Key facts
- Estonia’s very first harm reduction program is started by a non-governmental HIV prevention group in Tallinn, in 1997, the provision of OST starts two years later. The government starts funding OST programs in 2003. The country makes OST available in prisons in 2011.
- In 2018, Estonia had the highest rate of a fatal overdose of all the European Union countries, with fentanyl found in the majority of these cases.[1]
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| Population | 1,328,360 [2] |
| PWID | 9,000[4] |
| OST | Available in 9 operational sites, with methadone and buprenorphine.[5] |
| NSP | Available in 37 operational sites.[6] Two mobile NSP units began operating in 2018 via van, and combine HIV/hepatitis C/ tuberculosis and STI testing and treatment, although treatment for hepatitis C is not available.[7] |
| HIV | Prevalence among PWID – 54%.[8] It is estimated that only 30 new HIV infections were associated with injecting drug use in 2016, lower than in previous years.[9] |
| Hepatitis C | Prevalence among PWID – 79,2%.[10] In Estonia, treatment is only available at no cost to the person during the late stages of fibrosis. Hepatitis C treatment is provided primarily through health insurance; this represents a barrier for many people who use drugs who do not have private health insurance.[11] |
| Hepatitis B | Prevalence among PWID – 3-22%.[12] |
| Tuberculosis | Taking into account that tuberculosis remains a significant health challenge among people who live with HIV, free tuberculosis screening is provided on a regular basis for high-risk groups not covered by health insurance, including PWID.[13] |
| Overdose prevention | Naloxone is not accessible in the pharmacies at all, or without prescription, but ambulances/hospitals have it; it is also possible to get it in five harm reduction services via medical personnel. Since September 2013, a take-home naloxone programme has been available in the two most affected counties of Estonia (in Harju County and Ida-Viru County), and in 2015 the programme was extended to prisoners before release.[14] People who use opioids and their relatives are trained in how to recognise an overdose, administer naloxone and provide first aid until the emergency services have arrived.[15] |
| HR in closed settings | · ART is available in all prisons. |
Criminalization costs[16]:
| · Money spent on a prisoner/per year – €18,177 · Money spent on health and social services – €2,876.49 · Average sentence for drug law offence – approximately 2 years and 6 months |
| Drug laws | · Unauthorised consumption of narcotic drugs or psychotropic substances without a prescription, or illegal manufacture, acquisition or possession of small quantities is punishable by a fine (usually determined by the police) or by detention for up to 30 days. However, proceedings for misdemeanors may be suspended for reasons of expediency. Any act of illegal possession or dealing in drugs not intended solely for personal use is considered a criminal offence, regardless of the type and amount of illicit drug.[17] · Available alternatives: In 2011, the parliament adopted a legal basis for the implementation of drug treatment as an alternative to punishment for drug users. Treatment is an alternative to prison only if the offender is sentenced to imprisonment for a period of six months to two years and agrees to undergo the treatment course.[18] · In 2018 the first pilot diversion from arrest program SUTIK was initiated in Tallinn. |
[1] EMCDDA (2018) Estonia Drug Report 2018. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. Available from: http://www.emcdda.europa.eu/countries/drug-reports/2018/estonia_en
[2] Statistics Estonia (January 2020). Available from: https://www.stat.ee/stat-population-at-beginning-of-year
[3] Harm Reduction International. Global State of Harm Reduction 2018.Available from: https://www.hri.global/files/2018/12/10/Eurasia-harm-reduction.pdf
[4] EHRA (2018) Criminalization Costs. Eurasian Harm Reduction Association. Available from: https://old.harmreductioneurasia.org/criminalization-costs/
[5] Harm Reduction International. Global State of Harm Reduction 2018.Available from: https://www.hri.global/files/2018/12/10/Eurasia-harm-reduction.pdf
[6] Harm Reduction International. Global State of Harm Reduction 2018.Available from: https://www.hri.global/files/2018/12/10/Eurasia-harm-reduction.pdf
[7] EMCDDA (2018) Estonia Drug Report 2018. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. Available from: http://www.emcdda.europa.eu/countries/drug-reports/2018/estonia_en
[8] Harm Reduction International. Global State of Harm Reduction 2018.Available from: https://www.hri.global/files/2018/12/10/Eurasia-harm-reduction.pdf
[9] EMCDDA (2018) Estonia Drug Report 2018. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. Available from: http://www.emcdda.europa.eu/countries/drug-reports/2018/estonia_en
[10] Harm Reduction International. Global State of Harm Reduction 2018.Available from: https://www.hri.global/files/2018/12/10/Eurasia-harm-reduction.pdf
[11] Harm Reduction International. Global State of Harm Reduction 2018.Available from: https://www.hri.global/files/2018/12/10/Eurasia-harm-reduction.pdf
[12] Harm Reduction International. Global State of Harm Reduction 2018.Available from: https://www.hri.global/files/2018/12/10/Eurasia-harm-reduction.pdf
[13] EMCDDA (2018) Estonia Drug Report 2018. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. Available from: http://www.emcdda.europa.eu/countries/drug-reports/2018/estonia_en
[14] Harm Reduction International. Global State of Harm Reduction 2018.Available from: https://www.hri.global/files/2018/12/10/Eurasia-harm-reduction.pdf
[15] EMCDDA (2018) Estonia Drug Report 2018. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. Available from: http://www.emcdda.europa.eu/countries/drug-reports/2018/estonia_en
[16] EHRA (2018) Criminalization Costs. Eurasian Harm Reduction Association. Available from: https://old.harmreductioneurasia.org/criminalization-costs/
[17] EMCDDA (2018) Estonia Drug Report 2018. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. Available from: http://www.emcdda.europa.eu/countries/drug-reports/2018/estonia_en
[18] EMCDDA (2018) Estonia Drug Report 2018. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. Available from: http://www.emcdda.europa.eu/countries/drug-reports/2018/estonia_en