For example, when I visited Vancouver, Canada in 2024, I was shocked by how visible and severe the opioid crisis is there. Addiction often begins with a prescription—whether for post-surgery painkillers, long-term treatment of chronic conditions, or medications that become unaffordable or unavailable, which pushes people toward the illegal market.
In Estonia, the problem often starts with illicit drug use instead of prescription painkillers. Many opioid users began with heroin or homemade poppy mixtures (“mak”), and when heroin became scarce around 2003, illegally manufactured fentanyl swiftly took its place.
Fentanyl and its analogues, including 3-methylfentanyl, are significantly more potent than heroin, leading Estonia to have the highest overdose death rate in Europe for over a decade (from 2005 to 2013). The crisis also resulted in an increase in HIV and hepatitis C infections due to unsafe injection practices.
For some, particularly those born in the 1970s and 80s, this resulted in growing up in unstable households, surrounded by poverty, stress, or even substance abuse.
Estonia experienced a significant decline in overdose fatalities following a crackdown on local fentanyl production and distribution in 2017. However, recent statistics reveal a troubling increase in drug-related deaths, primarily linked to the emergence of potent synthetic opioids known as nitazenes.
The demographic group most affected by synthetic opioids is young men, particularly those living in poverty, lacking higher education, or with histories of trauma, mental health challenges, or unemployment.
During the decade when Estonia had the highest overdose death rate in Europe, men born between 1977 and 1986 were especially impacted. This was partly because they were in their formative years during the post-Soviet transition, which resulted in economic instability.
After the collapse of the Soviet Union in 1991, Estonia swiftly transitioned from a centrally planned economy—where the government controlled jobs, prices, and industries—to a free-market economy, in which supply and demand dictate business and employment.
This swift and bold transition, commonly referred to as “shock therapy,” involved the privatization of state enterprises, the removal of subsidies, and a decrease in state control. Numerous state-owned factories and farms shut down during this rapid change, leading to a spike in unemployment.
The government cut Soviet-era social safety nets, such as guaranteed housing, job placements, and unemployment protections. As a result, individuals who lost their jobs often found themselves without adequate support for retraining or economic survival. For some, particularly those born in the 1970s and 80s, this resulted in growing up in unstable households, surrounded by poverty, stress, or even substance abuse.
However, women of all ages also went through the same transition, and girls grew up in similarly turbulent households. While it was difficult for everyone, men probably faced more pressure to be the breadwinners.
From my upbringing and family in 1990s Estonia, I remember male relatives who used drugs, even though I was too young to understand which ones. I recall that some family members tried to help them, but nothing worked, ultimately frustrating those who attempted to assist.
I believe a significant reason Estonians face mental health and emotional well-being issues is the trauma that is passed down through generations from war, occupation, and upheaval, along with the stoic nature of the Estonian people.
I’ve never witnessed Estonian men display any raw emotion. When I reflect on the men around me growing up, I remember only one expression: a blend of seriousness and numbness.
I’ve heard Estonian women express a desire to be less emotional, believing that emotions are a sign of weakness. Yet, I have seen them cry. In contrast, I’ve never witnessed Estonian men display any raw emotion. When I reflect on the men around me growing up, I remember only one expression: a blend of seriousness and numbness.
Estonia has taken some steps to tackle its synthetic opioid crisis. For example, the 2017 crackdown on local fentanyl production and distribution led to a dramatic decline in overdose deaths. In addition, Estonia expanded needle exchange programs, increased access to naloxone (a life-saving medication that reverses overdoses), and continued opioid substitution therapy (OST) services.
Despite these efforts, the crisis continues to evolve, and overdose deaths are once again rising. Authorities now stress harm reduction strategies, community outreach, and improved healthcare and social services coordination. Estonia’s advanced digital infrastructure presents additional, largely untapped potential to enhance prevention, treatment, and early warning systems.
I would argue that all this can do is keep people alive for as long as possible. What truly needs to happen is that Estonian families must break the cycles of generational trauma they are caught in and confront their mental and emotional issues head-on as early as possible, rather than attempting to mask them with addictive substances.
If you’re interested in mental health and emotional well-being topics, check out my YouTube channel called “Question It With Marili.” You can start with this video below:
