Why is 'China White' killing Estonia's Russian speakers?

The Baltic nation has the highest per capita drug-related death toll in the EU, due almost entirely to synthetic opiate fentanyl – which is used primarily by Estonia's Russian-speaking minority.

When one thinks of countries with drug problems, the tiny Baltic nation of Estonia is likely not the first to come to mind.

But despite being best known for IT startups and the fairy tale medieval old town in Tallinn, the capital, Estonia has the dubious distinction of leading the European Union in deaths from drug overdoses per capita – almost entirely caused by the use of fentanyl, a synthetic opioid that took root among Estonia’s intravenous drug users during a heroin shortage a decade ago.

Stranger still, abuse of fentanyl is a particular scourge of Estonia’s marginalized Russian-speaking minority, and has not crossed into the majority ethnically Estonian community. This peculiarity has flummoxed social workers and government officials combating the problem, who say that it hints at deeper sociological roots to the drug's abuse.

“Russian-speaking Estonians, due to their socio-economic background, of being for a generation on the margins of Estonian society due to language and cultural borders and unemployment are more at risk to experience greater stresses in their lives,” says Kristina Joost, a social worker with Convictus, an Estonian nongovernmental organization that strives to mitigate the fentanyl problem and runs Tallinn’s needle exchange program.

“The bigger the stress the harder the drug. The drug use is just the tip of the iceberg and the causes of the problem run much deeper.”

Synthetic heroin

Called "China White" on the street, fentanyl in most of the world is a prescription pain reliever administered through a patch or tablets. Estonia’s addicts inject fentanyl, which can be hundreds of times stronger than heroin. The drug creates the intense but short lived euphoria that addicts crave – it is common for fentanyl users to use the drug three or four times a day.

Like heroin, it is extremely addicting and causes intense withdraw symptoms when use is ceased. For users, days and nights are centered on how to meet the needs of their habit and because fentanyl is so potent and doses vary in strength, overdosing is a constant threat.

According to the European Monitoring Center for Drugs and Drug Addiction, an EU agency, a total of 123 cases of direct drug-related deaths were recorded in Estonia in 2011, the last year in which statistics are available. Of these 95 percent were caused by fentanyl overdose. Nearly all were men and the average age was thirty.

Estonian Minister of the Interior Ken-Marti Vaher, whose office works to interdict the flow of illegal drugs, sees a link between fentanyl’s place of origin across the border in Russia and use among Estonia’s ethnic Russians. A heroin shortage of ten years ago was quickly seized upon by Russian producers of fentanyl.

“The sources of illegal fentanyl are mostly considered to be Russia, Belarus, and Ukraine,” Mr. Vaher says. “One of the reasons why fentanyl made it to Estonia’s injecting addicts so fast after the market was cleared of heroin is a common border with the producer country and some common communication networks between Estonian and Russian drug addicts and dealers.”

A cultural divide

But the fact that fentanyl use is largely confined to Estonia’s Russian speakers is a puzzle that leads experts to theorize about the country’s differing subcultures.

Peeter Vihma, a lecturer in sociology at Tallinn University who studies the city’s drug culture, sees differences in consumption habits between ethnic Russians and Estonians.

“Stimulant use is definitely greater among ethnic Estonians. It’s associated with the clubbing scene,” Mr. Vihma says. But where the drug scene for the majority group centers on partying and the cache of expensive drugs associated with nightlife, the Russian minority’s subcultures are more diverse and drug-use bonding is more cloistered and hard-core.

“Group solidarity is bigger with ethnic Russian subcultures," he says. "The Russian community is more differentiated and the obligation to the group seems stronger. There can be something of a ghetto effect." Bonding in the intravenous drug-use subculture means using fentanyl. 

Vaher too sees social factors as contributing greatly to the restriction of fentanyl use largely to ethnic Russians.

“It is true that there are considerably more Russian speakers among injecting drug addicts,” Vaher says. “The reason could partially be the fact that injected drugs first spread to Estonia among the Russian-speaking population in the beginning of the ‘90s, when times were hard and social protection structures were not functioning. Drug use is a social behavior that is passed on in circles.”

Though Estonia has made remarkable strides since gaining independence from the Soviet Union in 1991, the Russian-speaking population has lagged behind and not reaped the benefits of economic growth and political freedom. Substance abuse, high rates of HIV, and criminality plague these communities.

Atypical abusers

Estimates for the number intravenous drug takers in Tallinn run between 6,000 and 10,000. Of those, over half use fentanyl. Interestingly, these hard-core users may not fit everyone’s stereotype of a junkie.

“Most users have health insurance, which means they have jobs,” Ms. Joost says. “Among our needle exchange service clients we see mostly young men aged 20-30 who have jobs and go to school and less clients who you would consider totally cut off from society and living on the streets.”  

But fighting the fentanyl problem means more than just helping addicts. The sale of the drug is a lucrative business involving transnational criminal syndicates.

“One of the most important priorities towards decreasing the supply of drugs in the recent years has been activity against fentanyl sellers through the whole purveyance chain, starting with street dealers and ending with large criminal networks. This will remain a priority for the upcoming years,” says Vaher.

Both the Estonian state and the NGO community see some headway with their efforts.

“Estonia has been very good at developing harm reduction services for drug users in cooperation with NGOs,” says Joost.

Adds Vaher, “Fentanyl related deaths are decreasing and the falling trend is ongoing. We’re making progress.”

Michael Amundsen is co-editor at TallinnArts.com.