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China White-- Synthetic Heroin AKA Fentanyl-- Killing More Estonians Than Road Accidents

I try to make history readable and interesting, warts and all. We must look to the past to understand the present and confront the future.

Map of Estonia

Estonia (extreme northeast of the European Union), population 1.3 million, area 17,500 sq miles (45,000 sq km).

Estonia (extreme northeast of the European Union), population 1.3 million, area 17,500 sq miles (45,000 sq km).

Highest Death Rate in Europe

Officials in Estonia in northeast Europe are struggling to address the highest death rate from drug overdoses in the European Union (EU). At a death rate just under 150 per million, more Estonians aged 15 – 64 are dying from drug-related deaths than automobile accidents and far exceed Norway's rate of about 80 per million, the second-highest in Europe. Overall, the Estonian rate is seven times that of Europe's average. Latvia, Estonia's neighbor to the south, has a drug-related death rate of about 15 per million-- 10 times less. Even the United States, with one of the higher death rates related to drug overdoses in the developed world, has less at about 100 per million.


Syringe fitted with needle.

Syringe fitted with needle.


In a seemingly related health risk, cases of HIV/AIDS has more than doubled in Estonia since 2001 to 9,800 in 2009, or 0.7% of the population. Over two-thirds of Estonians injecting drugs are infected, due mainly to sharing needles.

Fentanyl (China White)

Fentanyl powder

Fentanyl powder

China White (Fentanyl) Drug of Choice

The majority of drug-related deaths are due to the use of “China White”, a synthetic form of heroin made in clandestine laboratories just across the border in Russia and smuggled into Estonia. A decade ago, there was a heroin shortage in Estonia and China White, clinically known as “fentanyl”, took its place. Fentanyl is used medically to treat chronic, intense pain and in surgical procedures and is known for its rapid onset and short duration. The problem is, fentanyl is hundreds of times more potent than heroin. The powder has to be cut-- mixed with other substances-- to reduce its strength extremely carefully or death can result. The powder is then mixed with water and injected. A single dose of amphetamine is slightly less than half a spoonful; the equivalent amount of fentanyl is enough to kill more than 10 people. That equivalent amount of fentanyl would provide 37 doses. A single, fatal dose is estimated at 2 milligrams. It suppresses the breathing reflex, leading to coma and death.

Heroin No Longer Effective

Fentanyl is highly addictive like heroin and has all but replaced it in the Estonian market. Users say that once they used the synthetic drug, heroin doesn't do anything for them anymore. Even with daily doses of methadone from a drug clinic to manage the withdrawal symptoms, some report they still use China White several times a month. Years ago, alcohol used to be Estonia's main scourge, but social workers say now it is China White that is the problem.

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Tallinn, Estonia

Panorama of Tallinn, Estonia's capital, from the Baltic Sea

Panorama of Tallinn, Estonia's capital, from the Baltic Sea

Many Questions

Officials in Tallinn, Estonia's capital, not only do not have a strategy for dealing with the drug overdose problem, they cannot understand why Estonia's problem is so severe in comparison to the rest of Europe. In addition, the vast majority of China White users are ethnic Russians, who make up about 25% of Estonia's population (nearly 40% in the capital, Tallinn). Some say Russians prefer injecting their drugs, while Estonians would rather inhale or take their drugs orally; others say Russians like heavy drugs. Or maybe there's a partial link between the constant tension between Estonian-speaking and Russian-speaking citizens. In any case, while it is still mainly an Estonian problem, officials say Europe cannot afford to be unprepared-- it is so lethal.

© 2012 David Hunt

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