Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul:81:102757.
doi: 10.1016/j.drugpo.2020.102757. Epub 2020 May 13.

The fentanyl epidemic in Estonia: factors in its evolution and opportunities for a comprehensive public health response, a scoping review

Anneli Uusküla  1 , Ave Talu  2 , Sigrid Vorobjov  3 , Maris Salekešin  3 , Jürgen Rannap  2 , Liis Lemsalu  3 , Don Des Jarlais  4
Affiliations

The fentanyl epidemic in Estonia: factors in its evolution and opportunities for a comprehensive public health response, a scoping review

Anneli Uusküla et al. Int J Drug Policy. 2020 Jul.

Abstract

Background: The spread of illicitly manufactured fentanyl has the potential to greatly increase the fatal overdoses in many places in the world. The purpose of this paper is to analyse the evolution of fentanyl use epidemic in Estonia.

Methods: this scoping review is based on extensive review and synthesis of broad range of literature: research reports, newspaper, magazine, coverage of illicit fentanyl use; policy documents, position papers, reports released by government agencies, and surveillance data.

Results: For an over a decade up to 2017, Estonia has had the highest overdose death mortality in Europe. The use of (injected) fentanyl is a major contributor to the Estonian overdose death epidemic. Shutting down a major producer and distributor of illicit fentanyl has been extremely effective in curbing the number of overdose deaths. Unfortunately, this supply-side intervention came ten years into the epidemic, and might be difficult to replicate in settings with decentralized production. In areas faced by fentanyl we would recommend large-scale implementation of opiate substitution treatment and naloxone distribution, syringe service programs to provide for safer injecting and link to other services (high frequencies of fentanyl injection create high risk for HIV and HCV transmission), and programs, such as "Break the Cycle," to reduce initiation into injecting drug use. Further, the means of responding to emerging substances should match the world in which different substances can be rapidly introduced, and where people who use drugs can change preferences based on market availability.

Conclusion: Addressing illicitly manufactured fentanyl may serve as a public health learning experience for developing early detection and rapid response programs in rapidly changing drug use environments.

Keywords: Estonia; Fentanyl; HIV; drug death; illicitly produced fentanyl; overdose.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest None

Figures

Figure 1.
Figure 1.
The fentanyl epidemic in Estonia: the amount of seized illicitly manufactured fentanyles (in grams), the number (n) of overdose deaths and overdose mortality per 100 000, the number of naloxone doses distributed to drug users and their family members, and the prevalence of injection drug use among population aged 15–44 years in 1999 to 2018 (data on from the first 8 months 2019 also presented)
Figure 2.
Figure 2.
The way of packing and transportation of illicitly manufactured fentanyl, Estonia (2017)
Figure 3.
Figure 3.
Illicit fentanyl manufacturing laboratory, fentanyl and inactive ingredients mixing instrument, and product, Estonia (2017)
See this image and copyright information in PMC

References

    1. Abel-Ollo K, Talu A, Vals K, Vorobjov S, Paimre M, Ahven A, et al. (2007) National Report (2006 data) to the EMCDDA by the REITOX National Focal Point. Estonia. New developments and trends and in-depth information on selected issues. Available at: http://www.emcdda.europa.eu/system/files/publications/949/NR2007Estonia.pdf (accessed 15 October 2019).
    1. Abel-Ollo K Fentanyl overdose deaths emergency and response in Estonia. Lisbon Addictions2019, Lisbon, Portugal, October 24, 2019. Available at: https://www.lisbonaddictions.eu/lisbon-addictions-2019/presentations/fen... (accessed October 15, 2019).
    1. Arksey H, & O’Malley L (2005). Scoping studies: towards a methodological framework. Int J Soc Res Methodol, 8(1), 19–32.
    1. Ashilevi J (2016). AASTA KÕIGE UNCOOL’IM RAAMAT [The most uncool book of the year]. Müürileht 2016; September 19. Available at: https://www.muurileht.ee/aastakoige-uncoolim-raamat/ (accessed on 19 December 2019).
    1. Claridge H, Williams BD, & Copeland CS (2019). A deadly trend in fentanyl fatalities (England, 1998–2017). Br J Clin Pharmacol October 29. - PMC - PubMed

Publication types