INNER WHISPER - Paolo Marchetti Photographer

Highest Rate of Deths for Overdose in EU

According to the WHO, Estonia has the European record for drug-induced deaths, with 191 deaths per million inhabitants every year, in second place we find Norway with 76 dead, less than half of the small Estonian state.

Also with regard to the rate of HIV patients, Estonia takes the top position in Europe, with more than 1% of the HIV-positive population, an incredibly high percentage considering that, compared to Finland, which takes second place in the old continent, its rate of people affected by the fatal virus is seven times higher.

But what other dramatic data can be found because of the systematic exchange of needles among drug addicts? the rate of diffusion of hepatitis C reaches up to 94%.

This dark page of the Estonian country interrupts in spite of the positive image it offers the world under the economic aspect, in fact the small country, overshadowed by mother Russia, like all countries belonging to the former Soviet Union, stands out in the old continent to be one of the most important high-tech countries, thanks to one of the fastest growing economies in all of Europe.

But then we must ask ourselves, how was this incredible European record of deaths due to overdose?

It all started in the late 90s, when due to the fall of communism, not only did the collapse of the industries of all the satellite countries of the mother Russia occur, but in this scenario of a consequent political-economic instability, it also upset the balance of criminal organizations.

This context, delicate and unstable has been a breeding ground for new markets, especially for drugs, a ripe area for drug dealers. In 1999, between 15,000 and 20,000 people out of a total of 1.3 million were heroin addicts, fed by a reliable supply from Afghanistan’s poppy fields.

And what happened the following year? The Taliban imposed a ban on the opium market and the supply was discontinued. The attention of the Estonian drug traffickers, in order to fill the void, turned to a new distribution of a synthetic drug on the street, his name is Fentanyl.

This is a synthetic opiate analgesic, it is about 100 times more powerful than morphine and tens of times more than heroin.

Fentanyl has been the most frequently used synthetic opiate in surgical practice for decades, but today it has literally invaded the drug market in many countries, completely replacing heroin, which in comparison is now considered by drug addicts to be a lighter alternative, therefore less effective compared to Fentanyl.

Immediately, this trend caused an epidemic of overdose deaths.
In 2002, for example, 105 cases of fatal overdose with illicit drugs were reported – 90% caused by Fentanyl. Over the next 10 years, the cases exceeded almost 1,000 again due to Fentanyl.

This data brought the Estonian state to the top of the European rankings, but the peak of this “synthetic epidemic” occurred in 2012, when the deaths from overdoses reached the dramatic number of 170 per year, which suddenly transformed Estonia in the country with the highest fatal overdose rate in the world.

In 2015 the European Monitoring Center for Drugs and Drug Addiction declared that the use of Fentanyl had by now passed the line of no return, thus becoming a “endemic phenomenon”.

Local and European experts, however, began to wonder why drug addicts never returned to old habits, that is to say heroin, because once it became available on the market, neither the demand nor the offer returned to manifest among the roads?
Ten years after the heroine returned to the markets, the dramatic evidence revealed a terrifying reality, Fentanyl was the new and undisputed drug.

According to statements by the head of the Department for the prevention of infectious diseases and drug abuse in Estonia, it seems that the situation is probably related to the offer, the ease of preparation, packaging of Fentanyl, but especially for the effectiveness on the market that this synthetic drug produces. In fact, Fentanyl, being much more effective than heroin, costs less and its side effect lasts less time than heroin, this leads drug addicts to get more doses and more frequently, here is one of the main explanations that would respond to the very high number of annual overdoses.

Therefore, it is the traffic that decides which drug must guard the streets.

The initial response to public health in Estonia was deployed on the territory with small initiatives such as the 1997 sterile needle distribution program and the 1999 program, the first methadone drug replacement program.

A more targeted response to Fentanyl only came in 2012, when the number of deaths from overdoses has brought media attention from all over the world. The use of the Naxolone was introduced, an antidote for overdoses that actually helped to slightly reduce the deaths by overdose, but did not bring solutions to the main problem, the spread of Fentanyl in the streets.

Other initiatives were taken by the government, and the rate of new HIV cases decreased to about 300 per year, from about 1,500 in 2003. In recent years there have been fewer deaths due to overdoses, and the 2015 censuses report only 84 deaths, but the rate remains the highest per capita in Europe.

Speaking with Andrei, 29, one of the protagonists of this project, says that “The drug is an internal voice that digs you inside, which breaks the soul

and kills you slowly, one needle at a time”. Andrei says that the emergency is not based on the problem of drugs, today is Fentanyl, tomorrow will be another substance, he believes that the real urgency concerns the main social factors and even before the spiritual ones that lead people to listen and give confidence to that fatal inner whisper.

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