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Uusküla A, Jarlais DD, Vorobjov S. Lancet Psychiatry 2019; 6(12): e985.


Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Tallinn, Estonia.


(Copyright © 2019, Elsevier Publishing)






Jo Kimber and colleagues have announced a public health crisis in response to the record number of drug-related overdoses in Scotland, England, and Wales. Illicitly manufactured fentanyl emerged in Estonia in 2003, and, within a year, replaced heroin as the most common drug in the illicit drug market. Because of fentanyl use, Estonia had the highest mortality due to drug overdoses in Europe for 2007–17.

Based on experiences in Estonia, we would recommend large-scale implementation of evidence-based programmes in areas with high fentanyl use, including distribution of naloxone to reverse opioid overdoses; syringe service programmes to provide for safer injecting and linkage to other services since over half of people who report injecting mainly fentanyl have HIV; opiate substitution treatment, with minimal restrictions on patients so they might be integrated into community life; and community programmes such as Break the Cycle to reduce initiation into injecting drug use.
Additionally, we would recommend developing programmes to reduce stigmatisation of opioid use because stigma often prevents drug users from using health services and compounds psychological damage caused by drug use.

In 2017, the Estonian police closed a domestic fentanyl production site and shut down distribution. This closure of a major producer coincided with a substantial reduction in overdose deaths. However, even if this intervention on the supply side of distribution was the cause of the reduction, it occurred 10 years into the epidemic, and might be difficult to replicate in settings with decentralised production ...

Language: en


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