Why Europe’s Healthiest Economy Has Its Worst Drug Problem

Estonia is an economic powerhouse — with more than 8% growth in 2011 — but it has a dreadful statistic has well: the highest number of per capita drug deaths in Europe

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Aivar has already begun to sweat. His last hit of “China white” was yesterday evening. Shortly his limbs will begin to ache, and if he doesn’t get a fix soon he will vomit what little food and water he’s had since waking up two hours earlier.

He is at a needle exchange in the center of Estonia’s capital Tallinn and is using the opportunity to reflect on the deaths of his closest friends and the four overdoses he has suffered since he started injecting drugs 14 years ago. The 32-year-old understands how easily he could add to the statistic. One day the defibrillators will not work, he says. Still he can’t stop. Neither can so many other Estonians.

Estonia has the highest number of per capita drug fatalities anywhere in Europe. The reason is fentanyl. Colloquially it is called China white, Persian white or Afghan. But they’re misnomers — glamorous tags attached to a powder, prosaically synthesized in clandestine labs across the border in Russia. It arrived in 2002 during a heroin drought. It never went away. These days it is the drug of choice for the many thousands of dedicated injectors in Tallinn. And, according to government chemists at the sparkling new labs in the capital’s Estonian Forensic Science Institute, it is anywhere between 100 and a thousand times stronger than the scag it replaced.

(MORE: It Ain’t All Snow: Swiss Cities Have Some of the Highest Cocaine Use in Europe)

The effectiveness of the drug makes it easy to smuggle. The largest single police bust last year was a batch of 1.5 kg — small enough to fit in a knapsack, but enough for almost 40,000 doses of the drug on the street. Uncut, it is hardly detectable at all.

The tiny brown-powder doses carried around by addicts in fingernail-size sachets of aluminum foil have to be cut with whey powder or glucose to make them “safe” for humans. Typically, says Aime Riikoja, chief chemist at the Estonian Forensic Science Institute, the purity level is from 5% to 10%. Tragically, the drug gangs’ amateur chemists can bungle the ratios. “In 2009 there were batches which were 13% to 14% pure,” says Peep Rauseberg, a forensic chemist at the institute. “Many people died.”

Sometimes the dealers know the drug is dangerously pure and warn their customers to be careful. Sometimes they can be carrying hits from several different batches at the same time and don’t know themselves what is and what is not safe. “It has happened that we bought two doses at the same time from the same guy,” recalls Aivar, who used to shoot up with his childhood friend in the alleyways of Tallinn. “When I woke up, my friend was already dead.” One of five friends who started injecting together in their late teens, Aivar is the only one still alive.

In 2011 there were 123 drug deaths in Estonia, making this country of just 1.3 million, easily the overdose capital of Europe. The 2012 figures for the rest of the E.U. are not yet available. But Estonia’s 160 deaths will see it top the table again. The injecting-drug scourge is also connected with Estonia’s other public-health epidemic: Aivar is one of the 1.2% of Estonian adults diagnosed with HIV. The European country in second place is next-door-neighbor Latvia with just 0.7%.

Despite topping these twin E.U. leagues of infamy, Estonia is, in many ways, the standout European success story of the past 20 years.

As a part of the Soviet Union until 1991, the country is often lumped in with its more sluggish Baltic neighbors, Latvia and Lithuania. But with its Finnic language, modern supermarkets and burgeoning information economy, the country feels more Nordic, orienting itself politically and culturally westward to its main trading partners, Germany, Finland and Sweden rather than to Russia on its eastern border.

The country is also pulling away economically. After becoming one of the first East European states to join the euro at the beginning of 2011, self-confident Estonian politicians now lobby the E.U. to make Latvia and Lithuania members of the currency union too. And despite savage contraction in the wake of the financial crisis in 2008 and 2009, Estonia has now resumed its gangbuster growth, expanding 8.3% in 2011, compared with an E.U. average of 1.5%, and 2.5% in 2012, even while the rest of the E.U. shrank.

(MORE: Mario Draghi: The Man Who Would Save Europe)

Aljona Kurbatova, head of infectious-disease prevention at the Ministry of Health, however, believes the breakneck growth has come at a price, with many young people left behind in the murky backwash of the economic ocean liner. “The 1990s were a time of great change. A lot of Estonians felt like they had to excel. But a lot of young people have not been able to keep up, and they have turned to these drugs.” The pockets of social deprivation where jobless young people with weak social networks have been allowed to fester, has helped to create the conditions where fentanyl has thrived.

“It is a social problem,” says Risto Kasemae, a major at the National Criminal Police. “The police can only do so much. We are not a police state. We need to deal with the underlying social problems as well.”

One of the many tragedies associated with fentanyl in Estonia is the youthful complexion of its users. It predominates among a marginalized group of mainly ethnic Russian men aged between 16 and 24. The drug’s victims also die wretchedly young: 28, on average, for women and 31 for men. In the U.K., where its few users tend to extract the drug from painkillers prescribed to cancer patients, the statistics are 47 for women and 39 for men.

In a November survey the E.U.’s drugs watchdog, the European Monitoring Centre for Drugs and Drug Addiction, suggested, among a series of measures proposed to limit the use of fentanyl, an information blitz for vulnerable people. But users in Estonia are already morbidly aware of the dangers. In the spirit of stoic black humor, some refer to the drug simply as “flatline.”

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Control: How a Fear of Foreigners Is Gripping Europe When Its Economy Needs Them Most

43 comments
RobertGrant
RobertGrant

"I hope it [fentanyl] never migrates over here, if it already hasn't."  Sorry. Your a decade too late. Fentanyl has been readily available for the past 15 years.  It comes in convenient transdermal patches just like the Nicotine patches. It's freely available by prescription. For five nine  years I was prescribed 15 patches per month--for chronic lower back pain that never existed. My medical insurance covered my habit. Did you know there is a "list" available in every city of the MDs who write prescriptions for money? "Cash and carry" medical practices, as they're known. For $150 bucks, every month I'd get 15 fentanyl patches, 120 OxyContin tablets, 60 Xanax tablets, and Ambien (for insomnia!!) People in the waiting room were from all walks of life, all races: housewives, professional people like myself, day laborers, parents with kids, writers, investors, executives. We are the"legal drug addicts" and we are diverse and nearly impossible to categorize. This is just FYI, I'm speaking as one of the (what did he call us)..."Self-centered, nihilistic, narcissistic" junkies..." as one gentleman so colorfully called us. Drugs are legal...ask any pharmicist.

MarkPossemiers
MarkPossemiers

gives one an idea what the situation must be in Russia ...

MarkElron
MarkElron

National Socialism can attest to the "effectiveness" of Fascism, but totalitarian police states have unique problems of their own, not the least of which is substance abuse. The Wehrmacht could not have survived without its homemade meth.

Benka
Benka

The simplistic belief that you solve a social problem by removal of legal barriers is a fool's dream!  That is not to say that prohibition works.  The experience in the US with prohibition of alcoholic beverages taught that, but one cannot say that alcoholism as a problem was eliminated by ending prohibition. 

Among the suggestions made in the Comments for coping with the problem is missing the way Singapore handles the issue of illegal drugs on its territory.  Namely, involvement with illegal drugs is punishable by death.  I'm not suggesting that the same policy be adopted in Estonia (and it would not be possible, either, because Estonia's legal system does not include death penalty), but I am mentioning Singapore as an example of a policy that is effective.

strayan
strayan

They prohibited opium and they got a heroin problem. They prohibited heroin and they got a fentanyl problem. Each drug more profitable, easily concealable and more potent than the last.

Prohibition is  a disaster.

LogicalPosition
LogicalPosition

Money and success brings the misery of drug use/abuse, sadly, as shown by this article. Too much time on their hands, too much expendable income. I work across a parking lot from a methadone clinic. Every morning there are tens of ppl lining up for their daily dose, mostly young whites. Some ppl just want to stay high. They didn't accidentally ingest these products, yanno, they made choices!

SouthLib1
SouthLib1

Proof again that the societal war against drug users causes more death than the actual use of drugs. If there were no restrictions on the use of heroin, no user would need fent, dosages of narcotics could be standardized and taxed, users would not be at the mercy of criminal dealers, society would not bear the burden of massive expenditures in interdiction and corruption, crop growers (usually subsistence farmers in the third world) would experience increased revenue and also no longer be at the mercy of criminal distribution syndicates, terrorist organizations such as the Taliban and Hezbollah would lose a prime source of revenue, medical treatment for addicts would be much cheaper than the current system of emergency treatment of overdoses, etc., etc., etc. A definition of insanity is infinitely repeating an action expecting a different result. By definition, the war against drug users is INSANE!

blitz120
blitz120

The fundamental problem is that due to government persecution, the market is forced underground.  As a result, it is virtually impossible for one to purchase fentanyl from an identifiable manufacturer, labelled with a known purity.

Eliminate the persecution and the market will normalize itself and the problem will disappear.

WilliamBarnes
WilliamBarnes

Oh yeah, one more new drug. This is just EXACTLY what we don't need. A new lethal drug. I have witnessed the evolution of drugs since 1960. Just to give an idea.......Alcohol, coke, smack, tobacco, grass, pills (dozens of different types), smack (again), crack.... and now this. Something so concentrated in the hands of braindead nihilist idiots is truly frightening. I hope it never migrates over here, if it already hasn't.

polonel
polonel

@RobertGrant thank you for your insights, Robert. It's good to read someone posting from personal experience rather than from feverish nightmares.

jerry48
jerry48

@MarkPossemiers  do you have any idea what the situation is the US with the drug problem combined with the gun culture ??

MarcusErikBergman
MarcusErikBergman

@Benka Actually, even in Singapore where simple possession almost guarantees economic ruin, and selling almost guarantees death, the majority of the reported first-time offenders are drug related crimes. Not only that, but the amount of illegal drug users and sellers in Singapore are, and have been for some time, on the rise. This indicates that not even such a harsh prohibition works, but rather sweeps the problem under the mat where it just grows seemingly indefinetly. :/ http://letterstoconservativeparents.wordpress.com/2012/01/22/no-mom-we-shouldnt-kill-the-drug-dealers/

MarcusErikBergman
MarcusErikBergman

@strayan Not to mention the other problems related to it. Since prohibition we've seen plenty of drugs invented solely because of prohibition. Examples of drugs like these are crack, meth, krokodil and every RC drug out there*. For instance, Spice was invented as a legal substitution for cannabis, Mephedrone as a legal substitution to MDMA, 4-ho-met because psilocybin is criminalized and so on. If we really want less drugs in our society we need to accept the ones that already exist, otherwise they'll just keep coming.

* Actually, the RC drugs are not necessarily created because of prohibition, but they reach the open market because of it. It does not make a different in reality.

Piacevole
Piacevole

@LogicalPosition The first few times, they "made choices."  After that, the choice was pretty much made for them by their own bodies.  That's the nature of addiction.  It's easy to get in, hard to get out.  If you have ever known someone who tried, and failed repeatedly, to quit smoking, ask about it. 

Dachman
Dachman

I guess your right a population legally on heroine would most likely be extremly productive....

TruckinDuck
TruckinDuck

@SouthLib1 This situation does not seem to have any of the hallmarks of the proof that you seem to have found.   The problem is more likely the societal one of exclusion, access and social networks. This according to the article is not a highly diversified problem; Estonia is not a highly diversified economy with respect to either the source, use or demographics.  While your conclusions may be valid vis a vis the issue of drug use being enhanced by prohibition (nothing new there), this problem is not one that fits that archetype.  The source, networks, societal use and death rate is not highly diversified.  This is not a market economy, with the government causing the problem.

Hadrewsky
Hadrewsky

@WilliamBarnes 

Fentanyl has existed for decades genius... It is already over 'here' in the form of a patch that lasts 72 hours. It is filled with a gel containing the drug that is slowly absorbed... of course you can also pull out the gel and inject it and it is a fairly common opiate to abuse.


Being 1000 times stronger than heroin it is also dangerous as hell and yet a very effective pain killer.... But know wtf you are talking about when you make such a silly claim as to suggest it isnt around you right this minute.

LogicalPosition
LogicalPosition

The mind controls the body or not. Weak willed ppl who didn't learn the true meaning of the word "NO!" I suppose you are correct however, the experts claim one is addicted for life.

LogicalPosition
LogicalPosition

The weak of character make excuses for bad behaviors, I understand. It's a chemical imbalance/reaction at the core of these matters. I have known several ppl in addiction circumstances and they all share a common thread, SELFISHNESS and Narccissism.

groznaya
groznaya

@Dachman Legal heroin for (registered) addicts is actually supplied in at least Switzerland and the UK. A much more common program is methadone maintenance, which is also medically accepted. Methadone's a potent opioid and in fact more toxic than heroin, so I suppose it's a similar idea to heroin maintenance.
They do pretty well, actually; controlled, legal access to a pure supply of the same amount is already a huge help for addicts' functioning before they even start treating their addiction, so they are more productive than untreated addicts or addicts in abstinence programs. The thing is addicts aren't exactly productive before treatment/on street drugs, and they often either had serious issues before they even started using, or acquired them later from drug abuse or the lifestyle.

SouthLib1
SouthLib1

@TruckinDuck@SouthLib1I still believe my comment has validity. Had Estonia not chosen to follow the rest of western society with idiotic anti-user laws, Aivar would have had access to dosage controlled drugs and appropriate medical care. Diversity of economics was not a factor. Estonia's government created the situation based on antiquated, hypocritical social values.

WilliamBarnes
WilliamBarnes

@Hadrewsky @WilliamBarnes Yeah, genius, and you obviously think the whole world's just one big drugstore, where you can find, buy and use it indiscrimitaely. Listen, silly, if this were true, we would have heard ALOT more about it by now. And, oh, by the way. I don't know where you live (but you seem to think I'm your neighbor), but in my part of the world no,  it isn't around me. Good Luck.

LogicalPosition
LogicalPosition

George,

I doubt they randomly burned ppl at the stake out of ignorance. Surely the "victim" exhibited some behavioral issues before they burned.

Please refrain from the namecalling and personal attacks.

GeorgeLahmon
GeorgeLahmon

What were the words you used selfish, narssisism! They burned people at the stake because of ignorance!!!! If "them people make more money than you, are they not more valuable to society than you! if your parents had an abortion(murder) there would be one less, hypocritical stupid,ignorant person. you!!!! logicalposition. also, a few hundred thousand is genocide idiot!

LogicalPosition
LogicalPosition

" It isn't a question of will."

After all the experts weigh in on the topic(realizing they get paid to ponder the matter), one still must make the case that the individual makes CHOICES to become addicted. I understand chemical imbalances create  "crazed" ppl, some may be uncontrollable. This doesn't excuse such behavior as normal, and society doesn't have to accept such behaviors.

Didn't they burn such ppl at the stake to prevent the individual from further harming themselves and humanity? We're not talking about genocide, it's just a few hundred thousand wackos who are not of any real value, right? If society can abort a fetus for convenience, surely it can euthanize the crazies.

Is there a genetic marker for addiction?

Piacevole
Piacevole

@LogicalPosition An expert in the field, Dr. Abraham Twersky, noted that "telling an addict to 'just say no' is like telling someone with diarrhea not to evacuate."  It isn't a question of will.  That idea bespeaks lack of experience with the condition.


LogicalPosition
LogicalPosition

Is Rush cured? Reminds me of Teddy "swimmer" Kennedy. Smart, wealthy ppl all seem to think alike.

LogicalPosition
LogicalPosition

"Whether his selfishness and narcissism predated and perhaps precipitated his addiction is hard to tell."

I can't say for certain, but I suspect the character traits were in place long before the addition set in.
.

SouthLib1
SouthLib1

@Piacevole @LogicalPosition Limbaugh would have gone to prison in a just society. He was saved from incarceration by a corrupt judicial system defending its primary prophet. Had he been a 24 year old from the backwoods he would have done serious time. That he was an addict who continued to pontificate against addiction was hypocritical and a result of his narcissism, self loathing, and delusional sociopathy.

Piacevole
Piacevole

@LogicalPosition The selfishness and narcissism are results of the addiction, much as, say, peripheral vascular and neurological problems are a result of diabetes.  Addiction causes personality problems. 

When, for example, Rush Limbaugh used oxycodone, he exhibited many of the problems of addicts, while inveighing against "junkies."  Whether his selfishness and narcissism predated and perhaps precipitated his addiction is hard to tell, isn't it?

WilliamBarnes
WilliamBarnes

@Hadrewsky @WilliamBarnes Bone headed is when you insist on something when you're wrong. Just because you chose to be a registered nurse and I didn't doesn't mean that I will be as interested in drugs enough to learn all this timely information about. Since you still seem dumb let me refresh your memory. The world is a big place and many places which you have never obviously read about don't even have  drugstores. This drug is new to me and anyone else who has never heard of it. The fact that I never heard of it is enough reason to believe that 'the mainstream public' in the country I live hasn't heard of it. wakeup!

GeorgeLahmon
GeorgeLahmon

you know you will not be a teenager for long, and soon you be what you despise

krikken
krikken

@TruckinDuck@Hadrewsky@WilliamBarnes
I hate to profile, but TruckinDuck's wager about ethnicity is accurate. The lead character does have an Estonian name, but a line like this is somewhat misleading: "Still he can’t stop. Neither can so many other Estonians." The drug of choice for Estonians continues to come in a bottle.

thomasvesely
thomasvesely

@Piacevole

there are reasons for this "rebelliousness" and i believe they arise from poor upbringing .

and that sets up "rebelliousness" in the teenager.

Piacevole
Piacevole

@tomxvesely @Piacevole I don't think it's so much a "lack of trust" as it is the teenagers' belief in their own immortality and difficulty considering that someone with more experience just might be right when saying that certain practices are not good ideas.  Not all teenagers have sanctimonious parents, but many teenagers are to some degree rebellious: it's part of the process of adolescence.

thomasvesely
thomasvesely

@Piacevole

"teenagers aren't particularly inclined to listen to adults"

.
that would be due to a lack of trust. the trust evaporates when reality confronts sanctimonious parental prattle.


TruckinDuck
TruckinDuck

@Hadrewsky @WilliamBarnes 

I have lived in Estonia for a few years and have traveled extensively up, down, back and forth since.  The clue I picked up from the article is that Estonia may be showing two sides to the "society"; Viz mentions the focus and vision of Estonian toward Finland etc.  

This is true for ethnic Estonians.While they may be the majority ethnic group, there is a very very sizable part of the population that  is Russian... particularly in the city.  Overall it is likely that more than 30% are strictly Russian (culturally, socially, intellectually) and do not associate with the Estonians. They tend not to be integrated into  either the social nor financial marketplace with the archetypical Estonian. It is not totally exclusive but there is a boundary layer in the society... often seen as "exclusion"  by the European view, but seen from five decades under the Soviet thumb, there is a mutual divide. Neither are not keen to associate socially, intellectually nor keen to adopt eachothers lifestyles. 

The statistics of the drug use may be difficult to ascertain, but the ethnicity of dead are likely to be known. I will place the bet on the Russian side. one.  Track the network and you will see... I wager it will burn hot to warm back across Narva to Petersburg. Social and traffic network would be Russian.

Whatanotion
Whatanotion

@Piacevole You sound credible in your assertions.  I have advocated that fire stations  serve as coffee shops wherein the firemen or EMTs which often operate out of fire stations are also trained in drug rehab or minor psychological facilitation.  I don't believe it would be a panacea but it would be something that might be the knot to hang onto at the end of someones rope. Plus the staff might gain insight therefrom.

Piacevole
Piacevole

People who aren't somehow tangential to or involved in drug usage often have no idea just how widespread the problem is: It's as if there is an alternate universe interspersed in the one the rest of us live in, and it operates on the same principle as a dog whistle: if someone isn't attuned to it, it's invisible and unnoticed, or ignored.

But everyone knows, works with, drives on the roads with, someone who is using.  How to change this situation, I don't know.  Treatment helps sometimes, but the rate of relapse is very high.  The only way I know of to protect oneself from becoming personally addicted is never to touch any in the first place.  Unfortunately, teenagers aren't particularly inclined to listen to adults.

Hadrewsky
Hadrewsky

@WilliamBarnes @Hadrewsky 

As a registered nurse these patches are all over the place for good and ill...

As for illicit fentanyl it appears in the ER with some regularity.... What people think to be heroin is often not heroin or is spiked with fentanyl... There is heroin around you i guarantee it and would further guarantee that fentanyl makes up a portion of that.

The reason fent is not as common as heroin is because it is a lot easier to grow and collect morphine to change into diamorphine (heroin) ... labs can and do produce it in every Western Nation.

So if you live in the US there are people all around you who have been exposed to fentanyl

You stated this as being a new drug - fentanyl has appeared in powered form since the 1970s your statement of this being a new drug was bone headed