Download the entire PDF report: Maine Monthly Overdose Report for October 2024
Overview: Composite total of fatal and nonfatal overdoses
This report documents suspected and confirmed fatal and nonfatal drug overdoses in Maine during October 2024 as wellas for the period January 2023–October 2024 (Table 1). The total number of confirmed and suspected fatal overdoses January–October 2024 is 405, 21.0% lower than the total confirmed fatal overdoses for the same period in 2023, 513. The total number of nonfatal overdoses January–October 2024 is 6,923, 13.5% lower than the total reported nonfatal overdoses for the same period in 2023, 8,006. During October 2024, the proportion of fatal overdoses averaged 5.1% of total overdoses.Monthly proportions of 2024 fatalities fluctuated from a low of 4.8% in May to a high of 7.2% in March. During the first ten months of 2024, fatal overdoses constituted 5.5% of all overdoses, lower than January–October 2023 (6.0%).
Data derived from multiple statewide sources were compiled and deduplicated to calculate fatal and nonfatal overdosetotals (Table 1). These include nonfatal overdose incidents reported by hospital emergency departments (ED), nonfatal emergency medical service (EMS) responses without transport to the ED, overdose reversals reported by law enforcement in the absence of EMS, and overdose reversals reported by community members or agencies receiving state-supplied naloxone through the Maine Naloxone Distribution Initiative. There are also an unknown number of private overdose reversals that were not reported and an unknown number of community-reported reversals that may have overlapped with emergency responseby EMS or law enforcement. The total number of fatal overdoses in this report includes those that have been confirmed, as well asthose that are suspected but not yet confirmed for June, August, September, and October 2024 (see Figure 1).
The total number of suspected and confirmed fatal overdoses and reported nonfatal overdoses for October 2024, 628, isdisplayed in Table 1 near the bottom row. Of those 628, there were 32 (5.1%) confirmed and suspected fatal overdoses, 297 (47.1%) nonfatal emergency department visits, 198 (31.4%) nonfatal EMS responses not transported to the emergencydepartment, 86 (13.7%) reported community overdose reversals, and 17 (2.7%) law enforcement reversals in incidents that did not include EMS.
Table 1: Composite reported overdose totals, all drugs, January 2023-August 2024
| 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 ’23 | 55 | 296 | 238 | 184 | 48 | 821 |
| Feb ’23 | 49 | 348 | 204 | 192 | 30 | 823 |
| Mar ’23 | 41 | 382 | 260 | 237 | 54 | 974 |
| Apr ’23 | 63 | 270 | 232 | 202 | 29 | 796 |
| May ’23 | 49 | 295 | 238 | 165 | 47 | 794 |
| Jun ’23 | 58 | 378 | 232 | 219 | 35 | 922 |
| Jul ’23 | 50 | 340 | 307 | 173 | 34 | 904 |
| Aug ’23 | 40 | 330 | 266 | 152 | 22 | 810 |
| Sep ’23 | 53 | 390 | 256 | 141 | 26 | 866 |
| Oct ’23 | 55 | 317 | 274 | 147 | 17 | 809 |
| Nov ’23 | 47 | 255 | 214 | 101 | 20 | 637 |
| Dec ’23 | 46 | 325 | 202 | 129 | 23 | 724 |
| 2023 Total | 606 | 3926 | 2921 | 2042 | 385 | 9880 |
| 2023 Total % | 6.1% | 39.7% | 29.6% | 20.7% | 3.9% | 100% |
| Jan ’24 | 43 | 269 | 226 | 139 | 23 | 703 |
| Feb ’24 | 43 | 305 | 242 | 136 | 28 | 754 |
| Mar ’24 | 59 | 379 | 233 | 119 | 27 | 817 |
| Apr ’24 | 43 | 253 | 205 | 190 | 14 | 705 |
| May ’24 | 38 | 311 | 257 | 165 | 24 | 795 |
| Jun ’24 | 42 | 344 | 232 | 202 | 12 | 832 |
| Jul ’24 | 38 | 293 | 235 | 166 | 23 | 755 |
| Aug ’24 | 32 | 289 | 215 | 119 | 10 | 665 |
| Sep ’24 | 35 | 318 | 199 | 114 | 6 | 672 |
| Oct ’24 | 32 | 297 | 198 | 86 | 17 | 630 |
| 2024 Total | 405 | 3058 | 2242 | 1436 | 187 | 7328 |
| 2024 Total % | 5.5% | 41.7% | 30.6% | 19.6% | 2.6% | 100% |
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 total activity of both law enforcement officials and EMS agencies is underrepresented in Table 1 because of the overlap between them. The process used to deduplicate overdoses begins by removing fatal overdoses from the emergency department and EMS overdose incidents. Then the number of patients transported to emergency departments by Maine EMS are removed from the EMS overdose incidents. Finally, EMS involvement and fatal overdose incidents are removed from law enforcement responses.
Table 2 shows the public safety response to fatal and nonfatal overdose events in January–October 2024 as well as January–December 2023. During January–October 2024, law enforcement officers responded to a reported 978 overdose incidents (369 fatal; 609 nonfatal), and Maine EMS responded to a reported 8,137 incidents (328 fatal; 7,809 nonfatal). During 2023, law enforcement officers responded to a reported 1,617 incidents (564 fatal; 1,053 nonfatal), and Maine EMS responded to a reported 10,318 incidents (480 fatal; 9,838 nonfatal).
Table 2. Fatal and nonfatal overdose emergency response count from law enforcement and Maine EMergency Medical Services, including overlapping cases
| Fatal overdose response Jan–Dec 2023 | Nonfatal overdose response Jan–Dec 2023 | Total overdose response Jan–Dec 2023 | Fatal overdose response Jan–Oct 2024 | Nonfatal overdose response Jan–Oct 2024 | Total Overdose Response Jan–Oct 2024 | |
| Maine EMS | 480 | 9838 | 10318 | 328 | 7809 | 8137 |
| Law Enforcement | 564 | 1053 | 1617 | 369 | 609 | 978 |
County Distribution of Suspected Nonfatal Overdoses
Table 3 shows the frequency distribution of nonfatal overdoses to which EMS responded at the county level. Overdose reversal totals reported by community partners and emergency departments are not reported by county; only EMS case data include county frequencies. The October 2024 monthly totals in the far right column can be compared to the percentage of the census population on the far left, the percentage of nonfatal overdoses for the year in 2023, or the January–October 2024 year-to-date total. Caution must be exercised viewing single counties, especially for a single month, due to small numbers. These may fluctuate randomly, without reflecting any statistically significant trend.
January–October 2024 percentage totals for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Compared to the 2020 census proportion, Cumberland County is 3 percentage points higher, Androscoggin County and Penobscot County are 2 percentage points higher, and York County is 4 percentage points lower.
Table 3. County of EMS Incident among suspected and confirmed nonfatal overdoses
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 9838 | Jan–Oct 2024 Est. N = 7809 | Oct 2024 Est. N = 726 | ||||
| Androscoggin | 8% | 1009 | 10% | 791 | 10% | 61 | 8% |
| Aroostook | 5% | 485 | 5% | 439 | 6% | 30 | 4% |
| Cumberland | 22% | 2309 | 23% | 1942 | 25% | 180 | 25% |
| Franklin | 2% | 160 | 2% | 134 | 2% | 12 | 2% |
| Hancock | 4% | 276 | 3% | 213 | 3% | 14 | 2% |
| Kennebec | 9% | 963 | 10% | 794 | 10% | 84 | 12% |
| Knox | 3% | 327 | 3% | 224 | 3% | 17 | 2% |
| Lincoln | 3% | 227 | 2% | 135 | 2% | 11 | 2% |
| Oxford | 4% | 397 | 4% | 280 | 4% | 18 | 2% |
| Penobscot | 11% | 1351 | 14% | 980 | 13% | 111 | 15% |
| Piscataquis | 1% | 114 | 1% | 80 | 1% | 8 | 1% |
| Sagadahoc | 3% | 151 | 2% | 131 | 2% | 14 | 2% |
| Somerset | 4% | 471 | 5% | 349 | 4% | 36 | 5% |
| Waldo | 3% | 220 | 2% | 161 | 2% | 9 | 1% |
| Washington | 2% | 215 | 2% | 201 | 3% | 25 | 3% |
| York | 16% | 1163 | 12% | 955 | 12% | 96 | 13% |
Age and Gender Distribution of Suspected Nonfatal Overdoses with EMS Response
Table 4 displays the age composition of individuals suspected of experiencing nonfatal overdoses involving EMS response in October 2024, January–October 2024, as well as January–December 2023. Overdose reversal totals reported by community partners and emergency departments are not categorized and reported by age; only EMS case data include monthly age frequencies. Age group totals can be compared to the 2020 census proportion in the far left column. Caution must be exercised as the small number of cases in each month is vulnerable to random fluctuation that may not reflect a significant statistical trend. The age distribution for both 2023 and 2024 year to date compared to the 2020 census proportion shows a disproportionately large impact of suspected nonfatal overdose victims with EMS involvement for those aged 25–54. This impact is illustrated by looking at the 25–54 year age groups, which comprise 36% in the 2020 census compared to 64% in the overdose population during 2023 and 62% in during the first ten months of 2024. In 2024, there are 14 percentage points fewer overdose victims among those under the age of 18 compared to the percentage of the census population in that age group. Similarly, there were 3 percentage points fewer overdose victims among those aged 55–64, and 11 percentage points fewer overdose victims among those 65 and older compared to the percentages of the census population for those age groups.
Table 4. Reported age group among suspected nonfatal overdose victims involving EMS response
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 9776 | Jan-Oct 2024 Est. N = 7850 | Oct 2024 Est. N = 726 | ||||
| < 18 | 18% | 402 | 4% | 329 | 4% | 22 | 3% |
| 18–24 | 7% | 903 | 9% | 708 | 9% | 55 | 8% |
| 25–34 | 12% | 2085 | 21% | 1544 | 20% | 146 | 20% |
| 35–44 | 12% | 2603 | 27% | 2008 | 26% | 181 | 25% |
| 45–54 | 12% | 1522 | 16% | 1275 | 16% | 120 | 17% |
| 55–64 | 16% | 1317 | 13% | 1034 | 13% | 105 | 14% |
| > 64 | 23% | 944 | 10% | 952 | 12% | 97 | 13% |
Table 5 displays the reported gender of individuals experiencing nonfatal overdoses involving EMS response in October 2024, January–October 2024, as well as January–December 2023. Overdose reversal totals reported by community partners and emergency departments are not categorized by gender; only EMS case data include monthly gender categories. Gender group totals can be compared to the 2020 census proportion by age group in the far left column or the January–December 2023 totals in the center column. When comparing the January–October 2024 with 2023, as well as the census populationproportion, caution must be exercised as the small number of cases in each month is vulnerable to random fluctuation thatmay not reflect a significant statistical trend. Males represent 49% of the 2020 estimated census population and 58% of the nonfatal overdose victims with EMS involvement during January–October 2024.
Table 5. Reported Gender among suspected nonfatal overdose victims involving ems response
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 9794 | Jan–Oct 2024 Est. N = 7547 | Oct 2024 Est. N = 699 | ||||
| Male | 49% | 5970 | 61% | 4385 | 58% | 373 | 53% |
| Female | 51% | 3798 | 39% | 3161 | 42% | 326 | 47% |
| Transgender | Not collected | 26 | 0.3% | 1 | 0% | 0 | 0% |
County Distribution of Suspected and Confirmed Fatal Overdoses
Table 6 shows the frequency distribution of fatal overdoses at the county level. The October 2024 monthly totals in the far right column can be compared either to the percentage of the census population in the far left column, the percentage of county fatal overdoses for 2023, or the January–October 2024 year-to-date percentages. Caution must be exercised when viewing single counties with small numbers for a single month. These may fluctuate randomly, without reflecting any significant statistical trend. The January–October 2024 percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Compared to the 2020 census proportion, Aroostook County, Kennebec County, and Washington County are 2 percentage points higher, and York County and Cumberland County are 4 percentage points lower.
Table 6. County of death among suspected and confirmed fatal overdoses
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 606 | Jan–Oct 2024 Est. N = 405 | Oct 2024 Est. N = 32 | ||||
| Androscoggin | 8% | 69 | 11% | 38 | 9% | 3 | 9% |
| Aroostook | 5% | 40 | 7% | 30 | 7% | 0 | 0% |
| Cumberland | 22% | 118 | 19% | 72 | 18% | 5 | 16% |
| Franklin | 2% | 6 | 1% | 4 | 1% | 1 | 3% |
| Hancock | 4% | 22 | 4% | 11 | 3% | 2 | 6% |
| Kennebec | 9% | 60 | 10% | 43 | 11% | 4 | 13% |
| Knox | 3% | 16 | 3% | 18 | 4% | 1 | 3% |
| Lincoln | 3% | 7 | 1% | 12 | 3% | 1 | 3% |
| Oxford | 4% | 25 | 4% | 18 | 4% | 0 | 0% |
| Penobscot | 11% | 91 | 15% | 50 | 12% | 4 | 13% |
| Piscataquis | 1% | 17 | 3% | 4 | 1% | 1 | 3% |
| Sagadahoc | 3% | 7 | 1% | 7 | 2% | 0 | 0% |
| Somerset | 4% | 29 | 5% | 19 | 5% | 2 | 6% |
| Waldo | 3% | 10 | 2% | 16 | 4% | 1 | 3% |
| Washington | 2% | 25 | 4% | 15 | 4% | 1 | 3% |
| York | 16% | 64 | 11% | 48 | 12% | 6 | 19% |
Age and Sex Distribution of Fatal Overdose Victims
Table 7 displays the age and sex composition of the fatal overdose population for October 2024, January–October 2024, and January to December 2023, compared to the 2020 estimated census population. When comparing the October 2024 data with 2023 as well as the census population proportion, caution must be exercised as the small number of cases ineach month is vulnerable to random fluctuation that may not reflect a significant statistical trend.
The cumulative proportion of males is lower in January–October 2024 (64%) compared to January–December 2023 (73%).
The age distribution for 2024 compared to the 2020 census proportion shows a disproportionately large impact of fatal overdoses in those aged 35–64, as was true in 2023. That group includes 40% of the 2020 estimated census population, compared to 74% in the fatal overdose population in 2023 as well as 76% during January–October 2024. Compared to the census population, in 2024 year to date, there were 5 percentage points fewer fatal overdoses among those aged 18–24 and 15 percentage points fewer among those 65 and older compared to the census estimated population for those age groups.
There were, however, differences between the age structures of the nonfatal overdoses (Table 4) and the fatal overdoses. In 2024 year to date, the highest proportion of overdoses was among those aged 35–44 (26% among nonfatal and 29% among fatal). The second highest age group for nonfatal overdoses was 25–34 (20%) among nonfatal, but 45–54 (26%) among the fatal overdoses.
Table 7. Decedent Reported Age Group and Sex among suspected and confirmed fatal overdoses
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 606 | Jan–Oct 2024 Est. N = 405 | Oct 2024 Est. N = 32 | ||||
| Male | 49% | 440 | 73% | 259 | 64% | 17 | 53% |
| < 18 | 18% | 3 | 0% | 3 | 1% | 0 | 0% |
| 18-24 | 7% | 28 | 5% | 10 | 2% | 0 | 0% |
| 25-34 | 12% | 85 | 14% | 51 | 13% | 2 | 6% |
| 35-44 | 12% | 199 | 33% | 116 | 29% | 8 | 25% |
| 45-54 | 12% | 135 | 22% | 107 | 26% | 8 | 25% |
| 55-64 | 16% | 118 | 19% | 84 | 21% | 10 | 31% |
| > 64 | 23% | 38 | 6% | 34 | 8% | 4 | 13% |
Race, ethnicity, and other demographic indicators of decedents
Table 8 displays the reported race and ethnicity of confirmed and suspected fatal overdoses in July 2024, January–October 2024, and January–December 2023 compared to the 2020 estimated census population. Note that race and ethnicity are not finalized until the full death certificate is entered into Vital Records, and a small number of decedents’ records currently lack information about these variables. Out of 403 decedents for whom race was reported January–October 2024, 93% of the victims were identified as White, 3% as Black/African American, and 2% as American Indian/Alaska Native. Out of 396 decedents for whom Hispanic ethnicity status was reported, 3% were identified as Hispanic.
Table 8. Decedent race (A) and ethnicity (B) among suspected and confirmed fatal overdoses
| A: Race | % 2020 Estimated Census Population | Jan–Dec 2023 Race N = 605 | Jan–Oct 2024 Race N = 403 | Oct 2024 Race Est. N = 32 | |||
| White alone | 94% | 554 | 92% | 374 | 93% | 31 | 97% |
| Black/African American alone | 2% | 25 | 4% | 11 | 3% | 1 | 3% |
| American Indian/Alaska Native alone | 1% | 12 | 2% | 9 | 2% | 0 | 0% |
| Other race and 2+ races combined | 3% | 14 | 2% | 20 | 5% | 1 | 3% |
| B: Ethnicity | % 2020 estimated Census population | Jan–Dec 2023 Ethnicity N = 589 | Jan–Oct 2024 Ethnicity N = 396 | Oct 2024 Ethnicity Est. N = 31 | |||
| Hispanic/Latinx | 2% | 7 | 1% | 10 | 3% | 0 | 0% |
military status and housing stability of fatal overdose victims
Out of the 405 cases for which military background was reported January–October 2024, 20 (5%) were identified as having a military background. Out of the 32 cases in October 2024 where military background was reported, 2 (6%) were identified as having a military background.
Of the 405 total suspected and confirmed fatal overdose cases year to date in 2024, undomiciled or transient housing status was reported for 56 (14%) victims. Among those 56, the largest proportions of undomiciled persons were found in Cumberland County (14, 25%), Androscoggin County (13, 23%) and Penobscot County (8, 14%). In October 2024, 6 fatal overdose victims (19%) were identified as undomiciled.
Basic incident patterns in fatal overdoses
Table 9 reports basic incident patterns for fatal overdoses. October 2024 can be compared to 2023 as a whole or to January–October 2024 year to date totals. Caution must be exercised interpreting a single month of data as numbers may fluctuate randomly and not reflect a statistically significant trend. In addition, data totals may change slightly as suspected cases are confirmed or eliminated.
Both EMS and police responded together to most fatal overdoses (72%) in 2024 year to date. Law enforcement wasmore likely to respond to a scene alone (19%) than EMS (9%). The overwhelming majority (92%) of confirmed fatal drug overdoses were ruled as, or suspected of being, accidental manner of death.
Of the 405 confirmed or suspected fatal overdoses in 2024, 129 (32%) had a history of prior overdose.
Although most cases had bystanders or witnesses present at the scene by the time first responders arrived, the detailsabout who was present at the time of the overdose were frequently unclear. However, responding family and friends or otherbystanders administered naloxone for 57 (14%) of the 2024 fatal overdoses, slightly higher than the proportion in 2023 (13%). Often, EMS and/or law enforcement administered naloxone in addition to bystanders or witnesses. During 2024, 26% of suspected and confirmed fatal overdose cases had naloxone administered at the scene by EMS, bystanders, and/or lawenforcement. This rate is the same as 2023 (26%).
Of the 328 suspected or confirmed drug death cases with EMS involvement during 2024, 167 (51%) victims were alreadydeceased when EMS arrived. In the remaining 161 (49%) cases, resuscitation was attempted either at the scene or presumablyin the ambulance during transport to the emergency room. One case had an unreported response once EMS arrived. Of those161 who were still alive when EMS arrived, 61 (38%) were transported, and 100 (61%) did not survive to be transported.Thus, out of 328 ultimately fatal cases with EMS response, only 61 (19%) remained alive long enough to be transported but died during transport or at the emergency room. This outcome is likely due to a combination of the high number of cases withfentanyl as a cause of death and individuals using alone. Fentanyl acts more quickly than other opioids, and there is less timefor bystanders to find an overdose victim alive, administer naloxone, and call 911.
Table 9. Incident CHARACTERISTICS among suspected and confirmed fatal overdoses
| Jan–Dec 2023 Est. N = 606 | Jan–Oct 2024 Est. N = 405 | Oct 2024 Est. N = 32 | ||||
| EMS response alone | 36 | 6% | 35 | 9% | 5 | 16% |
| Law enforcement alone | 120 | 20% | 76 | 19% | 6 | 19% |
| EMS and law enforcement | 443 | 73% | 293 | 72% | 21 | 66% |
| Private transport to Emergency Dept. | 5 | 1% | 0 | 0% | 0 | 0% |
| Naloxone administration reported at the scene | 155 | 26% | 107 | 26% | 9 | 28% |
| Bystander only administered | 39 | 6% | 43 | 11% | 4 | 13% |
| Law enforcement only administered | 15 | 2% | 8 | 2% | 0 | 0% |
| EMS only administered | 43 | 7% | 33 | 8% | 1 | 3% |
| EMS and law enforcement administered | 10 | 2% | 1 | 0% | 0 | 0% |
| EMS and bystander administered | 30 | 5% | 9 | 2% | 2 | 6% |
| Law enforcement and bystander administered | 8 | 1% | 4 | 1% | 0 | 0% |
| EMS, bystander, and law enforcement administered | 4 | 1% | 1 | 0% | 0 | 0% |
| Naloxone administered by unspecified person | 3 | 0% | 2 | 0% | 0 | 0% |
| History of prior overdose | 205 | 34% | 129 | 32% | 7 | 22% |
Key drug categories and combinations causing overdose deaths
Table 10 displays the frequencies of the most prominent drug categories causing death among confirmed drug deaths. As expected, within the confirmed drug death cases so far in 2024, nonpharmaceutical fentanyl was the most frequent cause of death, mentioned on the death certificate of 265 (73%) victims.
Fentanyl is nearly always found in combination with multiple other drugs. Heroin involvement, declining rapidly in recentyears, was reported as a cause of death in 11 (3%) of 2024 year-to-date deaths and 12 (2%) of 2023 deaths. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 365 confirmed deaths in 2024, there were 50 cases (14%) with xylazine listed in addition to fentanyl as a cause of death, and 1 case (<1%) with tramadol listed along with fentanyl.
Stimulants continue to increase as a cause of death, usually in combination with other drugs, particularly fentanyl. Cocaine-involved fatalities constituted 158 (43%) of confirmed cases so far in 2024, higher than 2023 (37%) and an increase from 29% in 2022. Fentanyl is mentioned as a cause in combination with cocaine in 123 cases, 78% of 2024 year-to-date cocaine cases. Methamphetamine was cited as a cause of death in 136 (37%) of the confirmed fatal overdoses so far in 2024, higher than in 2023 (33%); 106 (78%) of the methamphetamine deaths also involved fentanyl as a co-intoxicant cause of death. Cocaine and methamphetamine are named together on 37 (9%) death certificates in 2024, in most of those cases (30, 81%) as co-intoxicants of fentanyl.
| Cause of death (alone or in combination with other drugs) Sample size for confirmed cases only | Jan–Dec 2023 Est. N = 606 | Jan–Oct 2024 Est. N = 365 | Oct 2024 Est. N = 3 | |||
| Fentanyl or fentanyl analogs | 472 | 78% | 265 | 73% | 2 | 67% |
| Heroin | 12 | 2% | 11 | 3% | 0 | 0% |
| Cocaine | 226 | 37% | 158 | 43% | 1 | 33% |
| Methamphetamine | 199 | 33% | 136 | 37% | 1 | 33% |
| Pharmaceutical opioids** | 108 | 18% | 60 | 16% | 2 | 67% |
| Fentanyl and heroin | 12 | 2% | 11 | 3% | 0 | 0% |
| Fentanyl and cocaine | 192 | 32% | 123 | 34% | 1 | 33% |
| Fentanyl and methamphetamine | 163 | 27% | 106 | 29% | 1 | 33% |
| Fentanyl and xylazine | 60 | 10% | 50 | 14% | 1 | 33% |
| Fentanyl and tramadol | 3 | 0% | 1 | 0% | 0 | 0% |
Highlight of the Month
The Risk of using drugs alone
The tracking of overdoses for public health analysis is complicated. Every week, a dedicated group of 20 to 30 individuals, led by the research team at the Margaret Chase Smith Policy Center at the University of Maine, meet to review the data from the previous week. And while there has been a decline over the past 18 months in both non-fatal and fatal overdoses in Maine, within the statistics there are some startling findings.
- Using Alone. A recent review of Maine’s State Unintentional Drug Overdose Reporting System (SUDORS) data from 2023 suggests that 89% of fatal overdoses occur when an individual is using drugs alone and not in the presence of others, or behind a closed door. The most frequent location is one’s own home and in a bedroom, with the bathroom also being a frequent place of use. Other adults may be in the house, but if they do not know that the individual is using, the likelihood of a successful rescue is greatly reduced, especially when fentanyl is involved. Why do people use alone? A major reason is the stigma that continues to exist around using substances. The so-called “mask of sobriety” makes it difficult for the person using substances to develop a safety plan that prioritizes life.
- Non-fatal Overdoses. In Maine, approximately 94% of overdoses result in the individual being successfully resuscitated. But because many of these “saves” occur without calling 911, the event is not captured in our weekly data unless it is reported to one of the Tier I or Tier 2 naloxone distributors. So, while Maine is one of the few states that report data on non-fatal, non-EMS overdoses, we suspect that our count is under-estimated.
Because so many individuals are using alone, and because fentanyl works so quickly, by the time emergency responders arrive on the scene, the individual is deceased in over one-half of the calls. And while our naloxone saturation strategy is undoubtedly saving many lives, if there is no individual present at the location to administer it and to offer other life-saving interventions, the result is too frequently death. For instance, in one recent week with fourteen fatal overdoses (thirteen accidental), in only three cases was naloxone administered by bystanders or first responders. In the remaining cases, the individual was already deceased. The data in recent years shows naloxone being administered in under 30% of cases.
What public health measures can we undertake to improve this situation? We can look to other states and countries to see what has worked in other jurisdictions. We can also enhance and improve our messaging to those using substances, encouraging the development of safety plans. For those individuals with SUD who do not have a stable home, we can consider safe places for them to use or to utilize after using. Of course, such harm-reduction measures are controversial and have to be balanced with other interests, including public safety. The Harm Reduction Health Center Working Group will be holding its third meeting Dec. 20 to consider these options. One other promising development is the support recently by the Maine Recovery Council to contract with Boston Medical Center to bring the Safespot hotline to Maine. This lifeline is utilized daily by individuals across the country linking them to experienced people who can provide live-saving advice. This service is expected to be available in Maine beginning at some point in 2025. And, we must continue our efforts to educate the community about addiction, harm-reduction and treatment.
In addition to making more treatment resources available across the state, harm-reduction will continue to be a priority of our opioid response efforts, as will support for recovery and primary prevention.
Gordon Smith
Director of Opioid Response
Nov., 2024