Raido Paasma, then head of the intensive care unit at Pärnu Hospital and a clinical toxicologist and anesthesiologist, told ETV's "Ringvaade" that although a quarter of a century has passed since the tragedy, he still remembers many of the details.

At the time, Estonia was still a young country, having regained its independence just 10 years earlier, and incomes were limited. People bought alcohol on the black market where it was cheaper than in stores. To maximize their profits, illicit alcohol sellers mixed cheap methanol into vodka to increase the volume.

"People who knew where they could get their illicit vodka went there to buy it. If we look at the date, September 9 is right around the time pensions were paid. People had received their wages and pensions and it was also potato-harvesting season, so they went and stocked up. That's how it happened," Paasma said.

Paasma believes the people who mixed the drinks did not know how much harm they would cause. "To them, it was alcohol. The fact that it had one less H didn't bother them much."

The scale of the methanol poisoning was significant, but Paasma said the proportion of deaths was not exceptionally high compared with previous mass poisonings. "There have also been cases where 70 to 80 percent of those who consumed it died," he said.

Methanol is converted into a toxic metabolite in the body and ethanol is used as an antidote to treat methanol poisoning. During treatment, the concentration of ethanol in the blood must be kept sufficiently high; otherwise, the body begins to break down the methanol. This process produces toxic formic acid.

Drinking methanol does not cause the typical intoxication associated with ethanol. It also tastes different from regular vodka. "A couple of patients told me at the time, 'It was a damn strange drink. I drank it but didn't get drunk at all and it tasted strange too,'" Paasma recalled.

The mass poisoning was a major test for Pärnu Hospital. The hospital did not have sufficient capacity to treat all the patients, so some had to be transferred to other hospitals.

"We distributed the patients because we realized that our capacity to treat them on site was very limited. We could begin initial treatment, but then we needed somewhere with dialysis and greater intensive care capacity than Pärnu had at the time. Estonia's entire healthcare system responded to it and it responded as one. I think it was the first test ahead of the later Covid pandemic."

Paasma estimated that the most difficult period of the crisis lasted about a week and a half. Twenty-five patients died in the hospital, while 43 people were found dead outside the hospital. "When the poisoning has progressed so far that the heart is still working but the brain has already been damaged and the person develops what is known as brain death, unfortunately there is nothing that can be done."

Methanol poisonings still occur in Estonia today, but they are rare. "A month ago, there was a patient who had drunk methanol," Paasma said. "I don't know whether he is still alive. He did not regain consciousness, but his heart was working and he was able to breathe."

Paasma said methanol poisoning nevertheless remains widespread around the world, particularly in Asian countries. He cited three reasons: people seeking cheaper alcohol, poor availability of alcohol and religious restrictions on alcohol.

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