It seemed in January as if fentanyl had been largely crowded out in Estonia after a long campaign by the police to reduce overdoses. But the situation is once again becoming problematic as fentanyl is slowly returning to the illegal drug market.
Urmet Tambre, Head of the North Prefecture's criminal bureau, told ERR that fentanyl is slowly returning but will not come back on the level it was a few years ago. In 2017 overdoses killed 110 people in Estonia, in 2018 there were 39.
Inna Farber, CEO of Convictus Estonia, an NGO working to provide services to people with drug addictions, said they have not seen anyone addicted to fentanyl for several months but some have now appeared.
Farber said: "We do not know for sure, we do not ask directly. But it is something that resembles fentanyl."
In 2017, large-scale dealers of fentanyl were caught in Estonia, making the availability of the dangerous opioid more sparse.
Tambre said in 2017: "After that, fentanyl has no longer been available on the market in this form. The few dealers have been left behind are being detained and it could be said that there is basically no fentanyl on the Estonian market."
He said that now most of the fentanyl market has now been taken care of, with new dealers being detained almost immediately.
When fentanyl became less available, a drug called alpha-PVP started being distributed. The drug arrived to Estonia from Russia.
Alpha-PVP has been reported to be the cause, or a significant contributory cause of death in suicides and overdoses caused by combinations of drugs.
Inna Farber said: "It is the worst narcotic substance I've ever seen. The person can not communicate whatsoever, there is no contact with the person under the influence of it. They are aggressive."
Tambre said alpha-PVP has not been discovered in Estonia yet because borders with Russia are closed and many dealers have already been caught.
Aljona Kurbatova, head of the Infectious Diseases and Drug Abuse Prevention Department of the National Institute for Health Development (TAI), said the institute saw that people who had stopped using fentanyl were looking for replacements.
Kurbatova said: "Some sought treatment but we can not say that it would have been a massive turn toward treatment. /.../ According to the users, amphetamine was used to replace fentanyl."
Tambre explained that many users try to alleviate addiction with alcohol or sedatives. "They take stronger sedatives, try to find Xanax, or use any drugs they can get their hands on - cannabis, amphetamine - in order to stimulate their body and avoid the scary cramping."
The crackdown on fentanyl can be attributed to the decrease in drug overdose deaths.
Kurbatova explained: "It is partly due to fentanyl not being available. Fentanyl was previously the main culprit for overdoses."
Data from 2015, the latest data regarding injection drugs in Estonia was collected, shows there are 8,600 users of injectable drugs in Estonia. Kurbatova does not think there is cause to think that number has increased.
Kurbatova calls it a positive that there is not a young generation of injection drug users coming on. "The average age of injectable drug users has steadily increased."
Anneli Uusküla, professor of epidemiology at the University of Tartu, said that around 50 percent of users of injection drugs are HIV-positive. In 2016, when fentanyl was widely available, 67 percent of HIV-positive persons were in treatment. In 2018, just 38 percent were in treatment.
The amount of addicts being treated with methadone has also decreased: 28 percent of injection drug users received methadone treatment in 2016, but just 6 percent were in treatment in 2018.
Fentanyl and opioid addiction are difficult, if not impossible, to treat. Addiction treatments, however, can be of help. One of the options is methadone treatment, which allows addicts to return to a stable and normal life.
Uusküla said that imprisonment does not bring results. "If you ask an addict, they might be a 33-year old man. He's been imprisoned six times in his life. Imprisonment does not solve any problems. Our prisons are filled with people who come and go. An addict needs substitution therapy and support."
Editor: Kristjan Kallaste