The nitazene epidemic in Estonia: a first report.

Since 2022, Estonia, a north-east European nation of 1.3 million people, has faced challenges with nitazenes, a class of novel synthetic opioids, which present a new threat to public health. The purpose of this article is to provide the timeline of the nitazene epidemic in Estonia, examining the prevalence and health consequences of nitazene use in the country. This case study uses a multifaceted approach. Data sources include administrative statistics, surveillance and research data, national service provision information, and government documentation from 2015 to 2024, with a focus on health consequences from 2019 to 2024. Quantitative data is complemented by qualitative interviews with nitazene users. The number of drug-related deaths in Estonia has more than doubled since 2022 (39 vs. 80 cases), exceeding over 100 cases in 2023. The increasing prevalence of nitazenes from 2022 is confirmed by syringe residue studies and seizure data. Nitazenes are often sold on the drug market, usually with no or limited information to the user about the substance being sold. Users frequently describe the effect of nitazenes as stronger, faster, sharper and more short-lived compared to fentanyl. Harm reduction services have seen increased utilization since 2022, with first responders facing growing challenges linked to the emergence of the nitazene phenomenon. This study provides the first comprehensive description of the nitazene epidemic. Results indicate a need for more evidence-based information on the use of nitazenes and their consequences to effectively address emerging challenges.