Challenges of Synthetic Opioids in Estonia

In a quiet suburb of Tallinn, Rasmus goes through his routine several times a day. He mixes a powder with water, fills his syringe, and searches his body for a vein. The substance he uses varies in color and often requires him to add ascorbic acid for a stable solution—a step he never needed to take with fentanyl. Now, however, he relies on this new drug, which, due to various additives, can easily collapse a vein after just a few uses. “In 2019, I could hit myself blindfolded,” he shares, using a pseudonym. “Now it feels like surgery.”

Now in his 30s, Rasmus is a high-functioning opioid addict. He has a stable job, dresses sharply, and articulates his thoughts with confidence. It’s hard to believe he’s been on hard drugs for over half his life. From a young age, he was curious about various psychoactive substances, experimenting with everything from marijuana to MDMA. This journey into substance use led him to severe anxiety and depression by age 16, leaving him feeling hollow.

Opioids became his coping mechanism—first painkillers like tramadol, then eventually fentanyl. Rasmus vividly recalls the warmth of his first experience with fentanyl when he was about 19. “Before it was like being naked in the snow, freezing,” he remembers. “Then a stranger appears and invites you to a warm cottage. I felt human again.”

But those nostalgic memories are now overshadowed. Fentanyl has mostly disappeared from the Estonian market following a 2017 crackdown on criminal networks distributing it. In its place, a more dangerous drug has emerged—nitazenes, a new class of synthetic opioids that surfaced in Estonia in 2019. This substance can be significantly more potent than fentanyl and poses greater risks. By 2022, nitazenes were causing significant harm in Estonia.

“Fentanyl is bad, but it’s nowhere near as addictive as ‘zenes,” Rasmus explains, eyes hidden behind dark glasses. “It’s basically the crack of opioids.”

Nitazenes have similarly wreaked havoc in other regions. The drug has been associated with numerous deaths in the U.S., the EU, and the UK. In Britain, they’ve been linked to over 400 deaths in just a few months while many more opioid fatalities may have gone unreported. Nitazenes might lead to yet another opioid crisis in Europe, with Estonia emerging as an unexpected focal point. Since their introduction, around 96% of nitazene seizures have occurred in the Baltic states, with Estonia likely boasting the highest usage rate in Europe. By 2023, nitazenes contributed to 56 drug fatalities in Estonia, making up nearly half of the country’s overdose deaths.

Estonia’s struggle with opioids serves as a warning to the rest of Europe. Yet, this issue transcends simple law enforcement; it reflects a deep-seated societal demand for the drugs. Estonia’s ongoing opioid crisis is intertwined with post-Soviet economic disparities and social marginalization. The country struggles to address the scale of addiction with limited resources, illustrating that once a solid base of addicts forms, even economic growth cannot dislodge it. If nitazenes are eradicated, something equally troubling is likely to take their place.

“Despite our years of experience with fentanyls, we still face challenges with nitazenes,” observes Katri Abel-Ollo, a researcher focused on this issue. “I can imagine how shocking it could be for countries with no fentanyl experience.”

In 2002, Estonia was among the first European nations to encounter a fentanyl crisis, following disruptions in heroin smuggling routes. Local dealers, collaborating with Russian criminals, obtained fentanyls from St. Petersburg, linking Estonia to its former rulers. The result was a prolonged struggle, culminating in a successful police operation that curtailed the fentanyl trade.

“For five years, things seemed better,” reflects Rait Pikaro from the Estonian Police. They thought the market had become dormant, but that assumption proved incorrect.

While fentanyl became scarce, analogues lingered in the drug scene. When nitazenes emerged, they didn’t come from known networks but rather from China. This shift has created complexities for authorities trying to keep up with a fragmented market.

Nitazenes, while potentially less euphoric than fentanyl, offer quick relief from withdrawal symptoms. Rasmus notes their swift onset but short duration, making them frustrating for users. “You inject it, and it lasts maybe a minute or two,” he explains, clearly anxious about his own symptoms during our conversation.

The potency of nitazenes can also complicate overdose responses, often requiring more naloxone than standard opioids—adding to their dangers. Artur Kamnerov, a police investigator, warns that if nitazenes spread beyond Estonia, similar consequences are likely. “Once nitazene takes the market, overdose deaths will escalate,” he asserts.

Kamnerov also highlights the accessibility of drugs through platforms like Telegram, where many users now source opioids. This accessibility is a growing issue not just in Estonia but beyond, creating divergent communities among drug users. Older users stick to traditional street channels, while younger ones prefer online purchases.

Currently, the older Russian-speaking community still drives Estonia’s opioid market, rooted in the historical context of Soviet occupation. These residents have often faced socioeconomic challenges that have persisted over time. Russian speakers now represent a significant portion of the prison population and the homeless demographic in Tallinn, facing additional adversity due to geopolitical tensions.

Lasnamäe, a prominent Russian-speaking area, reflects some of these struggles. The stark landscape, marked by Soviet-style housing, embodies a long history of marginalization. Economic shocks after the Soviet Union’s fall resulted in deep inequalities, especially affecting Russian speakers, many of whom opposed Estonia’s independence.

As a harm reduction worker, Nikolai recalls the desperate strategies of the past. “Drugs became a way to cope better than alcohol,” he shares. In the past, areas like Lasnamäe were pivotal to the opioid market, with Rasmus noting that fentanyl was easily accessible—if you spoke Russian.

Rasmus found himself deeper in the drug scene as a result, with his initiation into this culture solidifying as he experienced his first overdose. At the harm reduction organization MTÜ Convictus, a clear shift is visible, with more ethnic Estonians seeking help, indicating a widening crisis.

Harm reduction strategies aim to mitigate the impact of drug use on both individuals and society. Yet, funding for such initiatives is increasingly at risk, as peer-led organizations reassess their roles. Activists stress that building community support is critical to address the intertwined issues of addiction and social isolation. A comprehensive approach must include safe access to drugs and robust health resources, emphasizing the issue as a public health crisis rather than a simple law enforcement challenge.

With minimal recent drug deaths indicating a possible decrease in nitazenes, Rasmus remains vigilant, noting other synthetic opioids, like brorphines, threatening to take their place. The ongoing struggle suggests that Estonia’s patterns with opioids will persist.

Kalvet reflects on cultural influences contributing to these ongoing issues. “We’re caught between dark Scandinavian tendencies and Eastern European hardships,” he observes, noting the historical pressures that have shaped present-day drug use.

The broader implications for countries facing similar challenges are significant. As nitazenes gain traction, the risk of a social wound that continually harms society looms large. Rasmus, reflecting on his struggles, succinctly expressed his bleak outlook on the future: “Most likely dead.”