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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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.