Opioids in Finland
Opioids, mainly illegally sold buprenorphine, and amphetamines, both of which are injected, are the main substances linked to high-risk drug use in Finland. The estimated sizes of the populations of high-risk opioid and high-risk amphetamine users are very similar; moreover, a significant proportion of high-risk users use both substances.
Opioids are the main drug associated with specialised treatment demand among all clients entering treatment, and treatment
is mainly sought for primary use of buprenorphine. However, this is often used together with other licit or illicit substances.
Cannabis and buprenorphine are the most frequent primary substances reported by those seeking treatment for the first time. One third of treatment clients are female; however, this proportion varies by type of primary drug used and by programme.
In 2017, data from the general mortality register indicated a slight increase in the number of reported drug-induced deaths compared with 2016. Toxicological data indicate that buprenorphine, usually in combination with alcohol or benzodiazepines, was involved in the majority of drug-induced deaths. In 2017, the majority of the victims were male. In one out of eight deaths, a new psychoactive substance (NPS), such as alpha-PVP, etizolam or various synthetic opioid derivatives, was detected in the post-mortem toxicological analyses. In 2016 and 2017, an NPS opioid, U-47700, was present in 10 deaths.
In Finland, drug treatment is provided in a broader context of substance use treatment. The provision of substance use treatment is the responsibility of the regions and municipalities and is regulated by the Act on Welfare for Substance Abusers, the Social Welfare Act, the Mental Health Act and a decree governing detoxification and opioid substitution treatment (OST).
In addition, social support and employment assistance are provided to facilitate treatment and recovery. Specialised medical care for individuals with drug dependencies is also provided in emergency clinics and mental health services. However, the available treatment is often focused on the needs of opioid users. Long-term treatment options for amphetamine users remain limited.
In 2017, clients whose primary problem drug was an opioid (mainly injected buprenorphine) accounted for approximately half of all clients entering treatment in Finland that year. Buprenorphine is the most common primary drug among clients in inpatient settings, but the least common among clients entering treatment in primary healthcare and other outpatient settings. In these settings, clients frequently seek treatment for the use of sedatives, benzodiazepines or multiple substances.
The availability of heroin in the market plummeted after 2001, and heroin was replaced by buprenorphine-based opioid substitution medications, typically originating from Lithuania and France. In 2017, almost 25 000 Subutex (buprenorphine) tablets were seized in Finland. Synthetic drugs (amphetamines and MDMA) originating in Western Europe are brought into the country via Estonia, Lithuania, Sweden and, sometimes, Russia. Since 2016, a reportedly rising threat is the trafficking of counterfeit Rivotril from Central Europe to Finland and other Nordic countries. Rivotril belongs to the class of benzodiazepines that includes clonazepam, and is classified as a narcotic substance in Finland.
Determinants of prescription opioid use in Finland
Addiction, January 2021
Prescription opioid use increased in Finland from 1995 to 2016 (from less than 1 to 7%), but the increase was explained by the change in the treatment of codeine-based opioids in National Health Insurance. The area-level unemployment rate was positively correlated with the share of opioid users at the municipal level (r = 0.36; P < 0.001). In comparison with being employed, being outside the labour force was associated with increased opioid use in 1995-2007 [odds ratio (OR) = 2.22, 95% confidence interval (CI) = 2.10-2.36] and non-codeine opioid use in 2009-16 (OR = 2.16, 95% CI = 2.06-2.27), but not with codeine opioid use in 2009-16.
Prescription opioid use in Finland appears to be more common among low socio-economic status people, similar to the United States and the United Kingdom.
THL report: Drug deaths double in a decade
YLE, November 2020
Drug-related deaths are on the rise in Finland, and overdose deaths are happening to younger people, according to new figures in November 2020.
A report by the National Institute for Health and Welfare (THL) shows that the number of drug-related deaths continues to rise while the average age in drug-related deaths is younger than ever before.
The report reveals that 189 people died from drug overdoses in Finland last year. Ten years ago, that figure was just over 100.
THL’s statistics are based on the cause of death certificates as defined by doctors. Official mortality statistics are maintained by Statistics Finland, which records drug-related deaths in accordance with international regulations, for comparative purposes.
The THL report explains the increase in deaths as largely attributable to the growing use of cannabis, but amphetamines and opioids, such as buprenorphine, are also increasingly being found in the deceased.
Buprenorphine is used to treat opioid use disorder, acute pain, and chronic pain. In 2019, it was found to be the major cause in 91 overdose deaths, or about one in two.
Other opioids are also increasingly found to be a factor in overdose deaths, with opioids the main cause in a total of 80 percent of all drug overdose deaths in 2019.
Over the past five years, the proportion of under-30s in drug overdose deaths has risen from 33 percent to 49 percent. THL says it is concerned about the growing proportion of young people in these statistics.
Problem use of amphetamines and opioids prevalence in Finland in 2017
According to the results, it was estimated that there were 31,100–44,300 problem amphetamine and opioid users in Finland in 2017, which is 0.9–1.3% of Finns aged 15–64 in relation to the population. The most common problem use was among 25–34-year-olds (1.1–2.8%) and men (1.3–1.7%) and Southern Finland (1.0–1.9%).
The number of problem amphetamine users is estimated at 20,900–27,800 and the number of problem opioid users at 23,500–29,500. Mixed-use of amphetamines and opioids is common (7). Due to mixed-use, substance-specific estimates do not add up to the overall estimate. Thus, the same person may have entries in the data on the use of both opioids and amphetamines.
CONCLUSIONS. The high-risk opioid and amphetamine use is at a higher level than previously estimated in Finland. Social and health care services should be designed to meet the growing need due to increasing problematic use.
Statistics Finland: Number of deaths from drugs decreased in 2019
Statistics Finland, December 2020
The growth in the number of deaths caused by drugs, which had continued for three consecutive years, halted in 2019, when 234 persons died from drugs in Finland. The number of deaths caused by drugs was 27 lower than in the previous year, but nearly 60 more than ten years earlier.
Drug-related deaths can be defined in many ways. Statistics Finland uses the definition by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA’s Selection B classification1)). In it opioids, cannabis and cannabinoids, other hallucinogens, and stimulants suitable for abuse, such as amphetamine and its derivatives are classified as drugs.
The majority of drug-related deaths were poisonings from multiple substances where the effect from drugs was dominant. In addition to drugs, the person had also used, for example, psychopharmacons and/or alcohol. Drug-related deaths are classified according to the substance judged as most influential. Most commonly, in 60 per cent of the deaths, the most influential substance was some opioid, usually a synthetic pharmaceutical opioid, such as buprenorphine.
In ten years, drug mortality, or the number of deaths from drugs per 100,000 population, has grown by 27 per cent. Men's drug mortality is considerably higher than women's. Three out of four of those who died from drugs were men. In 2019, the drug mortality was 4.2, for men 6.5 and for women 2 (Appendix table 4).
Narcotics Decree amended to prohibit new psychoactive substances – synthetic opioids and synthetic cannabinoids continue to raise concerns
Ministry of Social Affairs and Health, August 2020
The Finnish Government Decree on narcotic substances, preparations and plants (Narcotics Decree) and the classification of substances will be amended again on the basis of UN and national decisions. For the first time, the list of substances classified as narcotics and placed under international control will include new psychoactive substances, that is synthetic opioids, synthetic cannabinoids and synthetic cathinones. The amended Decree entered into force on 21 September 2020.
The list of substances subject to international control will include for the first time crotonylfentanyl and valerylfentanyl. They are synthetic opioids that closely resemble pain medicine fentanyl, which has been classified as a narcotic substance, in structure.
Fentanyls are highly dangerous, because they are effective in very small doses and their accurate dosing is difficult. Overdose will lead to a life-threatening respiratory depression. The substances are marketed in a way that provides no certainty on the content or purity of the sold product or they are sold as a completely different product or substance. This can also result in situations that unintentionally pose a risk to life and health.
The Decree will also classify isotonitazene as a narcotic substance nationally. Isotonitazene is a synthetic opioid, which resembles morphine and fentanyl. It is related to etonitazene and clonitazene, which the UN Single Convention has classified as narcotic substances. The substance may cause misuse and addiction similar to morphine. The most harmful effect of an overdose is a life-threatening respiratory depression.
Substance Use and Addiction Strategy
Joint guidelines until 2030
MINISTRY OF SOCIAL AFFAIRS AND HEALTH, April 2021
The Substance Use and Addiction Strategy sets out the priorities and joint guidelines until
2030. The Strategy is based on the recognised need to provide more comprehensive guidance
on the prevention and treatment of risks, harms and problems related to alcohol, tobacco,
drugs and gambling. The Strategy also deals with digital gaming in connection with gambling.
Finland's drug policy has aimed to prevent the use and distribution of drugs so that the health, social and individual harm and economic costs of their use and control are kept to a minimum. The disadvantages of drug use may be related to the substance's short- and long-term effects, the uses, or the drug subculture. The risk of physical and mental dependence and other harms associated with the use of different drugs varies. Social addiction refers to a circle of friends built around drug use that can be difficult to break away from. Drugs are also linked to crime and are often related to violence. Injecting predisposes to various inflammations as well as serious blood-borne infections.
The 1997 National Drugs Strategy strengthened the role of social and health care in drug policy and introduced harm reduction measures, such as social and health counselling, into the range of instruments. The so-called two-track model was born, in which the activities of social and health care and law enforcement agencies are parallel.
Drug policy has been guided and further developed by Government decisions in principle and related drug programs, which have been adopted six times since the 1997 strategy. In each term of office, prevention work, treatment, harm reduction and law enforcement action have been developed according to priorities and available funding.
The Finnish Drugs Act (373/2008) is based on the UN drug conventions. Common EU drug legislation is also based on the same conventions. In recent years, national drug legislation has been developed to reduce the risks and harms associated with new modified drugs entering the market. Other important legislation includes legislation on treatment, communicable diseases and preventive work. Drug policy is addressed and coordinated as a broad cross-cutting issue and cooperation between different government sectors. An important inter-sectoral co-operation body is the STM-coordinated, multi-administrative drug policy coordination group.
1 Reduce the harm caused by drug use to the user himself, relatives, communities and society, emphasising reducing drug-related mortality.
2 Prepare the Government's decision-in-principle on drug policy for each term, which strengthens targeted measures. To ensure the best expertise, thematic working groups will be set up as necessary to support the preparation. Ensuring national drug policy coordination between authorities at the national, EU and international level and regular involvement of stakeholders in the preparation of drug policy.