1. Introduction On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. Following March 13, 2020, the Estonian government declared a state of emergency which included social dis- tancing and stay-at-home orders to slow down the viral spread of COVID-19. No movement ban was imposed in Estonia during the entire pandemic. Estonia has approximately 8,600 people who inject drugs (PWID) (Raag et al., 2019), up to 800 differ- ent drug treatment slots, and around 3,500 regular harm reduction clients (National Institute for Health Development, 2022). Based on the available studies and information, this paper gives an insight into the effects of the COVID-19 pandemic on the illicit drug Journal of Geography, Politics and Society 2022, 12(1), 8–16 https://doi.org/10.26881/jpgs.2022.1.03 The ImPacT of The coVID-19 PanDemIc on DruG DemanD anD SuPPly In eSTonIa Katri Abel-Ollo (1), Margo Kivila (2), Aljona Kurbatova (3), Svetlana Ovsjannikova (4) (1) National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia e-mail: Katri.Abel-Ollo@tai.ee (corresponding author) (2) Police and Border Guard Board, Pärnu mnt 139, Tallinn 15060, Estonia e-mail: Margo.Kivila@politsei.ee (3) National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia e-mail: Aljona.Kurbatova@tai.ee (4) National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia e-mail: Svetlana.Ovsjannikova@tai.ee citation Abel-Ollo K., Kivila M., Kurbatova A., Ovsjannikova S., 2022, The impact of the COVID-19 pandemic on drug demand and supply in Estonia, Journal of Geography, Politics and Society, 12(1), 8–16. abstract The COVID-19 pandemic has changed the world and imposed restrictions and rules that democratic countries could not have foreseen. The global health and social care system was put under enormous pressure, and preventing it from a total collapse became the primary objective. This paper looks at how the pandemic affected the illicit drug market, people who use drugs and services designed to support and help them. Based on the available studies and administrative statistics from 2019 and 2020, illicit drug use and need for services remained the same despite the pandemic. Services quickly adopted new operating rules and became available for the target group. There is ample evidence that in some cases illicit drug use (e.g. cannabis) even gained in popularity as a coping method for anxiety and stress. The drug supply fell only temporarily due to the COVID-19, to which it quickly adapted through new IT and crypto possibilities (dark web). Key words COVID-19, drug demand, drug supply, service availability, Estonia. received: 26 March 2022 accepted: 02 May 2022 Published: 27 May 2022 The impact of the COVID-19 pandemic on drug demand and supply in Estonia 9 demand and supply. As all harm reduction and treat- ment services had to quickly revise their operating procedures to rearrange service provision for their clients, this paper also looks at the availability and use of help and support services for people who use drugs (PWUD). 2. Data The data presented and analyzed in this paper come from different surveys and administrative statistics. All the research describing prevalence of drug use comes from the National Institute for Health Devel- opment (NIHD). The NIHD is responsible for several general population studies describing illicit drug use (Vorobjov et al., 2019; Reile, Veideman, 2021), surveys among vulnerable groups (Salekešin et al., 2021) and alternative study methods like wastewa- ter study, syringe residue study and web-based sur- vey among PWUD (Abel-Ollo et al., 2021a; Abel-Ollo et al., 2022; Kütt, 2020). Supply reduction statistics and intelligence information is presented in coop- eration with Police and Border Guard Board and EMCDDA’s National Focal Point (NFP) situated in the NIHD. The Estonian NFP regularly collects and ana- lyzes supply reduction data from Police and Border Guard Board and Estonian Forensic Science Institute. Information and statistics on harm reduction and treatment service delivery is part of Estonian NFP’s regular work, as all the services are coordinated by the NIHD. 3. results 3.1. Drug use in estonia before and during the coVID-19 pandemic As of 2018, a quarter (25%) of 16–64-year-olds in Estonia had used illicit drugs in their lifetime, with the last year prevalence of 7% and the last 30 days prevalence of 3%. Cannabis was the most frequently used illicit drug (24%), followed by amphetamine (6%), ecstasy (5%), and cocaine (5%) (Vorobjov et al., 2019). Based on the Estonian health behavior sur- vey conducted in 2020, 13% of the population aged 16–64 had used drugs or psychotropic prescription pharmaceuticals without a doctor’s prescription dur- ing their lifetime, 7% of them in the last 12 months, and 6% in the last 30 days. Drug use was more com- mon among men than women (17% vs 11%) and significantly higher in younger age groups (Fig. 1). The main drug used in the last 30 days was cannabis, followed by sedatives/hypnotics, ecstasy, ampheta- mines, and cocaine. Although studies before the COVID-19 and dur- ing the pandemic show different rates for lifetime il- licit drug use, the rates for more recent drug use are comparable. Based on the 12 months’ and 30 days’ 34.2 29.2 19.7 9.4 2.9 29.2 18.5 8.1 2.8 1.5 23.3 16.3 6.1 2.8 1.5 0 5 10 15 20 25 30 35 40 16–24 25–34 35–44 45–54 55–64 incl last 30 days incl last 12 months Life time use Fig. 1. Use of narcotic drugs or misuse of psychotropic prescription pharmaceuticals in men by age group (%) 2020 Source: Estonian Adult Health Behavior Survey 2020 – Reile, Veideman, 2021. 10 Katri Abel-Ollo, Margo Kivila, Aljona Kurbatova, Svetlana Ovsjannikova prevalence data from the 2018 and 2020 population studies, we can assume that illicit drug use has re- mained stable or even increased with time (last 30 days prevalence 3% vs 6%). To obtain a better insight into the impact of COV- ID-19 on the drug situation, at the beginning of the pandemic (April–May 2020), Estonia participated in the EMCDDA-led mini web survey. The main objec- tive of the survey was to assess possible changes in the drug market, illicit drug use, and availability of support services in times of local and global restric- tions due to COVID-19. According to the results, 84% of the respondents (n=1146) had used at least one substance in the past 30 days. Most of the respond- ents used cannabis (92% had used cannabis in the past 12 months, 76% in the past 30 days). Almost 30% of the respondents had not made any changes to their use of illicit drugs during the lockdown. 21% of the respondents reported they used illicit drugs less and 17% had not used any illicit drugs during the COVID-19 restrictions. 24% of the respondents began using drugs more frequently, and 8% found it difficult to tell whether their drug use pattern had changed. Those who reduced the use of illicit drugs justi- fied it with fewer opportunities to use drugs (34%) and limited opportunities to buy drugs (27%), also due to their financial situation. People had more free time during the lockdown, but there were also fewer options to spend time outside home and limited social support to cope with the difficult times. Drug use mostly increased because of boredom (77%) and anxiety (44%) (Kütt, 2020). Based on the results of the 2019 and 2020 (15−21.09.2020) Tallinn wastewater survey, it can be stated that despite the restrictions and a decrease in tourism, drug use had not significantly decreased compared to 2019, but rather increased in the case of some substances. The most common substances in Tallinn wastewater were cannabis, amphetamine, and cocaine, followed by methamphetamine and MDMA (Fig. 2). The situation had not changed sig- nificantly compared to 2019. Comparing the 2019 and 2020 results of the Tal- linn survey, the amount of methamphetamine in wastewater dramatically increased, which indicates an increase in the availability of this substance on the drug market. For both study years, differences in use between days of the week were most seen for MDMA and cocaine. These two substances were mostly used at weekends, and it can be assumed that they were also used for recreational purposes at gatherings/parties during the fall of 2020. Although there were no large public events and parties, there is reason to believe that both online and in-person private parties and 304.8 83.7 63.2 294.0 7 053.7 368.0 251.0 111.0 288.0 8 331.0 0 1 000 2 000 3 000 4 000 5 000 6 000 7 000 8 000 9 000 Amphetamine Metamphetamine MDMA Cocaine Cannabis (THC) 2020 2019 Fig. 2. The average amount of used substance in Tallinn wastewater per 1000 inhabitants per day by days, mg, 2019, 2020. Source: Wastewater study for drugs and their metabolic products in Tallinn and Pärnu: Abel-Ollo, Riikoja, Barndõk, Kurbatova, 2021a. The impact of the COVID-19 pandemic on drug demand and supply in Estonia 11 gatherings took place more than usual. Cannabis use, which has somewhat increased since 2019, may indicate a method of coping with stress in uncertain and anxious times during the COVID-19 pandemic (Hollo et al., 2020; Abel-Ollo et al., 2021a). 3.2. Service provision Findings suggest there was a decline in the avail- ability of European drug services during the first two months of the pandemic in both providing treat- ment and harm reduction interventions (EMCDDA, 2020). Estonia reacted quickly to the situation; with- in the first weeks of the pandemic, a new operational framework for drug treatment and harm reduction services was created. There were no service closures during the pandemic. Only residential treatment was closed to new patients for a few weeks. Although new patients were not admitted as a precaution to protect the patients already in treatment, patients on the waiting list were supported by counselors via mobile and online channels. Later, a COVID unit was organized where COVID-19 was also treated as part of the residential drug treatment. A set of rules and recommendations was developed by the National Institute for Health Development for drug services with the focus on implementing new hygiene and social distancing measures. Needle and syringe ex- change programs and opioid substitution treatment were always available with the recommendation to provide clients with drug use paraphernalia and take-home methadone for longer period than usual- ly. Most of the clients were happy to be quarantined and to be able to visit a substitution treatment site once a week instead of daily visits (Eurasian Harm Reduction Association, 2020). Also the police were informed that higher doses of methadone were made available for the substitution treatment clients during the COVID-19 restrictions period. Take-home naloxone provision and individual counselling con- tinued via mobile harm reduction services, outreach work, and treatment centers. Clients of drug services were contacted via mobile or online platforms to mitigate the difficulties in providing face-to-face care. Mobile harm reduction and outreach services helped to compensate for the lack of contact al- though there was feedback from some service pro- viders that clients missed the face-to-face interaction and everyday routine to visit the services. As Estonia did not have a personal drug treatment register in 2019 (the new personal register became operational in February 2020), it is difficult to provide accurate data on how COVID-19 affected the drug treatment demand. Based on the information from drug treat- ment centers, the demand for drug treatment had not significantly increased. At the beginning of the pandemic, there were some signs that the demand for opioid substitution treatment had increased, but as the drug market quickly stabilized, demand for treatment remained unchanged. Also, the mini web survey confirmed that neither the intention to seek professional support nor the use of remote professional support had increased during the first months of the pandemic. However, the respondents whose intentions to seek professional support had increased used online or remote professional sup- port services (Kütt, 2020). The main challenges in the first months of the pandemic were staff shortages due to a sickness and quarantine of the staff as well as helping more vulnerable and marginalized clients to access essen- tial hygiene-related services. Also, challenges linked to the use of remote technology (phone and video) and problems with enrolling new clients were ob- served. Harm reduction and drug treatment services were supplied with the personal protective equip- ment (masks, gloves, etc.) for the staff. The personal protective equipment was purchased centrally by the government. In 2019 and 2020, harm reduction services saw stable numbers of regular clients (around 3,500). Approximately 1.5 million syringes were distributed to PWID via the harm reduction services in 2020. In 2020, the support services and drug use parapher- nalia were used to a lesser extent compared to 2019, which was caused by movement restrictions and a fear of personal contact due to the COVID-19 pan- demic (Table 1). Also based on the results of the mini web survey, harm reduction services (drop-in cent- ers and outreach services) and pharmacies remained popular places among PWID to obtain syringes. Ac- cess to clean drug use paraphernalia remained the same for most of the PWID in this study as it had been before the COVID-19 pandemic (Kütt, 2020). Apart from maintaining the existing harm re- duction and treatment services, new services were developed during the COVID-19 pandemic. A new substitution treatment and harm reduction center started operating. Support services for problematic drug users and cooperation with pharmacies ex- panded. In May 2020, new mental health counsel- ling service was opened for users and their loved ones, in both an in-person format and by using dif- ferent communication channels (Facebook, mes- senger, and phone). Also, aftercare service provided psychological support to the users and their loved ones at the beginning of the pandemic. Based on the HIV prevalence study among PWID (Salekešin et al., 2021), more than half of the PWID (59%) considered COVID-19 to be very dangerous or rather dangerous, and 9% to be not dangerous 12 Katri Abel-Ollo, Margo Kivila, Aljona Kurbatova, Svetlana Ovsjannikova at all. Based on research results, only few PWID had SARS-CoV-2 antibodies in spring 2020 (Salekešin et al., 2021). Starting from summer 2021, COVID-19 vaccines were made widely available for PWUD via mobile harm reduction services and drug treatment services. These vaccination opportunities were used by many PWUD. 3.3. Drug overdose deaths For over a decade up to 2017, Estonia had the high- est overdose mortality in Europe. The use of illicitly manufactured fentanyl was a major contributor to Estonia’s overdose death epidemic. Since 2018 over- dose deaths have been relatively low and remained stable (Abel-Ollo, 2022). In 2020, there were 31 cases of overdose deaths (110 cases in 2017). The reason for the decline is associated with the successful po- lice work which led to the dismantling of many crim- inal networks related to the illicit fentanyl market in Estonia, wider scale take-home naloxone distribu- tion (Fig. 3), and other harm reduction programs. As harm reduction services (including take-home naloxone provision) were constantly available, and a shortage of fentanyl on the Estonian drug market continued, the COVID-19 pandemic had not had a significant impact on drug overdose mortality. 3.4. People who inject drugs Since 2005 Estonia has regularly used cross-section- al respondent-driven sampling studies among PWID in three Estonian cities (Tallinn, Narva and Kohtla- Järve). The studies have aimed to monitor the risky behavior of PWID and the prevalence of infectious diseases. The latest study before the COVID-19 pan- demic was conducted in Narva in 2018 and during the pandemic in Kohtla-Järve in 2020. Based on the studies, the average age of PWID and their inject- ing career had increased from year to year, being Table 1. Statistics on the use of harm reduction services, 2018–2020 2018 2019 2020 Total number of service users (with a client code) 3,738 3,474 3,523 Number of times the service is used annually 92,562 92,297 77,189 Number of consultations with harm reduction workers 42,232 44,992 38,335 Number of consultations with social workers 8,463 9,420 8,486 Number of psychological consultations 1,669 5,587 2,410 Health-related counselling 5,398 5,288 4,505 Number of syringes 1,680,531 1,629,477 1,529,814 Source: National Institute for Health Development, 2021a. 0 1 000 2 000 3 000 4 000 5 000 6 000 7 000 2013 2014 2015 2016 2017 2018 2019 2020 2021 0 20 40 60 80 100 120 N a l o x o n e O v e r d o s e Fig. 3. Naloxone provision in relation to drug overdose deaths in Estonia, 2014–2021. Source: National Institute for Health Development, 2022. The impact of the COVID-19 pandemic on drug demand and supply in Estonia 13 37 years and 18 years respectively in the 2020 Koht- la-Järve study. The risky behavior of PWID has im- proved over years. In 2020, only 0.9% of PWID shared syringes previously used by others (3% in Narva in 2018), which also indicates the availability of sterile injecting paraphernalia. Until 2017, the main inject- ing drug had been either fentanyl or amphetamine, depending on the region (Salekešin, et al., 2019, 2021). In recent years, the availability of fentanyl has decreased, and amphetamine has been the main substance in both Tallinn and the Ida-Viru County. As services for the PWID community were operational during the COVID-19 pandemic, the main develop- ment in the target group was the general higher anxiety level in the community as well as possible changes on the drug market and the availability of the drug of choice. To get a better overview of injected drugs, a sy- ringe residue study was conducted in Narva and Tal- linn harm reduction centers in 2021 (Abel-Ollo et al., 2021b). In summary, the syringes in Tallinn and Nar- va predominantly contained amphetamine (60%), followed by α-PVP (17%), buprenorphine with na- loxone (15%), and methamphetamine (14%) (Fig. 4). Buprenorphine and naloxone are known mostly as drugs used in the treatment of opioid dependence, and their injection indicates drug misuse. The study of syringe residues confirmed the low prevalence of fentanyl and its analogues in Estonia in the spring of 2021. Fentanyl was found twice in syringes in Tallinn. Isotonitazene, a synthetic opioid that is considered to be one of the so-called substitutes for missing fentanyl, was found in 9% of syringes. 3.5. Drug supply and drug market There is an indication that two-thirds of the mini web survey respondents obtained or attempted to obtain illicit drugs during the COVID-19 pandemic. The most widely obtained drug was cannabis (85% of the respondents obtained cannabis during the restrictions). Over half of the respondents did not change the way in which they obtained illicit drugs. The patterns of using drugs, price, purity, and quan- tity received remained the same as before for most of the respondents (Kütt, 2020). From the supply reduction side, the COVID-19 pandemic brought some temporary changes to the drug supply field, but mostly it affected the lower- level sellers and individual smugglers. COVID-19 did not hinder drug offenders with good international contacts and allowed criminals to increase the prices of substances by about 10%. COVID-19 had a signifi- cant effect on ordering illicit substances via the dark- net by regular parcel/post. Among other reasons, the COVID pandemic increased the use of darknet and cryptocurrency in the drug supply field. It is known that the use of IT and modern technology field in organized crime has been a growing problem; the COVID pandemic only gave an extra boost to it. Cannabis, amphetamine, MDMA, and cocaine continue to be the most prevalent drugs used and traded in Estonia. cannabis seizures, price, and 60.0 17.3 14.6 14.1 9.7 9.2 5.4 2.7 1.6 0.5 0.5 0.5 1.1 0 10 20 30 40 50 60 70 amphetamine ?-PVP buprenorphine metamphetamine cocaine isotonitazene methadone MDMA diazepam carfentanil fentanyl 6-MAM, morphine, codeine AC Syringe without substance Fig. 4. Proportions of substances found in syringes used in Tallinn and Narva (%), 2021 Source: Syringe residues analysis collected in harm reduction centers in Tallinn and Narva (Abel-Ollo et al., 2021b). 14 Katri Abel-Ollo, Margo Kivila, Aljona Kurbatova, Svetlana Ovsjannikova purity have been stable for many years. Based on studies, there is reason to believe that cannabis use increased during the pandemic as a method of cop- ing with mental health pressure caused by COVID-19 (Kütt, 2020). Synthetic cannabinoids have not been very prevalent on the Estonian drug market. Based on data from the Estonian Forensic Science Insti- tute, in 2020, three types of synthetic cannabinoids (5C-APINACA, AB-FUBINACA, JWH-210) were con- fiscated, with the biggest amount being AB-FUBIN- ACA  – 14.6  g. The decreasing trend of NPS seizures has been explained by the generic group-based legislative change that took place in 2016. Most syn- thetic cannabinoids fall under the already existing substance groups and are automatically controlled. Cocaine, amphetamine/methamphetamine, and MDMA seizures have increased over the past years. The hypothesis that the use of recreational drugs would decrease with COVID-19 restrictions was not confirmed in Estonia (Kütt, 2020; Abel-Ollo et al., 2021a). In 2020, the record amount of cocaine was con- fiscated in Estonia (Table 2). With the decreased price and improved standard of living, cocaine had become more affordable to young people and had lost its “high class” image (Table 3). According to the Estonian Forensic Science Institute, the purity of co- caine has increased steadily since 2015. In 2020, the most common purity of cocaine was 81% (0.6−86). Also, the MDMA tablet purity was on the rise. While in the years of 2016 and 2017 the most common pu- rity of tablet MDMA had increased from 36 mg to 93 mg, in 2020 the most common purity of MDMA had increased to 137 mg (34−243). Amphetamine purity has been relatively low over the years in Estonia. Although the purity has increased a little, the most common purity of 17% in 2020 was still low. The bigger amounts of ampheta- mine/methamphetamine seizures over the years have been related to large-scale seizures. Estonian PWID use both methamphetamine and ampheta- mine, whereas sometimes the users are not able to tell the difference between methamphetamine and regular amphetamine. methamphetamine seizures increased many times in 2020 (Table 2). Increased concentration of methamphetamine was also found in 2020 wastewater analysis (Abel-Ollo et al., 2021a). According to the police, the increased availability of methamphetamine may also be related to orders placed on the darknet, which became more active during the pandemic. The darknet distinguishes between amphetamine and methamphetamine, and the subscriber is likely to receive the desired substance. fentanyl shortage continued in 2020. The trend started in 2017 and is not related to the COVID-19 pandemic. Fentanyl was available on a small scale only in the East-Virumaa and Harjumaa counties, other regions were not affected by fentanyl. The shortage caused an increase in the price of fentanyl (Table 3). Fentanyl is mostly smuggled from Latvia. People who use fentanyl compensated for the short- age or low purity of the substance with the use of amphetamines, cathinones (α-PVP), and prescrip- tion drugs. α-PVP is mainly trafficked from the Rus- sian Federation. Lately, drones have been used to transport drugs across the border. In 2020, the α-PVP availability decreased due to the closure of the borders of the Russian Federation related to the COVID-19 restrictions and closure of some smug- gling networks by the Estonian police. While in 2019 Table 2. Amounts and number of seizures of confiscated narcotic substances 2018–2020. Substance 2018 2019 2020 Number of seizures Amount (kg) Number of seizures Amount (kg) Number of seizures Amount (kg) Cannabis resin 48 110.3 46 2.22 39 1.56 Herbal cannabis 707 72.1 807 97.3 727 60.2 Cannabis plant 40 19.5 31 74.7 40 36.3 Heroin 7 0.012 4 0.004 2 1.4 Fentanyl 98 0.7 31 11.097 20 0.16 Cocaine 164 3.6 149 17 139 413.4* Amphetamine 346 17.3 310 111.2 352 133 Methamphetamine 126 5.1 37 4.04 135 27.1 MDMA 275 8.13 199 33.5 227 70.5 GHB/GBL 68 140.9 63 129.71 104 44.75 *411 kg is one-time big seizure Source: Estonian Forensic Science Institute, 2021 (EMCDDA standard table 13: Number and quantity of seizures of illicit drugs). The impact of the COVID-19 pandemic on drug demand and supply in Estonia 15 1.2  kg of α-PVP was seized, in 2020 the amount of α-PVP decreased to 685 g. As for opioids, isotonitazene appeared on the Estonian drug market in 2019 to compensate for the shortage of other opioids. Isotonitazene (street name ISO) is a potent synthetic opioid that, similarly to fentanyl, can cause a high rate of overdose deaths if the use becomes locally more prevalent. There is reason to believe that the small amounts of isotoni- tazene confiscated over the past years are related to the fact that the substance has been controlled only since January 2020. Before the substance was offi- cially listed as controlled, it had been problematic to define a big amount of isotonitazene and classify a criminal offense. In 2019, 58.2  g of isotonitazene (ISO) was confiscated; in 2020 the situation remained stable (53.8 g). Both substances, ISO and α-PVP, were related to overdose deaths in 2020. 3.6. Drug-related crime In 2020, in a total of 3,701 drug-related misdemea- nors (Act on Narcotic Drugs and Psychotropic Sub- stances and Precursors thereof, §  15.1: Unlawful handling of small quantities of narcotic drugs or psy- chotropic substances) and criminal offenses (Penal Code §§ 183–190) were registered. Compared to the years 2018 and 2019, the number decreased in 2020 (4,505 vs 3,998 vs 3,701). The records of drug-related crime are not sufficiently detailed to give an over- view of the background, level, or scale of drug-relat- ed crime. Arresting people who use drugs for using them has not been a priority for the law enforcement over the last five years, whereas the focus has been on linking the PWUD with treatment and support services. In 2020, the level of seizures and the num- ber of criminal investigations also decreased be- cause police forces were heavily involved in enforc- ing restrictions related to the spread of COVID-19. The performance of law enforcement staff was also affected by illness, self-isolation requirements, and work-from-home orders. 4. Discussion The COVID-19 pandemic has affected countries so- cially and economically all over the world. The pan- demic has influenced all areas of life, either directly or indirectly. Globally, the health system’s sustain- ability and the population’s physical and mental health were put under enormous pressure. As illicit drug use is controversial, and reasons and patterns of use greatly vary, it is difficult to describe the over- all effect of COVID-19 on illicit drug use. Based on dif- ferent surveys, we can conclude that some people used illicit drugs (mainly cannabis) during COVID-19 more as a self-help method to reduce stress and anxiety. Some people who use illicit drugs as part of their recreation and social life reduce the use, whereas others continued to use drugs in other set- tings (e.g. private parties instead of public nightlife). Wastewater studies show that despite restrictions and lack of entertainment options, the use of rec- reational drugs like stimulants remained the same in 2020, with increased use at weekends. Although there were no large gatherings and parties in the fall of 2020, it would be naïve to assume that young people did not explore the possibilities of organiz- ing leisure time activities and private events. For the problematic drug users and dependent individuals, drug use was not a matter of choice, and they tried to cope with the changes in the organiza- tion of drug services and the drug market in general. Due to social distancing and other restrictions that impacted the work of the health and social services, PWID quickly became more vulnerable than ever. Estonia managed to keep all the treatment, harm re- duction, and support services for PWUD operational/ Table 3. The street-level price of substances 2018–2020 (EUR). Substance (dose or gram) 2018 2019 2020 Min Max Mode Min Max Mode Min Max Mode Cannabis (resin) 10 20 – 10 15 10 12 15 15 Cannabis (herbal) 15 20 – 15 24 20 15 25 20 Fentanyl 15 25 – 20 25 20 20 30 25 Amphetamine 15 20 – 15 25 20 20 25 20 Cocaine – – 150 120 180 150 100 150 150 MDMA (tablet) – – 15 8 15 10 7 15 10 GHB – – 5 – – 5 5 8 5 LSD – – – – – 5 – – 10 α-PVP – – – 20 25 – 20 25 – Source: Estonian Police and Border Guard Board, 2021 (EMCDDA standard table 16: Price of illicit substances (in Euros). 16 Katri Abel-Ollo, Margo Kivila, Aljona Kurbatova, Svetlana Ovsjannikova available within the first weeks of the pandemic al- though because of fear of contracting COVID-19 and social distancing rules, the use of services slightly decreased in 2020. Estonian drug overdose mortal- ity statistics, surveys among PWID, and data from services providers illustrate that vital services were available and used by the target group during the pandemic. The demand for drug treatment did not significantly increase in March 2020. The Estonian drug market and availability of il- licit drugs mostly depend on other countries and international drug trafficking. The first hope that the COVID-19 travel restrictions and the closure of borders would decrease the availability of drugs was premature. After the first shock on the illicit drug market, the availability of drugs remained the same. Drug supply had started to move onto the darknet and crypto world before; the COVID-19 pandemic just gave an extra boost to that activity. Temporarily, the lower-level sellers felt the effect of COVID-19, but bigger international networks were not affected by restrictions and reacted by increasing prices of illicit drugs. To conclude, based on the EMCDDA mini web survey, most people did not change their pattern of drug use or channels of acquiring drug supplies. The long-known philosophy remained the same: where there is demand, there is supply. 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