Download the entire PDF report here: Maine Monthly Overdose Report for July 2022
The monthly overdose report, funded jointly by the Maine Office of the Attorney General and the Office of Behavioral Health, provides an overview of statistics regarding suspected and confirmed fatal and nonfatal drug overdoses in Maine during each month. Data for the report is collected at the Office of Chief Medical Examiner and as part of the Maine Naloxone Distribution Initiative. Year-to-date numbers will be updated with each new monthly report, as cases are finalized, and their overdose status is confirmed or ruled out. The totals are expected to shift as this evolution occurs. In addition, due to the smaller sample size in any given month, totals are expected to fluctuate due to the effects of random variation.
Whereas the overall number of overdose deaths is a critical indicator of individual and societal stress, this metric itself can be quite resistant to public policy interventions due to its complexity. Overdose fatalities occur because of multiple unique and interacting factors such as underlying medical conditions and drug lethality. For that reason, this monthly report will develop ways to monitor components that can be directly affected by specific public health education and harm reduction interventions. For example, reports will be given on the number of decedents that had access to naloxone and the number who were alone while using.
Overview: Composite total of fatal and nonfatal overdoses
During July, the proportion of fatal overdoses averaged 7.9% of total overdoses. The monthly proportion of 2022 fatalities has fluctuated, however, including a low of 5.3% in May 2022 and a high of 8.0% in April. During the first seven months of 2022, the average number of overdoses per month was approximately 836 (57 fatal and 779 nonfatal cases). This compares to the monthly average for January – July 2021 of 695 (49 fatal and 678 nonfatal cases). The number of fatal overdoses in 2022 is 17% higher than during the same time in 2021.
From January 2022 to July 2022, there were an estimated 5,852 fatal and nonfatal drug overdoses statewide, of which 399 (6.8%) were suspected and confirmed fatal overdoses. The remaining 5,453 (93.2%) were nonfatal overdoses: 2,595 (44.3%) emergency department visits; 1,554 (26.6%) EMS patents who were not transported to the emergency room, 1,255 (21.4%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 49 (.8%) law enforcement reversals without EMS present. There were also an unknown number of nonfatal overdoses in which 911 was not called and no reversal report was provided to the Maine Naloxone Distribution Initiative.
| Fatal Overdoses | Emergency Department Nonfatal | EMS Not Transported to the ED Nonfatal | Reported Community Reversals Nonfatal | Law Enforcement Without EMS Nonfatal (estimated) | Total Overdoses | |
| January ’21 | 51 | 270 | 164 | 127 | 0 | 612 |
| February ’21 | 41 | 277 | 118 | 100 | 0 | 536 |
| March ’21 | 58 | 329 | 172 | 156 | 2 | 717 |
| April ’21 | 46 | 334 | 190 | 136 | 0 | 706 |
| May ’21 | 47 | 409 | 163 | 100 | 1 | 720 |
| June ’21 | 54 | 411 | 223 | 189 | 0 | 877 |
| July ’21 | 44 | 482 | 225 | 167 | 0 | 918 |
| August ’21 | 50 | 428 | 232 | 222 | 3 | 935 |
| September ’21 | 59 | 473 | 234 | 276 | 2 | 1,044 |
| October ’21 | 65 | 383 | 246 | 208 | 2 | 904 |
| November ’21 | 61 | 308 | 219 | 195 | 2 | 785 |
| December ’21 | 55 | 344 | 198 | 176 | 11 | 784 |
| 2021 Total | 631 | 4,448 | 2,384 | 2,052 | 23 | 9,538 |
| 2021 Total % | 6.6% | 46.6% | 25.0% | 21.5% | 0.2% | 100% |
| January ’22 | 44 | 296 | 206 | 178 | 1 | 725 |
| February ’22 | 49 | 333 | 185 | 153 | 4 | 724 |
| March ’22 | 66 | 457 | 201 | 202 | 9 | 935 |
| April ’22 | 58 | 290 | 177 | 189 | 7 | 721 |
| May ’22 | 47 | 402 | 248 | 186 | 12 | 895 |
| June ’22 | 66 | 479 | 250 | 177 | 11 | 983 |
| July ’22 | 69 | 338 | 287 | 170 | 5 | 869 |
| 2022 Total | 399 | 2,595 | 1,554 | 1,255 | 49 | 5,852 |
| 2022 Total % | 6.8% | 44.3% | 26.6% | 21.4% | 0.8% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine July 2022
Fatal Drug Overdoses in Maine January – July 2022
During the first 6 months of 2022, the proportion of fatal overdoses averaged 7.9% of total overdoses. From January to July 2022 there was a total 399 fatal drug overdoses consisting of 311 confirmed and 88 suspected drug deaths. The graph below shows the considerable monthly fluctuation since January 2020. Although the average since 2020 is 48, the range extends from 33 (October 2020) to 69 (July 2022). The proportion of fatal to nonfatal overdoses decreased from 9% to 7% between January and December of 2021. During 2022, the monthly proportions fluctuated from a low of 6% in January and May to 8% in April. The proportion of fatalities in January – July 2022 (399) is 17% higher than the first seven months of 2021 (341) For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.
*Note: The timing of the monthly overdose report has been substantially delayed during the last several months due to pandemic-related issues. The toxicology reports are currently returning to the Office of the Chief Medical Examiner in as much as 10 weeks following death; this is 3 to 4 times longer than the prepandemic turn around time. For more information see the full report.
Distribution of drug deaths by Maine county
The following table shows the frequency distribution of deaths at the county level. The monthly 2022 totals can be compared either to the percent of the census population on the far left or the percent of all Maine drug deaths for 2019, 2020, 2021 and January-July 2022. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.
The cumulative January-July 2022 percentages of deaths in all counties except Cumberland and Penobscot fall within plus or minus 0%-1% of the 2020 census distribution. Cumberland County is 3% lower than the 202 census proportion in 2022 and Penobscot County is 4% higher. Comparing 2022 with 2021, all counties are within plus or minus 2% of 2021 proportions, except York, which is 5% higher in 2022.
| County | % of 2020 Census Population | Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Jul 2022 Est. N=399 | Jul 2022 Est. N=69 |
|---|---|---|---|---|---|---|
| Androscoggin | 8% | 33…….(9%) | 52.(10%) | 69…..(11%) | 37 (9%) | 7 (10%) |
| Aroostook | 5% | 14…….(4%) | 17…(3%) | 39……(6%) | 25 (6%) | 4 (6%) |
| Cumberland | 22% | 100…..(26%) | 97.(19%) | 114….(28%) | 75 (19%) | 11 (16%) |
| Franklin | 2% | 5……..(1%) | 8…(2%) | 8…….(1%) | 9 (2%) | 0 (0%) |
| Hancock | 4% | 9…….(2%) | 13…(3%) | 22……(3%) | 10 (3%) | 2 (3%) |
| Kennebec | 9% | 42……(11%) | 49.(10%) | 64….(10%) | 33 (8%) | 11 (16%) |
| Knox | 3% | 7…….(2%) | 16…(3%) | 11……(2%) | 9 (2%) | 1 (1%) |
| Lincoln | 3% | 11…….(3%) | 9…(2%) | 16……(3%) | 6 (2%) | 1 (1%) |
| Oxford | 4% | 9…….(2%) | 15…(3%) | 28……(4%) | 18 (5%) | 2 (3%) |
| Penobscot | 11% | 53…..(14%) | 94.(19%) | 106…..(17%) | 61 (15%) | 9 (13%) |
| Piscataquis | 1% | 3…….(1%) | 10…(2%) | 11……(2%) | 4 (1%) | 0 (0%) |
| Sagadahoc | 3% | 8……(2%) | 8….(1%) | 7……(1%) | 6 (2%) | 1 (1%) |
| Somerset | 4% | 16……(4%) | 13…(3%) | 26…..(4%) | 19 (5%) | 5 (7%) |
| Waldo | 3% | 3…….(1%) | 9…(2%) | 15…..(2%) | 14 (4%) | 3 (4%) |
| Washington | 2% | 10……(3%) | 20..(4%) | 25…..(4%) | 9 (2%) | 3 (4%) |
| York | 16% | 57….(15%) | 74.(15%) | 70….(11%) | 64 (16%) | 9 (13%) |
Race, ethnicity, and other demographic indicators of decedents
During January – July of 2022, out of 397 confirmed and suspected fatal overdoses for which race was reported, 376 (95%) of the victims were identified as White, 10 (3%) as Black or African American, 4 (1%) as American Indian/Alaska Native, and 1 (<1%) Hawaiian/Pacific Islander. Out of the 387 fatal overdoses for whom ethnicity was reported, 381 (98%) were reported as not Hispanic, and 6 (2%) were identified as Hispanic. Out of the 399 cases for which military background was reported, 30 (8%) were identified as having a military background. Prior overdose history was reported for 145 (36%) of the victims. Transient housing status was reported for 46 (12%) of the victims. The largest totals of undomiciled persons (January-July2022) were found in Cumberland County (20, 43%), and Penobscot County (11, 24%), which under 5 each in York, Androscoggin, Aroostook, Kennebec, and Somerset Counties.
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2021 Est. N=627 Race N=621 Ethnicity | Jan-Jul 2022 Est. N=327 Race N=320 Ethnicity |
|---|---|---|---|
| Race and Ethnicity | |||
| White | 91% | 585 (93%) | 376 (95%) |
| Black or African American | 2% | 21 (3%) | 10 (3%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 4 (1%) |
| Other race, 2+ races combined, non-hispanic | 7% | 7 (1%) | 6 (1%) |
| Not Hispanic | 98% | 611 (99%) | 381 (98%) |
| Hispanic | 2% | 10 (2%) | 6 (2%) |
| Military Background | 30 (8%) | ||
| Prior Overdose History | 145 (36%) | ||
| Undomiciled/Transient Housing Status | 46 (12%) |
Age and sex composition of decedents
The following table displays the age and sex composition* of the monthly fatal overdose population. The cumulative proportion of males has risen from 68% in 2019 to 71% in 2020 and 2021, and to 72% in the first seven months of 2022. The cumulative age distribution in January – July 2022 compared to 2021 shows 1 fewer decedent under age 18, no change in the proportion of those aged 18-39, a 1% decrease in those aged 40-59, and a 2% increase in the proportion 60 and above.
| % of 2020 Census Population | Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Jul 2022 Est. N=399 | Jul 2022 Est. N=69 | |
|---|---|---|---|---|---|---|
| Percent Males | 49% | 258..(68%) | 357…(71%) | 451.(71%) | 286…(72%) | 46 (67%) |
| Percent under 18 | 19% | 0….(0%) | 2…(<1%) | 2..(<1%) | 1…..(<1%) | 0 (0%) |
| Percent 18-39 | 26% | 171..(45%) | 213..(42%) | 247.(39%) | 165…(39%) | 36 (52%) |
| Percent 40-59 | 27% | 175..(46%) | 235..(47%) | 316.(50%) | 186..(49%) | 27 (39%) |
| Percent 60+ | 29% | 33….(9%) | 54…(11%) | 66..(10%) | 47…..(12%) | 6 (9%) |
Basic incident patterns in fatal overdoses
The following table highlights some event characteristics among suspected and confirmed overdoses. Both EMS and police responded to most fatal overdoses, that is, 75% in the first seven months of 2022. In the first seven months of 2022, law enforcement was more likely to respond to a scene alone (19%) than EMS (5%). The overwhelming majority (95%) of drug overdoses were ruled, or suspected of being, accidental manner of death.
During 2022, 27% of fatal overdose cases had naloxone administered at the scene by EMS, bystanders, or law enforcement. This rate is higher than the 22% of fatal overdose cases in which naloxone was reportedly administered at the scene in 2020, but slightly lower than the 30% recorded in 2021. Although most cases had bystanders present at the scene when first responders arrived, the details about who may have been present at the time of the overdose were usually unclear. However, bystanders, including family and friends, administered naloxone during 13% of the fatal overdoses, often in addition to EMS and/or law enforcement. The 2020 drug death report documents only 4% of victims who had received bystander-administered naloxone and increased to only 9% of victims in 2021.
Based on 320 suspected and confirmed drug death cases with EMS records during January – July of 2022, 164 (51%) of victims were already deceased when EMS arrived. Of the remaining 156 (49%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 130 who were still alive when EMS arrive, only 52 (16%) remained alive long enough to be transported but died during transport or at the emergency room and 104 (67%) did not survive to be transported. This is likely due to the high number of cases with fentanyl as a cause of death. Fentanyl acts more quickly than other opioids and there is less time for victims to be found alive.
| Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Jul 2022 Est. N=399 | July 2022 Est. N=69 | |
|---|---|---|---|---|
| Public safety response | ||||
| ……EMS alone | 28…(6%) | 30….(5%) | 21….(5%) | 3 (4%) |
| ……Law enforcement alone | 107.(21%) | 104..(16%) | 76…(19%) | 16 (23%) |
| ……EMS and law enforcement | 365.(72%) | 485..(77%) | 299…(75%) | 50 (72%) |
| ……Private transport to the Emergency. Dept. | — | 7….(1%) | 3…..(<1) | 0 (0%) |
| Naloxone administration | ||||
| Naloxone administration reported at the scene | 83.(22%) | 187..(30%) | 107..(27%) | 14 (20%) |
| ……Bystander only | 11…(2%) | 36….(6%) | 25…(6%) | 5 (7%) |
| ……Law enforcement only | 8…(2%) | 22….(3%) | 15….(4%) | 1 (2%) |
| ……EMS only | 55..(11%) | 84..(13%) | 31…(8%) | 4 (6%) |
| ……EMS and law enforcement | 4…(1%) | 20….(3%) | 8….(2%) | 2 (3%) |
| ……EMS and bystander | 8..(2%) | 15….(2%) | 18….(5%) | 2 (3%) |
| ……Law enforcement and bystander | 0..(0%) | 5…..(1%) | 4….(1%) | 0 (0%) |
| ……EMS, bystander, and law enforcement | —……. | 2..(<1%) | 4….(1%) | 0 (0%) |
Key drug categories and combinations causing overdose deaths
The following table displays the overall pattern of the most prominent drug categories in confirmed drug deaths. As expected, for those 325 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 256 (79%), the slightly higher than the rate in 2021 (77%) and 12% higher than the rate in 2020 (67%).
Fentanyl is nearly always found in combination with multiple other drugs. Illicit stimulants have been increasingly mentioned as co-intoxicants of fentanyl during the past several years. Heroin involvement, declining each year, was reported as a cause in 2% of 2022 deaths, 3% of 2021 deaths, compared to 11% in 2020. Methamphetamine was cited as a cause in 35% of the overdoses, a substantial increase from 27% in 2021. Cocaine-involved fatalities January – July constituted 26% of cases, a slight increase from 25% in 2021 and 23% in 2020. Fentanyl is found in combination with cocaine in 21% of 2022 cases, and in combination with methamphetamine in 29%. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 325 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 18 (6%) of confirmed overdose deaths, and 6 (2%) with tramadol listed along with fentanyl.
| Cause of death (alone or in combination with other drugs) Sample size for complete cases only | Jan-Dec 2020 N=504 | Jan-Dec 2021 N=627 | Jan-Jul 2022 N=325 | July 2022 N=8 |
|---|---|---|---|---|
| Nonpharmaceutical opioids | ||||
| ……Fentanyl or fentanyl analogs | 336.(67%) | 489..(77%) | 256..(79%) | 8 (100%) |
| ……Heroin | 57..(11%) | 22….(3%) | 7….(2%) | 0 (0%) |
| Nonpharmaceutical Stimulants | ||||
| ……Cocaine | 118.(23%) | 156..(25%) | 85.(26%) | 2 (25%) |
| ……Methamphetamine/amphetamine | 99.(20%) | 172..(27%) | 114.(35%) | 3 (38%) |
| Pharmaceutical opioids** | 118.(23%) | 130..(21%) | 65..(20%) | 0 (0%) |
| Key combinations | ||||
| ……Fentanyl and heroin | 47…(9%) | 20….(3%) | 7….(2%) | 0 (0%) |
| ……Fentanyl and cocaine | 97.(19%) | 127..(20%) | 68..(21%) | 2 (25%) |
| ……Fentanyl and methamphetamine/amphetamine | 70.(14%) | 133..(21%) | 93..(29%) | 3 (38%) |
| ……Fentanyl and xylazine | 0…(0%) | 53….(8%) | 18….(6%) | 0 (0%) |
| ……Fentanyl and tramadol | 0…(0%) | 24….(4%) | 6….(2%) | 0 (0%) |
Highlight of the month regarding substance use disorder public policy response
TREAT ME
TREAT ME is a project of the Maine Chapter, American Academy of Pediatrics, the purpose of which is to offer, at no cost, quality education for primary pediatric providers focused on treatment of adolescent substance use disorder. This learning collaborative is organized by the Chapter, the Maine Medical Association Center for Quality Improvement, DayOne and the Opioid Response Network in collaboration with OCFS, DHHS and the Governor’s Office of Policy Innovation and the Future. An Advisory Committee has met for the past year to provide input into the structure and content of the education. The education was be offered through both live events and asynchronous recordings. All asynchronous recordings will be completed by Sept. 22 and the first will be available in October. The first monthly webinar will be presented on Nov. 17 and two live half-day sessions will be offered in 2023.
Recruitment of participants has begun. The faculty for the course has been drawn primarily from the Adolescent Addiction program at Boston Children’s Hospital and similar programs at Boston Medical Center and Yale. The program will complement educational sessions held during the past 12 months by OCFS and the SBIRT initiatives on-going within DHHS. For more information and enrollment information, contact dee.kerry@maineaap.org.
TREAT ME funded by the Maine Health Access Foundation with support from the State of Maine and the Opioid Response Network.