Drug overdose deaths spiked due to combination of substances

Baltic sea.
Baltic sea. Source: Unsplash

Mixing mind-altering drugs has caused a decade-long rise in drug use. Since last year, drug overdose deaths have skyrocketed due to the introduction of the ultra-strong synthetic opioid isotonitazene, or "ISO."

The fatalities resulting from drug overdoses in Estonia escalated from 31 cases in 2020 to 39 in 2021 and subsequently more than doubled, reaching 80 in 2022.

This year, overdoses have claimed the lives of 90 people during the first nine months, an increase of six since our last report on the matter a month ago.

According to specialists, the problem now transcends across different age groups, genders and substance preferences, rendering the concept of a "typical user" obsolete.

"Users may be our children, classmates, coworkers, parents or grandparents. There is also no significant economic distinction between users and non-users," Marit Oja, a nightwatcher volunteer, said.

Among 90 cases reported so far this year, the cause of death was determined to be illegal and therapeutic opioids in 75 cases; nitazene or ISO was detected in exceptionally high concentrations in 50 cases. Prescription tranquilizers, sleeping pills and pain relievers were found in 48 cases.

A combination of several drugs has been linked to 72 fatal overdoses; in these cases, it is often impossible to determine with certainly which chemical caused death.

In the past nine months, overdoses have killed people ranging in age from 17 to 78, with 10 of them between the ages of 17 and 24. The average age is 37.3. Three-quarters of them are men.

Cannabis is the most commonly used drug in Estonia, followed by cocaine, also known as "speed" or "coca." Amphetamine, also known as "ants," "speed" or "näff," has a comparable popularity. Methamphetamine, or meth, is stronger than amphetamine and less common. MDMA, known as "candy" or "dope," is also used.

The Estonian illegal drug market has changed a lot in 20 years. The user no longer steals from their family to get another dose, so to speak. One in four adults and one in three teens have used drugs. Users can be prosperous business people in suits or devoted parents.

Klaus, who wished to remain anonymous while speaking with "AK," is 30 years old, works as a product developer, and has been in the IT business for over a decade. He also maintains a physically active lifestyle. A man's life revolves around his family, healthy eating habits and his physical exercise. But he also lives in another realm of partygoers and illegal narcotics.

"Mushrooms first, then LSD, then MDMA on top of that, maybe a little cannabis. That takes quite a long time, but then again, in between, there are a few hits, maybe some speed, maybe a little alcohol, but not much; the alcohol is not used much thanks to these substances. Then you keep adding more, maybe increase the amounts, so that it becomes even more interesting the next few days," he described his usual night out.

Mikk Oja, senior specialist at the center for drugs and addictions of the National Institute for Health Development (TAI), said that the number of drug users has increased over the past decade. The central problem, he said, is the mixing of mind-altering drugs, which can be fatal.

"Perhaps one of the most important things to bear in mind is the need to differentiate which substances are depressants. For instance, among the permitted substances, alcohol functions as a depressant. Other depressants include tranquilizers, sleeping medications, and opioid painkillers. Ketamine is also one of them. These are the kind of drugs that have a depressant effect and taking them together is the most dangerous thing you can do," he explained.

Most drug users don't even know what their drugs contain and it's almost impossible to find the pure stuff, he added.

However, this hidden world makes help hard to find. In Estonia, nightwatch volunteers deliver first aid and clean supplies to partygoers in a harm reduction project established last year.

"The fact that we are not tackling this problem in any way does not help. We see that the use of substances is on the rise and that if people are going to use them anyway, they should do so in a more informed and safer way," Marit Oja said.

Rita Kerdmann, the administrator of the Viljandi hospital's center for addiction patients, said that people often start taking drugs to deal with their difficulties and as a result of long-term use, problems mount: a significant proportion of people develop mental health problems that would otherwise never have arisen.

"These are depressions and activity-attention disorders in adults, including anxiety disorders, sleep problems and nervousness," she said.

Mind-altering substances are consumed in nightclubs, friends' homes or shaman rites; people increasingly are using them to improve their work performance as well.

While the use of stimulants and hallucinogens has remained stable in recent years, the TAI estimates that the abuse of legal prescription drugs that has increased. "A person may have been prescribed these drugs but they might be using them in a way that is contrary to what their doctor has wished for. People could be getting them from friends who have prescriptions or family members. Perhaps they buy it or orders it over the internet," she said.

Estonia's drug policy target for 2030 is zero drug-related deaths per year.

"The safest way to use drugs is not to use them," Marit Oja recommended.


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Editor: Merili Nael, Kristina Kersa

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