Anneli Uusküla1, Ave Talu2, Sigrid Vorobjov3, Maris Salekešin3, Jürgen Rannap2, Liis Lemsalu3, Don Des Jarlais4. 1. Department of Family Medicine and Public Health, University of Tartu, Ravila 19 Tartu 50411, Estonia. Electronic address: anneli.uuskula@ut.ee. 2. Department of Family Medicine and Public Health, University of Tartu, Ravila 19 Tartu 50411, Estonia. 3. Drug and infectious diseases epidemiology department, National Institute for Health Development, Hiiu 42 Tallinn 11619, Estonia. 4. College of Global Public Health, New York University, 665 Broadway New York, NY 10012, USA.
Abstract
BACKGROUND: The spread of illicitly manufactured fentanyl has the potential to greatly increase the fatal overdoses in many places in the world. The purpose of this paper is to analyse the evolution of fentanyl use epidemic in Estonia. METHODS: this scoping review is based on extensive review and synthesis of broad range of literature: research reports, newspaper, magazine, coverage of illicit fentanyl use; policy documents, position papers, reports released by government agencies, and surveillance data. RESULTS: For an over a decade up to 2017, Estonia has had the highest overdose death mortality in Europe. The use of (injected) fentanyl is a major contributor to the Estonian overdose death epidemic. Shutting down a major producer and distributor of illicit fentanyl has been extremely effective in curbing the number of overdose deaths. Unfortunately, this supply-side intervention came ten years into the epidemic, and might be difficult to replicate in settings with decentralized production. In areas faced by fentanyl we would recommend large-scale implementation of opiate substitution treatment and naloxone distribution, syringe service programs to provide for safer injecting and link to other services (high frequencies of fentanyl injection create high risk for HIV and HCV transmission), and programs, such as "Break the Cycle," to reduce initiation into injecting drug use. Further, the means of responding to emerging substances should match the world in which different substances can be rapidly introduced, and where people who use drugs can change preferences based on market availability. CONCLUSION: Addressing illicitly manufactured fentanyl may serve as a public health learning experience for developing early detection and rapid response programs in rapidly changing drug use environments.
BACKGROUND: The spread of illicitly manufactured fentanyl has the potential to greatly increase the fatal overdoses in many places in the world. The purpose of this paper is to analyse the evolution of fentanyl use epidemic in Estonia. METHODS: this scoping review is based on extensive review and synthesis of broad range of literature: research reports, newspaper, magazine, coverage of illicit fentanyl use; policy documents, position papers, reports released by government agencies, and surveillance data. RESULTS: For an over a decade up to 2017, Estonia has had the highest overdose deathmortality in Europe. The use of (injected) fentanyl is a major contributor to the Estonian overdose death epidemic. Shutting down a major producer and distributor of illicit fentanyl has been extremely effective in curbing the number of overdose deaths. Unfortunately, this supply-side intervention came ten years into the epidemic, and might be difficult to replicate in settings with decentralized production. In areas faced by fentanyl we would recommend large-scale implementation of opiate substitution treatment and naloxone distribution, syringe service programs to provide for safer injecting and link to other services (high frequencies of fentanyl injection create high risk for HIV and HCV transmission), and programs, such as "Break the Cycle," to reduce initiation into injecting drug use. Further, the means of responding to emerging substances should match the world in which different substances can be rapidly introduced, and where people who use drugs can change preferences based on market availability. CONCLUSION: Addressing illicitly manufactured fentanyl may serve as a public health learning experience for developing early detection and rapid response programs in rapidly changing drug use environments.
Authors: Joseph Friedman; Fernando Montero; Phillippe Bourgois; Rafik Wahbi; Daniel Dye; David Goodman-Meza; Chelsea Shover Journal: Drug Alcohol Depend Date: 2022-02-26 Impact factor: 4.852
Authors: Marta Katarzyna Choińska; Ivana Šestáková; Vojtěch Hrdlička; Jana Skopalová; Jan Langmaier; Vítězslav Maier; Tomáš Navrátil Journal: Biosensors (Basel) Date: 2022-01-05