Aivar has already begun to sweat. His last hit of “China white” was yesterday evening. Shortly his limbs will begin to ache, and if he doesn’t get a fix soon he will vomit what little food and water he’s had since waking up two hours earlier.
He is at a needle exchange in the center of Estonia’s capital Tallinn and is using the opportunity to reflect on the deaths of his closest friends and the four overdoses he has suffered since he started injecting drugs 14 years ago. The 32-year-old understands how easily he could add to the statistic. One day the defibrillators will not work, he says. Still he can’t stop. Neither can so many other Estonians.
Estonia has the highest number of per capita drug fatalities anywhere in Europe. The reason is fentanyl. Colloquially it is called China white, Persian white or Afghan. But they’re misnomers — glamorous tags attached to a powder, prosaically synthesized in clandestine labs across the border in Russia. It arrived in 2002 during a heroin drought. It never went away. These days it is the drug of choice for the many thousands of dedicated injectors in Tallinn. And, according to government chemists at the sparkling new labs in the capital’s Estonian Forensic Science Institute, it is anywhere between 100 and a thousand times stronger than the scag it replaced.
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The effectiveness of the drug makes it easy to smuggle. The largest single police bust last year was a batch of 1.5 kg — small enough to fit in a knapsack, but enough for almost 40,000 doses of the drug on the street. Uncut, it is hardly detectable at all.
The tiny brown-powder doses carried around by addicts in fingernail-size sachets of aluminum foil have to be cut with whey powder or glucose to make them “safe” for humans. Typically, says Aime Riikoja, chief chemist at the Estonian Forensic Science Institute, the purity level is from 5% to 10%. Tragically, the drug gangs’ amateur chemists can bungle the ratios. “In 2009 there were batches which were 13% to 14% pure,” says Peep Rauseberg, a forensic chemist at the institute. “Many people died.”
Sometimes the dealers know the drug is dangerously pure and warn their customers to be careful. Sometimes they can be carrying hits from several different batches at the same time and don’t know themselves what is and what is not safe. “It has happened that we bought two doses at the same time from the same guy,” recalls Aivar, who used to shoot up with his childhood friend in the alleyways of Tallinn. “When I woke up, my friend was already dead.” One of five friends who started injecting together in their late teens, Aivar is the only one still alive.
In 2011 there were 123 drug deaths in Estonia, making this country of just 1.3 million, easily the overdose capital of Europe. The 2012 figures for the rest of the E.U. are not yet available. But Estonia’s 160 deaths will see it top the table again. The injecting-drug scourge is also connected with Estonia’s other public-health epidemic: Aivar is one of the 1.2% of Estonian adults diagnosed with HIV. The European country in second place is next-door-neighbor Latvia with just 0.7%.
Despite topping these twin E.U. leagues of infamy, Estonia is, in many ways, the standout European success story of the past 20 years.
As a part of the Soviet Union until 1991, the country is often lumped in with its more sluggish Baltic neighbors, Latvia and Lithuania. But with its Finnic language, modern supermarkets and burgeoning information economy, the country feels more Nordic, orienting itself politically and culturally westward to its main trading partners, Germany, Finland and Sweden rather than to Russia on its eastern border.
The country is also pulling away economically. After becoming one of the first East European states to join the euro at the beginning of 2011, self-confident Estonian politicians now lobby the E.U. to make Latvia and Lithuania members of the currency union too. And despite savage contraction in the wake of the financial crisis in 2008 and 2009, Estonia has now resumed its gangbuster growth, expanding 8.3% in 2011, compared with an E.U. average of 1.5%, and 2.5% in 2012, even while the rest of the E.U. shrank.
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Aljona Kurbatova, head of infectious-disease prevention at the Ministry of Health, however, believes the breakneck growth has come at a price, with many young people left behind in the murky backwash of the economic ocean liner. “The 1990s were a time of great change. A lot of Estonians felt like they had to excel. But a lot of young people have not been able to keep up, and they have turned to these drugs.” The pockets of social deprivation where jobless young people with weak social networks have been allowed to fester, has helped to create the conditions where fentanyl has thrived.
“It is a social problem,” says Risto Kasemae, a major at the National Criminal Police. “The police can only do so much. We are not a police state. We need to deal with the underlying social problems as well.”
One of the many tragedies associated with fentanyl in Estonia is the youthful complexion of its users. It predominates among a marginalized group of mainly ethnic Russian men aged between 16 and 24. The drug’s victims also die wretchedly young: 28, on average, for women and 31 for men. In the U.K., where its few users tend to extract the drug from painkillers prescribed to cancer patients, the statistics are 47 for women and 39 for men.
In a November survey the E.U.’s drugs watchdog, the European Monitoring Centre for Drugs and Drug Addiction, suggested, among a series of measures proposed to limit the use of fentanyl, an information blitz for vulnerable people. But users in Estonia are already morbidly aware of the dangers. In the spirit of stoic black humor, some refer to the drug simply as “flatline.”