Country overview: Estonia
- Situation summary
- Drug use among the general population and young people
- High-risk drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-induced deaths and mortality among drug users
- 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 (28 countries)||Source|
|Population||2013||1 320 174 ||505 665 739||Eurostat|
|Population by age classes||15–24||2013||11.8 %||11.5 % ||Eurostat|
|25–49||34.5 %||35.0 % |
|50–64|| 20.0 % ||19.7 % |
|GDP per capita in PPS (Purchasing Power Standards) 1||2012|| |
|Total expenditure on social protection (% of GDP) 2||2011||16.1 %||29.0 % p||Eurostat|
|Unemployment rate 3||2013||8.6 %||10.8 %||Eurostat|
|Unemployment rate of population aged under 25 years||2013||18.7 %||23.4 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2012||257.8||:||Council of Europe, SPACE I-2012|
|At risk of poverty rate 5||2012||17.5 %||17.0 % e||SILC |
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, 2012.
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 a sample of 1 401 people aged 15–69. Whilst a 2003 survey found that 15 % of people aged 15–64 had tried illicit 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 illicit 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; in 2008 some 36 % of this group had already tried an illicit drug at least once in their lifetime (16 % in 2003). Cannabis remained the most prevalent illicit substance used those aged 15–34, with last year prevalence at 13.6 % and last month prevalence at 3.2 % in 2008 (10.1 % and 3.3 % respectively in 2003). Amphetamine was the second most frequently used substance during the last year and last month.
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 1995–2007 revealed an increase in prevalence rates for illicit drug use, with some signs of stabilisation in the latest available study. Lifetime experience of any illicit drug other than cannabis 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 cannabis. This increased to 23 % in 2003; 26 % in 2007; and 24 % in 2011. Lifetime use of ecstasy, which increased from 3 % in 1999 to 6 % in 2007, fell to 3 % in 2009. In 2003 the lifetime prevalence of amphetamine use was 7 %; 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, males reported use of illicit substances more frequently than females; however, prevalence rates among males remained stable in 2011 compared to the results of 2007 study, while among females there was an increase in prevalence in the same time period.
In Estonia, prevention was part of the National Strategy for the Prevention of Drug Dependency 2004–12. From 2013, however, drug prevention issues are covered under the National Health Plan 2009–20, and its implementation plan for 2013–16, managed by the Ministry of Social Affairs.
Universal prevention activities are mainly implemented in school settings. Life skills based education is integrated in the subject syllabus of personal, social and health education for grades 2, 5 and 8. A new textbook was developed to assist implementation of the course. Following a comprehensive assessment of school-based drug prevention activities in the previous years, new visual aids, a film and informative leaflets were prepared for use by teachers in classroom settings and were distributed to schools and youth centres. In 2010 the National Institute for Health Development (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 2010–12.
Nineteen 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. A website, narko.ee, updated in 2012, provides the general public with information on drug-related issues.
Selective prevention activities target children who are at risk and their parents, and 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.
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. However, in 2012 a new definition of ‘high-risk drug use’ was adopted. The new definition includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances). Details are available here.
The latest estimate of the number of injecting drug users was conducted in 2010 using a capture-recapture method and three administrative databases: the register of the causes of death, the Estonian Health Insurance Fund and the POLIS database. The estimated number of injecting drug users aged 15–44 in Estonia in 2009 was 5 362 (range from 3 906 to 9 837). When transformed to the EMCDDA standard age range (15–64), there were estimated to be 5.9 injecting drug users per 1 000 inhabitants (range from 4.3 to 10.8).
No estimates for high-risk drug use populations by substance are available in Estonia.
The treatment demand database is hosted by the Infectious Diseases and Drug Monitoring Department of the National Institute for Health Development (the Estonian National Focal Point), and the data are available from 2008.
The drug treatment demand data in Estonia for 2012 came from a total of 14 drug treatment centres, including outpatient and inpatient treatment and three treatment units in prisons.
In 2012 a total of 546 clients entered treatment, of which 125 were new clients entering treatment for the first time.
Opioids users (mainly illicit fentanyl or 3-methylfentanyl) constituted 93 % of all treatment clients and 86 % of new treatment clients in 2012. Cannabis or amphetamines were reported as a main problem substance for a much smaller proportion of drug treatment clients. Overall, 77 % of all treatment clients and 70 % of new treatment clients injected their primary substance of abuse, indicating some decrease in drug injection among treatment demand clients in recent years.
In 2012 some 18 % of all treatment clients were under the age of 25. New treatment clients tended to be younger, with 39 % under the age of 25. With regard to gender distribution among all treatment clients, 77 % were male and 23 % female, while among new treatment clients 72 % were male and 28 % female. Most treatment clients in Estonia were ethnic Russian.
National data on drug-related infectious diseases is collected by the Health Board, which receives information from various sources including hospitals, clinics and human immunodeficiency virus (HIV) testing centres and laboratories. Behavioural surveillance studies among people who inject drugs (PWID) using a responded driven sampling method have been implemented in Tallinn, Kohtla-Jarve and Narva in Ida-Viru County. In 2001 the Health Board registered the highest number (1 340) of newly diagnosed HIV infections among PWID. This number subsequently decreased between 2002 and 2007 (from 702 to 115). Although there was a sharp decline in the number of newly registered HIV cases in 2008 compared to previous years, with 36 new cases detected, in 2009 the number of newly detected cases among PWID increased to 85. There were 62 newly notified cases of HIV among PWID in 2010; 69 in 2011; and 72 in 2012. In recent years the transmission route has been unknown in almost two-thirds of newly registered HIV cases, and therefore the data should be interpreted with caution. The number of people infected with HIV registered by the Health Board continued to decline in 2012 (315 cases in 2012; 370 in 2011; 372 in 2010; 411 in 2009; 545 in 2008; 633 in 2007).
Sero-behavioural studies carried out between 2005 and 2012 among injecting drug users indicated that more than half of those tested were HIV positive. In 2012 HIV prevalence among 599 tested PWID in Kohtla-Jarve was 61.8 %, while a HIV prevalence of 69 % was recorded among 350 PWID tested in Narva in 2007.
Statistics from the Health Board indicate that in 2012 there were five cases of acute and 82 cases of chronic hepatitis C virus (HCV) and seven chronic and one acute case of hepatitis B virus (HBV) registered as linked to injecting drug use. Between 2002 and 2012 there was a decline of the incidence of acute HBV infection, which is attributed to the widespread availability of immunisation among infants and children aged 13. The bio-behavioural surveillance studies among PWID in Kohtla-Jarve indicated HCV prevalence rates of 75 % (599 people tested) in 2012 and 76 % in 2010 (350 tested).
Tuberculosis is a common co-infection among HIV-positive PWID. In 2011 there were 41 case of tuberculosis and HIV co-infection registered, of which 40.5 % were drug users. In a bio-behavioural study conducted among PWID in Kohtla-Jarve in 2012, nine respondents indicated ever having tuberculosis.
Data on drug-induced deaths are reported from the register of the causes of death (general mortality register). Data extraction and reporting is in line with the EMCDDA definitions and recommendations.
A record number of 170 cases of drug-induced deaths were recorded in 2012. This is a dramatic increase on the 101 cases reported in 2010 and 123 cases reported in 2011. Toxicology was known for 165 cases, and 157 of these deaths were attributed to overdose by synthetic opioids, fentanyl and 3-methylfentanyl in particular, and in many instances other psychoactive substances were also present. With regard to the distribution of drug-induced deaths by gender, the majority were men (152 cases). The deceased were on average 31.1 years old. This is an increase compared to the early years of the twenty-first century, when most cases were in their early twenties. Three-quarters (72 %) of the victims reported in 2012 were ethnic Russians and 21 % were Estonians.
Based on these data, the drug-induced mortality rate among adults aged 15–64 was 191 deaths per million in 2011. The mortality rate in Estonia has been an outlier for some years, and is even more so now according to the most recent data available. The Estonian mortality rate of 191 deaths per million in 2011 is considerably higher than the European average in 2012 of 17.1 deaths per million.
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/acquired immune deficiency virus (AIDS) prevention strategy and by some larger municipalities. It is worth noting that, despite the financial difficulties experienced in 2010–12, the amount of funding allocated for drug treatment services has remained stable.
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 opioid substitution treatment (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. However, treatment capacities still seem to be unable to meet the growing number of treatment demands in recent years.
In 2012 an estimated 1 157 clients received MMT through seven service providers funded by the national HIV/AIDS prevention strategy and 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 (<15 %).
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 needle and syringe programmes has improved over the years. Non-governmental organisations (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 needle and syringe programmes. New national guidance recommends annual HIV testing for the 18- to 49-year-old population attending primary care. Free testing and counselling is available at AIDS prevention centres and other locations in nine Estonian cities, but diagnostic blood-testing services cannot be offered by NGOs, due to legal provisions.
Taking into account that tuberculosis remains a significant health challenge among people who live with HIV, free screening for tuberculosis is provided on a regular basis for high-risk groups not covered by health insurance, such as PWID, residents of shelters and prisoners.
More than 2.2 million syringes were distributed in 2012 through a total of 37 syringe exchange sites (13 stationary and 24 outreach programmes, all operated by NGOs).
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.
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 and 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 European Union for large quantities of cocaine coming from South America (which was illustrated by a record 218 kg of cocaine seized in 2010), in the following year 34 seizures resulted in only 0.83 kg of cocaine being seized, while in 2012 a total of 3 kg of cocaine was confiscated in 49 seizures.
In 2012 the law enforcement priority was to decrease the availability of illicit fentanyl, and as a result there were 258 seizures of fentanyl (109 in 2011) seizing 1.7 kg of substance, which is twice the amount seized in 2011 (0.9 kg). In 2012 a record amount of 27 kg of methamphetamine were seized. The amount of seized cannabis products, amphetamine, heroin and ecstasy decreased in 2012 when compared to 2011.
Almost 29 kg of GHB was seized in 2012, an increase on previous years (14 kg in 2011; 16.1 kg in 2010; 25.1 kg in 2009). Cannabinoids were the main new psychoactive substances seized in Estonia in 2012.
A total of 4 616 initial reports on drug-law offences (criminal offences and misdemeanours) were reported in 2012, more than in 2010 and 2011, but still fewer than the number reported between 2001–08. The vast majority of the reports are on use-related offences.
The Act on Narcotic Drugs and Psychotropic Substances and Precursors thereof regulates the field of narcotics and psychotropic substances in the Republic of Estonia. Under this law, 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, is punishable by a fine (usually applied by the police) or by detention of up to 30 days. However, proceedings for misdemeanours may be suspended for reasons of expediency. Repeated use or personal possession were deleted as criminal offences from 1 September 2002.
Any act of illegal possession or dealing in drugs not intended for personal use only is considered a criminal offence, regardless of the type and 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 supply are punishable by up to three years’ imprisonment for the smallest quantities, through to 6–20 years and even life in prison, depending on the quantities involved and other defined aggravating circumstances such as organised crime.
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.
New psychoactive substances (NPS) are regulated by amending schedules of narcotic and psychiatric substances, and in 2013 a new schedule – Schedule V – was added in order to regulate turnover of NPS, in particular for cases when a substance is sold with the intention to cause intoxication, while it may have also other legal applications beyond that purpose. This was specifically required to regulate industrial trade of GBL and 1,4-BD.
View the European Legal Database on Drugs (ELDD) for additional information.
View ‘Legal profile’ for additional information.
Following the completion of the Estonian National Strategy for the Prevention of Drug Dependency 2004–12, measures to reduce drug use have been addressed as part of the National Health Plan 2009–20 and its Action Plan 2013–16. The plan seeks to prevent and reduce the consumption of narcotic substances and reduce the health and social damage caused by drug use. This change reflects adjustments to objective-setting and strategy development in other policy areas, where overarching cross-cutting strategies, such as the National Health Plan 2009–20, have replaced individual strategies in some areas. While the Minister of 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 is responsible for coordination at the inter-ministerial level. Its tasks are: setting drug prevention priorities; monitoring and assessing ongoing actions; proposing policy solutions and advising the government on drug problems; and coordinating measures related to drugs enacted under the National Health Plan. The Minister of the Interior chairs the committee. It has members from the Ministry of Education and Research, Ministry of Justice and Ministry of Social Affairs.
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 Infectious Diseases and Drug Monitoring Department of the National Institute for Health Development (the Estonian National Focal Point) is a member of the Government Committee for Drug Prevention and is responsible for drafting annual reports on the drug situation for this committee.
The 2007–09 and 2011 Action Plans had annual associated budgets. An evaluation report on the implementation of the National Strategy for Prevention of Drug Depedency 2004-12 (NSPD) was completed at the start of 2013. Among other conclusions, this report stressed that a shortcoming of the expiring Strategy was its limited budget. This budget has not been made public, however. The new national strategy, the National Health Plan 2009–20, has still not presented an associated budget. Estimates for labelled drug-related public expenditures (1) have, however, been published since 2007. The methodology used to collect and estimate these expenditures cannot be assessed, but results appear to be comparable over time (except for 2012).
The latest data, from 2011, show that labelled drug-related expenditures represented 0.023 % of gross domestic product (GDP). Between 2007–11, labelled expenditures were classified as demand reduction activities (about 76 %) and supply reduction activities (about 24 %).
Based on the available data, trend analysis shows that between 2008 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 decrease 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. Comparable data is not available 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.
View ‘Public expenditure profile’ for additional information.
Drug-related research is organised through the current National Strategy for the Prevention of Drug Dependency and the National HIV/AIDS Strategy. 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 HIV/AIDS Strategy and foreign (mainly United States) or European Union 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 2013 Estonian National report mainly focused on aspects related to the prevalence incidence and patterns of drug use and on consequences of drug use. 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.