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 | 2010 | 1 340 415 | 501 105 661 p | Eurostat | |
| Population by age classes | 15–24 | 2010 | 14.0 % | 12.1 % p | Eurostat |
| 25–49 | 34.9 % | 35.8 % p | |||
| 50–64 | 18.8 % | 19.1 % p | |||
| GDP per capita in PPS (Purchasing Power Standards) 1 | 2009 | 64 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 2 | 2008 | 15.1 % | 26.4 % p | Eurostat | |
| Unemployment rate 3 | 2010 | 16.9 % | 9.6 % | Eurostat | |
| Unemployment rate of population aged under 25 years | 2010 | 32.9 % | 20.9 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 4 | 2009 | 265.2 | Council of Europe, SPACE I-2009 | ||
| At risk of poverty rate 5 | 2009 | 19.7 % | 16.3 % | 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 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, 2009.
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).
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 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 some time in their lives, then 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-to-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 2007, based on a nationwide sample of schoolchildren aged 15−16. 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 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.
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.
The universal prevention activities are mainly implemented in the school settings, drug prevention is to some extent included into the subject syllabi of human and family studies of the national study programme. In 2009, the National Institute for Health Development (NIHD) initiated preparation of guidelines on drug prevention. These guidelines are aimed for youth workers and should provide them with common-ground information on how to conduct drug prevention initiatives. In addition, the Ministry of Education together with NIHD had implemented number of trainings to improve knowledge and skills of wide spectrum of professionals involved in drug prevention activities.
Due to budget cuts in 2009, planned national and local information campaigns and events were not implemented.
Selective and indicated prevention projects in Estonia are presently unavailable.
Problem drug use
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 compared with EU Member States.
(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 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.
Treatment demand
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 persons receiving drug treatment, and the data are available since 2008.
The drug treatment demand data in Estonia for 2009 were based on 11 outpatient and inpatient centres (including two prisons).
In 2009, a total of 687 clients entered treatment, out of which 157 were new treatment clients. 88.5 % of those who sought treatment for the first time were opiate users and the rest were amphetamines and cannabis users — 6.4 % and 3.8 %, respectively. The figures for all persons entering treatment show the same distribution: 96.4 % were opiate users (mainly fentanyl or 3-methylfentanyl), 2.2 % amphetamines users and 0.9 % were cannabis users.
In 2009, 24 % of all clients entering treatment were aged less than 25 years. On the other hand, first-time treatment clients were considerably younger, with 38 % under the age of 25 years. The age of clients seeking treatment has increased in 2009 in comparison to 2008. With regards to gender distribution among all clients entering treatment, 77 % were male and 23 % female. This distribution was also evident among first-time treatment clients with 73 % male and 27 % female.
Drug-related infectious diseases
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 the previous years (26.8 cases for a million population), in 2009 the rate has increased to 63.4 new HIV cases among IDUs registered per million of population. The actual number of new IDU-related cases has almost tripled in 2009 when compared to 2008 (85 and 36 cases respectively). In 2009, similarly to previous years, a majority of newly-diagnosed HIV infections among IDUs was found in Ida-Viru (north-east of Estonia) and Harju counties.. By region, HIV incidence is the highest in Kohtla-Järve and Narva. However, due to limited and incomplete HIV surveillance data, the HIV epidemic among IDUs is probably underestimated. In 2009, almost for two thirds of newly registered HIV cases the transmission route was unknown. In 2009, the number of people infected by HIV registered in the Health Board continued to decline (411 in 2009, 545 in 2008, 633 in 2007).
According to the statistics of the Health Board, in 2009 there were 16 cases of acute hepatitis C virus (HCV) and four cases of hepatitis B virus (HBV) registered as linked to injecting drug use. In 2008, the number of cases was 15 and 10 respectively. Between 2002 and 2009, there has been a significant drop in the acute cases of virus hepatitis B 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, 36 cases of tuberculosis and HIV co-infection cases were registered, 66.7 % of them among injecting drug users.
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 133 cases of direct drug-related deaths were recorded in Estonia in 2009, which is almost twice as many if compared to previous years (67 in 2008, 68 in 2006, 57 in 2005, 98 in 2004). With regards to the distribution of drug-related deaths by age and gender, the majority were men aged 25–34 (88 cases), and only 13 cases out of 133 occurred among females.
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. 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, out-patient and in-patient rehabilitation programmes).
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 2009, an estimated total of 1 012 clients received methadone maintenance treatment in five treatment centres funded by the state (through the national HIV/AIDS prevention strategy and Tallinn Social Welfare and Health Care Department).
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 2009, almost 2.3 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.
Drug markets and drug-related offences
In 2009, around 4 241 initial reports on drug-related offences were reported, which the smallest amount since 2001. A vast majority of the reports are on use-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 and 2007, three clandestine laboratories were discovered by the police. However, in 2009, police did not dismantle any clandestine laboratories and the amounts of ecstasy tablets seized continued to decline (19 465 tablets in 2008 to 13 574 tablets in 2009).
In 2009, the most commonly seized illicit drug was amphetamine with a total of 325 amphetamine seizures. In terms of quantities, 56 kg of amphetamine were seized in 2009, followed by GHB and GHB-GBL primary materials.
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.
In 2009, in total eight substances were added to the List I of narcotic drugs and psychotropic substances (mephedrone, JWH-073, JWH-018, CP 47497, CP 47497-C6-homologue, CP 47497-C8-homologue, CP 47497-C9-homologue, HU-210).
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 and Police and the Boarder 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 in a year 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 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 2010 Estonian National report mainly focused on aspects related to the prevalence of drug use among the general population and schoolchildren. Studies on bio-behavioral aspects of high risk drug consumption and drug-related consequences remain a research priority for the institute. A number of studies have been published recently on prevalence of blood-borne infections among IDUs. Dissemination of research findings is mainly carried out through the national focal point, universities, scientific journals and the media.
