 % under the age of 25. With regards to gender distribution among all clients entering treatment, 77.3 % were male and 22.7 % female. This distribution was also evident among first-time treatment clients with 74.4 % male and 25.6 % female.
National data on drug-related infectious diseases is collected at 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 of the population), in 2009, the rate has increased to 63.4 new HIV cases among IDUs registered per million of the population, but in 2010, a decrease to 46.3 new HIV cases among IDUs per million of the population was registered. The actual number of new IDU-related cases in 2010 has also dropped to 62, compared to 85 cases in 2009. In recent years, for almost two thirds of newly registered HIV cases, the transmission route was unknown; therefore, data should be interpreted with caution. In 2010, the number of people infected by HIV registered in the Health Board continued to decline (315 in 2010, 411 in 2009, 545 in 2008, 633 in 2007). Sero-behavioural studies done between 2005 and 2009 among injecting drug users indicated that more than half of injecting drug users tested are HIV positive, however some indications exist that the infection rates are declining among new injectors (34 % in 2005, 16 % in 2009, p = 0.046).
According to the statistics of the Health Board, in 2009 there were two cases of acute hepatitis C virus (HCV) and 13 cases of hepatitis B virus (HBV) registered as linked to injecting drug use. In 2009, the number of cases was 16 and four respectively. Between 2002 and 2009, there has been 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 13 years of age.
Tuberculosis is a common co-infection among HIV-positive injecting drug users. In 2009, 31 cases of tuberculosis and HIV co-infection cases were registered, 54.8 % of them among injecting drug users.
In Estonia, data on drug-related deaths are only available for deaths caused by an acute intoxication of drugs. A total of 101 cases of direct drug-related deaths were recorded in Estonia in 2010, which is less than in 2009 when 133 cases were recorded, but still exceeds the levels observed in previous years (67 in 2008, 68 in 2006, 57 in 2005, 98 in 2004). Opioids, 3-methylfentanyl in particular, were present in 99 % of all death cases with known toxicological results. With regards to the distribution of drug-related deaths by age and gender, the majority were men (89 cases), and only 12 cases occurred among females.
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. Treatment is also funded through the national HIV/AIDS prevention strategy and by some larger municipalities.
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 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. Service provision by 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 remain limited.
Methadone detoxification has been present in Estonia since 1998, but while methadone maintenance treatment was officially introduced in 2001, it has only become used on a significant scale since 2003 with the opening of a specialised 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 sets out to develop the professional capacities among staff and to improve the availability and quality of treatment services.
In 2010, an estimated total of 1 064 clients received methadone maintenance treatment through five 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.
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 2010, almost 2.4 million syringes were distributed through a total of 36 syringe exchange sites (13 stationary and 23 outreach programmes, all operated by NGOs).
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.
In 2010, approximately 2 839 initial reports on drug-related offences were reported, which is the smallest amount since 2001. 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 western Europe for domestic use, as well as for other Scandinavian countries. However, in recent years, Estonia has been used as an entry point to the EU for large quantities of cocaine coming from South America.
In 2010, cocaine was the main illicit drug seized with a total of 218 kg, followed by 48 kg of amphetamines and 15 kg herbal cannabis. Seized amounts of methamphetamine have increased up to 0.5 kg compared with data reported in 2009, however is significantly below the record amount of 38 kg seized in 2008. In 2010, seized amounts of GHB dropped when compared with 2009 (16.1 kg in 2010 and 25.1 kg in 2009). Despite a drop in the seized amount of fentanyl and its analogues in 2010, they remain the most popular opiates used and illicitly produced in Estonia.
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.
In 2011, Parliament adopted a legal basis for 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 for an imprisonment for a length of six months to two years, and he/she shall agree to undergo the treatment course.
In 2010, in total, three new psychoactive substances were added to the List I of narcotic drugs and psychotropic substances, while in 2009, eight new psychoactive substances were put under control in Estonia.
View ‘Legal profile’ for additional information.
The Estonian ‘National strategy on the prevention on drug dependency (NSPDD) 2004–12’ came into force in 2005 and replaced the former ‘Alcoholism and Drug Abuse Prevention Programme, 1997–2007’. 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.
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 of Estonia 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 2010, show that labelled drug-related expenditures represent 0.01 % of GDP. These labelled expenditures were classified as demand reduction activities (76.2 %) and supply reduction activities (23.8 %).
Based on the available data, trend analysis shows that between 2007 and 2010 labelled expenditures fell continuously, from 0.02 % of GDP in 2007 to 0.01 % in 2010. This decrease was probably associated to 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.
A new estimate for drug-related public expenditures is foreseen for 2012.
(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.
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 mainly 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 (USA mainly) 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), together with research and development institutes, such as the National Institute for Health Development. Recent drug-related studies mentioned in the 2011 Estonian National report mainly focused on aspects related to drug-related consequences and high risk drug consumption and on interventions. 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.