May 2023 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for May 2023

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 May, the proportion of fatal overdoses averaged 6.4% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.1% in March and a high of 8.2% in April. During May 2023, there were an estimated 739 fatal and nonfatal drug overdoses statewide, of which 47 (6.4%) were suspected and confirmed fatal overdoses. The remaining 692 (93.6%) were nonfatal overdoses: 276 (37.3%) emergency department visits; 221 (29.9%) EMS patents who were not transported to the emergency room, 165 (22.3%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 30 (4.1%) 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
Jan ’22	45	295	206	178	39	763
Feb ’22	48	333	185	153	37	756
Mar ’22	65	458	201	202	30	956
Apr ’22	60	290	178	189	26	743
May ’22	47	402	248	186	41	924
Jun ’22	66	482	250	177	44	1013
Jul ’22	66	347	287	183	40	923
Aug ’22	64	385	272	255	37	1013
Sep ’22	55	458	256	153	33	955
Oct ’22	65	283	238	177	27	790
Nov ’22	66	287	206	200	20	779
Dec ’22	76	362	212	198	14	862
2022 Total	723	4,382	2,739	2,251	388	10,483
2022 Total %	6.9%	41.8%	26.1%	21.5%	3.7%	100%
Jan ’23	53	296	219	184	44	796
Feb ’23	49	347	226	192	27	841
Mar ’23	40	382	256	237	54	969
Apr ’23	64	269	217	202	27	779
May ’23	47	276	221	165	30	739
2023 Total	253	1,570	1,139	980	182	4,124
2023 Total %	6.1%	38.1%	27.6%	23.8%	4.4%	100%

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Number of suspected and confirmed fatal overdoses

Law Enforcement Response to Fatal and Nonfatal Overdose Incidents

Due to the method used to deduplicate nonfatal overdose incidents to derive a composite number of overdoses for the month, the activity of law enforcement officials and EMS is under represented in the above chart. See the full report for the process involved. The table below shows the public safety response to fatal and nonfatal overdose events in January – May 2023 as well as 2022.

	Maine EMS	Law Enforcement
Fatal Overdose Response 2022	582	672
Nonfatal Overdose Response 2022	9,376	1,471
Total Overdose Response 2022	9,958	2,143
Fatal Overdose Response Jan – May 2023	197	236
Nonfatal Overdose Response Jan – May 2023	3,666	598
Total Overdose Response Jan- May 2023	3,863	834

County Distribution of Suspected Nonfatal Overdoses

The following table shows the distribution of nonfatal overdoses at the county level. Due to how overdose reversals are reported by community partners and emergency departments, only EMS overdoses are included. The May 2023 monthly totals can be compared to the percentage of census population, the percentages of nonfatal overdoses in the center column, or the percentages of nonfatal overdoses during 2023. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. The January – May percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Penobscot County is 3 percentage points higher; Androscoggin County is 2 percentage points higher than the 2020 census proportion. York County is 4 percentage points lower, and Sagadahoc County is 2 percentage points lower than the 2020 census proportion.

County	% of 2020 Census Population	Jan-Dec 2022 Est. N=9376	Jan-May 2023 Est. N=3666	May 2023 Est. N=760
Androscoggin	8%	1055 (11%)	384 (10%)	63 (8%)
Aroostook	5%	490 (5%)	155 (4%)	39 (5%)
Cumberland	22%	2194 (23%)	858 (23%)	164 (22%)
Franklin	2%	140 (1%)	58 (2%)	12 (2%)
Hancock	4%	287 (3%)	115 (3%)	30 (4%)
Kennebec	9%	922 (10%)	368 (10%)	68 (9%)
Knox	3%	245 (3%)	134 (4%)	35 (5%)
Lincoln	3%	162 (2%)	59 (2%)	13 (2%)
Oxford	4%	410 (4%)	137 (4%)	28 (4%)
Penobscot	11%	1292 (14%)	528 (14%)	99 (13%)
Piscataquis	1%	90 (1%)	45 (1%)	5 (1%)
Sagadahoc	3%	130 (1%)	52 (1%)	15 (2%)
Somerset	4%	392 (4%)	188 (5%)	40 (5%)
Waldo	3%	199 (2%)	84 (2%)	14 (2%)
Washington	2%	221 (2%)	65 (2%)	16 (2%)
York	16%	1147 (12%)	436 (12%)	119 (16%)

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County Distribution of Suspected and Confirmed Fatal Overdoses

The following table shows the frequency distribution of deaths at the county level. The monthly total can be compared either to the percent of the census population on the far left, the percent of all Maine drug deaths for 2022, or the percent of drug deaths in 2023. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.

The cumulative January-May 2023 percentages of deaths in most counties fall within plus or minus 0 to 2 percentage points of the 2020 census distribution. Androscoggin County is 5 percentage points higher and Penobscot County is 4 percentage points higher. York County is 6 percentage points lower than the 2020 census proportion.

County	% of 2020 Census Population	Jan-Dec 2022 Est. N=723	Jan-May 2023 Est. N=253	May 2023 Est. N=47
Androscoggin	8%	69 (10%)	34 (13%)	7 (15%)
Aroostook	5%	47 (7%)	13 (5%)	7 (15%)
Cumberland	22%	134 (19%)	54 (21%)	4 (9%)
Franklin	2%	13 (2%)	2 (1%)	2 (4%)
Hancock	4%	24 (3%)	6 (2%)	2 (4%)
Kennebec	9%	54 (7%)	27 (11%)	4 (9%)
Knox	3%	20 (3%)	4 (2%)	0 (0%)
Lincoln	3%	14 (2%)	4 (2%)	0 (0%)
Oxford	4%	36 (5%)	8 (3%)	2 (4%)
Penobscot	11%	109 (15%)	39 (15%)	6 (13%)
Piscataquis	1%	9 (1%)	8 (3%)	0 (0%)
Sagadahoc	3%	11 (2%)	2 (1%)	1 (2%)
Somerset	4%	35 (5%)	11 (4%)	4 (9%)
Waldo	3%	21 (3%)	4 (2%)	2 (4%)
Washington	2%	24 (3%)	11 (4%)	0 (0%)
York	16%	103 (14%)	26 (10%)	6 (13%)

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Race, ethnicity, and other demographic indicators of decedents

During the five months of 2023, out of 251 confirmed and suspected fatal overdoses for which race was reported, 226 (90%) of the victims were identified as White, 11 (4%) as Black or African American, and 3 (1%) as American Indian/Alaska Native. Out of the 247 fatal overdoses for whom ethnicity was reported, 246 (99%) were reported as not Hispanic, and 1 (<1%) were identified as Hispanic.

Out of the 251 cases for which military background was reported in January – May 2023, 14 (5%) were identified as having a military background. Out of the 47 cases in May 2023 where military background was reported, 2 (4%) were identified as having a military background.

Prior overdose history was reported for 95 (38%) of the victims during January-May 2023.

Of 253 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 27 (11%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (9, 33%), Penobscot County and Androscoggin County (5, 19%), and Kennebec County (2, 7%). In May 2023, 6 decedents (13%) were identified as undomiciled.

Demographic Indicator	% of 2020 Census Population	Jan-Dec 2022 Est. Race N=720 Ethnicity N=706	Jan-May 2023 Est. Race N=251 Ethnicity N=247	May 2023 Est. Race N=47 Ethnicity N=47
Race and Ethnicity
White	91%	670 (93%)	226 (90%)	43 (91%)
Black or African American	2%	17 (2%)	11 (4%)	2 (4%)
American Indian/Alaska Native	1%	14 (2%)	3 (1%)	1 (2%)
Other race, 2+ races combined, non-hispanic	7%	12 (2%)	6 (2%)	0 (0%)
Not Hispanic	98%	699 (99%)	246 (99%)	46 (98%)
Hispanic	2%	7 (1%)	1 (<1%)	1 (2%)
Military Background		81 (11%)	14 (5%)	2 (4%)
Prior Overdose History		269 (37%)	95 (38%)	11 (23%)
Undomiciled/Transient Housing Status		81 (11%)	27 (11%)	6 (13%)

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 in recent years from 68% in 2019 to 71% in 2020 and 2021 and 73% in 2022. During the first five months of 2023 it has continued to rise to 74%. The cumulative age distribution in January – May 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 1 deaths in 2023, a 3 percentage point decrease in the proportion of those aged 18-39, a 2 percentage point increase in those aged 40-59, and a 1 percentage point increase in the proportion 60 and above.

	% of 2020 Census Population	Jan-Dec 2022 Est. N=723	Jan-May 2023 Est. N=253	May 2023 Est N=57
Percent Males	49%	527…(73%)	187 (74%)	34 (72%)
Percent under 18	19%	3…(<1%)	1 (<1%)	0 (0%)
Percent 18-39	26%	295…(41%)	95 (38%)	21 (45%)
Percent 40-59	27%	333..(46%)	121 (48%)	21 (45%)
Percent 60+	29%	92…(13%)	36 (14%)	5 (11%)

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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 (72%) in 2023. In 2023, law enforcement was more likely to respond to a scene alone (21%) than EMS (6%). The overwhelming majority (91%) of drug overdoses were ruled, or suspected of being, accidental manner of death.

During 2023, 26% of fatal overdose cases had naloxone administered at the scene by EMS, bystanders, or law enforcement. This rate is slightly higher than the 22% of fatal overdose cases in which naloxone was reportedly administered at the scene in 2020 and the 25% reported in 2022, and 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 15% (38) of the fatal overdoses, often in addition to EMS and/or law enforcement. This is higher than 2022 (12%), 2021 (9%), and 2020 (4%).

Based on 197 suspected and confirmed drug death cases with EMS involvement during the first five months of 2023, 108 (55%) of victims were already deceased when EMS arrived. In the remaining 89 (45%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 89 who were still alive when EMS arrived, only 24 (27%) remained alive long enough to be transported but died during transport or at the emergency room and 65 (73%) did not survive to be transported. This is likely due to the high number of cases with fentanyl as a cause of death and individuals using alone. Fentanyl acts more quickly than other opioids and there is less time for victims to be found alive.

	Jan-Dec 2022 Est. N=723	Jan – May 2023 Est. N=253	May 2023 Est. N=47
Public safety response
……EMS alone	38….(5%)	15 (6%)	4 (9%)
……Law enforcement alone	131…(18%)	54 (21%)	9 (19%)
……EMS and law enforcement	541…(75%)	182 (72%)	33 (70%)
……Private transport to the Emergency. Dept.	13…..(2%)	1 (<1%)	0 (0%)
Naloxone administration
Naloxone administration reported at the scene	182..(25%)	65 (26%)	17 (36%)
……Bystander only	44…(6%)	17 (7%)	5 (11%)
……Law enforcement only	31….(4%)	4 (2%)	2 (4%)
……EMS only	49….(7%)	20 (8%)	4 (9%)
……EMS and law enforcement	11….(2%)	3 (1%)	1 (2%)
……EMS and bystander	26….(4%)	15 (6%)	4 (9%)
……Law enforcement and bystander	5….(1%)	5 (2%)	0 (0%)
……EMS, bystander, and law enforcement	6….(1%)	1 (<1%)	0 (0%)
……Naloxone administered by unspecified person	0…(0%)	1 (<1%)	0 (0%)

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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 205 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 165 (80%).

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 4% (9) of 2023 deaths and 3% (19) of 2022 deaths, compared to 11% (57) in 2020. Methamphetamine was cited as a cause of death in 30% (62) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – May constituted 34% (70) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 89% (62) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 83% (51) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 205 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 22 (11%) of confirmed overdose deaths, and 1 (<1%) with tramadol listed along with fentanyl. 

Cause of death (alone or in combination with other drugs) Sample size for complete cases only	Jan-Dec 2022 N=723	Jan-May 2023 N=205	*May 2023 N=10
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs	560..(77%)	165 (80%)	8 (80%)
……Heroin	19….(3%)	9 (4%)	0 (0%)
Nonpharmaceutical Stimulants
……Cocaine	213.(29%)	70 (34%)	2 (20%)
……Methamphetamine	234.(32%)	62 (30%)	1 (10%)
Pharmaceutical opioids**	156..(22%)	65 (17%)	1 (10%)
Key combinations
……Fentanyl and heroin	18….(2%)	9 (4%)	0 (0%)
……Fentanyl and cocaine	171..(24%)	62 (30%)	2 (20%)
……Fentanyl and methamphetamine	189..(26%)	51 (25%)	0 (0%)
……Fentanyl and xylazine	46….(6%)	22 (11%)	2 (20%)
……Fentanyl and tramadol	10….(1%)	1 (<1%)	0 (0%)

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