Fentanyl is used in the medical profession as a painkiller or anaesthetic, but is also produced illegally as a synthetic form of heroin. Ever since a shortage of heroin in Estonia a decade ago, it has increasingly become the drug of choice among young people. Like heroin, it’s highly addictive and once hooked, users need a daily dose of methadone to cope with withdrawal symptoms.
Estonian authorities are particularly worried by the high mortality rates caused by the drug. Because of its strength, only a very small amount (less than half a teaspoon) can kill ten people. Drug dealers can therefore easily make a mistake when cutting the drug with other substances. If they don’t reduce the strength correctly, the consequences can be fatal.
Overdoses aren’t the only health risk faced by young Estonians injecting fentanyl. The multiple use of syringes by different people is accelerating the spread of hepatitis and HIV/AIDS in Estonia. In 2001, there were an estimated 4,700 adults (aged over 15) living with HIV/AIDS (according to UNAIDS). By 2009, this number had more than doubled to 9,800, equating to 1.2% of the adult population. In a 2008 survey among Estonians injecting drugs, over two-thirds of users were found to have been infected with HIV/AIDS.
Speaking to the BBC, two young Estonian men hooked on fentanyl tried to explain why they ignore the dangers. One young man, Marko, started injecting at the age of 18, when he was “young and stupid” and then couldn’t stop. Despite surviving two overdoses and also staying off the drug for a while while he was out of the country, Marko went back to becoming a user once he returned to Estonia. “It’s so addictive,” he told the BBC reporter, though having lost two friends to overdoses, he would like to stop. Drug overdoses are now causing more fatalities in Estonia than road accidents. (In 2009, there were 133 drug-related deaths.)
Even for those lucky enough to avoid overdoses or becoming infected with diseases such as HIV/AIDS, the drug can easily ruin lives. Many users turn to theft or petty crime to fund their habit. And addiction often leads to the breakdown of families. Social workers in the country say that while two generations ago, alcohol was the main scourge, now it’s fentanyl. To avoid more deaths, health experts are arguing that users should be allowed to keep the overdose antidote of naloxone in their home. But the question which experts don’t seem able to answer, is how to reduce the numbers of users. For now, this lethal drug seems to have taken hold in Estonian society and medics are warning other countries should be prepared.