April 2021 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for April 2021

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.

Number of suspected and confirmed fatal overdoses

Fatal Drug Overdoses in Maine April 2021

Fatal Drug Overdoses in Maine January – April 2021

The April 2021 total of 48 fatal drug overdoses consists of 10 confirmed drug deaths and 38 suspected drug deaths. The graph below shows the considerable monthly fluctuation since January 2020. Although the 2020 average is 42, the range extends from 34 to 53. The average so far for 2021 is 50, and the range is 42 to 57. For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.

Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for April 2021.

Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The April 2021 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 or 2020 also on the left. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. In general, the cumulative percentages for January – April fall within 0%-1% of the 2019 census distribution. Compared to the county death frequencies in 2019, there has been a northward shift of the higher percentages. For example, the cumulative January-April 2021 percentages for York and Cumberland Counties have dropped by 4%, and 5% respectively, while Androscoggin and Penobscot Counties have increased by 5% and 6% respectively.

CountyPercent of 2019
Census Population
Jan-Dec 2020
April 2021
Est. N=46
Cumulative Jan-Apr 2021
Est. N=199
Androscoggin8%33…….(9%)52.(10%) 5.(10%)25….(13%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for April 2021.

Race, ethnicity, and other demographic indicators of decedents

During the first four months of 2021, out of 199 confirmed and suspected fatal overdoses, 187 (94%) of the victims were identified as White, 8 (4%) as Black or African American, and 4 (1%) as American Indian/Alaska Native. Out of the 199 fatal overdoses reported, 192 (99%) were reported as not Hispanic, and 2 (1%) were identified as Hispanic. Out of the 199 cases, 17 (9%) were identified as having a military background. Prior overdose history was reported for 33% of the victims. Transient housing status was reported for 17 (9%) of the victims.

Demographic IndicatorNumber of decedentsPercent of decedents
Race and Ethnicity
Black or African American84%
American Indian/Alaska Native41%
Not Hispanic19299%
Military Background179%
Prior Overdose History33%
Person Experiencing Homelessness179%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for April 2021.

Age and gender composition of decedents

The following table displays the age and gender composition of the monthly fatal overdose population. The cumulative proportion of males has increased since 2019. In the first four months of 2021, it was 75%, which is higher than the 71% level in 2020 and the 68% level in 2019. The cumulative age distribution in January – April 2021 compared to 2019 shows the percentage of those 18-39 decreased by 4%. The percentage of those 40-59 rose by 2%, and the percentage of those over 60 remained the same. There are no decedents that were under 18 in 2021, and only 9% over 60, the same as 2019.

Jan-Dec 2020
Jan-Apr 2021
Est. N=199
Est. N-45
Percent Males258..(68%)357(71%)138.(69%)36(75%)
Percent under 180….(0%)2(<1%)0(0%)0…..(0%)
Percent 18-39171..(45%)213..(42%)83.(41%)17(35%)
Percent 40-59175..(46%)235..(47%)97.(48%)22..(46%)
Percent 60+33….(9%)54(11%)19(9%)6(13%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for April 2021.

Basic incident patterns in fatal overdoses

The following table highlights some event characteristics among suspected and confirmed overdoses. Roughly similar to 2020, during the first four months of 2021, Both EMS and police responded to most fatal overdoses, 77%. Law enforcement was more likely to respond to a scene alone (20%) than EMS (4%). The overwhelming majority (95%) of drug overdoses were ruled as accidental manner of death.

Based on the death investigation records, during April, naloxone was administered to 44% of the victims at the scene or in the ambulance, whether by EMS, bystanders, or law enforcement, greater than in the first quarter of 2021 (35%) or 2020 (33%). This may be due to the greater availability of police trained to administer it through programs like the Attorney General’s Naloxone Distribution Initiative or ODMAP. It may also be due to the greater availability in the community due to the Maine Naloxone Distribution Initiative. Several victims reportedly had naloxone prescriptions, but none of those were evidently used: 7 in 2020; 4 in the first four months of 2021.

Based on 161 suspected and confirmed drug death cases with EMS records during the first four months of 2021, 71 (44%) of victims were already deceased when EMS arrived. Of the remaining 90 (56%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of the 90 cases who were still alive when EMS arrive, 26 were transported, and 64 did not survive to be transported. Thus, out of 161 cases with EMS records, only 26 (16%) remained alive long enough to be transported, but died during transport or at the emergency room.

Jan-Dec 2020
Jan-Apr 2021
Est. N=199
Est. N=45
Public safety response
……EMS alone28(6%)7….(4%)1……(2%)
……Law enforcement alone107.(21%)27..(18%)9(20%)
……EMS and law enforcement365.(72%)115..(77%)35(80%)
Manner of death (suspected or confirmed)
Naloxone administration
Naloxone administration at the scene and/or
(presumably) in ambulance during transport to
emergency room
Naloxone administration reported at the scene83.(22%)69.(35%)19..(42%)
……Bystander only11(2%)11….(6%)3….(7%)
……Law enforcement only8(2%)10….(5%)4….(8%)
……EMS only55..(11%)32..(16%)9..(20%)
……EMS and law enforcement4(1%)10….(5%)2….(4%)
……EMS and bystander8..(2%)4….(2%)1….(2%)
……Law enforcement and bystander0..(0%)1…..(1%)0….(0%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for April 2021.

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, nonpharmaceutical fentanyl is the most frequent cause of death to date in 2021, at 73%, 9% higher than in 2020. Fentanyl is nearly always found in combination with multiple other drugs. Heroin involvement has been declining during the last several years; it represents only 7% of 2021 deaths, compared to 11% last year. Illicit stimulants have been increasing in recent years, and in the first four months of 2021, methamphetamine caused 28% of the overdoses, compared to 20% in 2020. Cocaine-involved fatalities constituted 20% of cases, slightly lower than 23% in 2020. Fentanyl is found in combination with cocaine in 17% of cases, and fentanyl and methamphetamine as a combination in 21% of cases. Pharmaceutical opioids were identified as a cause of death in 25%, all in combination with other drugs, just 2% higher than in 2020.

Cause of death (alone or in
combination with other drugs)
Jan-Dec 2020
Jan-Apr 2021
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)132..(76%)16..(73%)
Nonpharmaceutical Stimulants
Pharmaceutical opioids118.(23%)43.(25%)7..(32%)
Key combinations
……Fentanyl and cocaine97.(19%)29..(17%)7..(32%)
……Fentanyl and methamphetamine/amphetamine70.(14%)36..(21%)3..(14%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for April 2021.

Five partially overlapping metrics that estimate the number of nonfatal overdoses in a given month

There is not a precise way to calculate nonfatal overdoses. Several metrics can be used to estimate numbers of nonfatal overdoses from different perspectives (see the chart below). This includes, for example, counting the number of responses by EMS in which the EMT or paramedic suspects an overdose and administers naloxone. However, many persons involved with an overdose event do not call 911. One syringe access program in Maine estimates that as many as 74% of overdose events do not include a 911 call. Put another way, the 911 calls may represent only 26% of the overdoses, whereas 74% constitute “private overdoses.” Some of these persons will unfortunately die. In about 15% of EMS overdose cases, the patient is revived, but refuses to be transported to the emergency room. Some may receive naloxone, but are found later not to have had an overdose, but were unconscious or had stopped breathing for another reason.

Metrics frequently used to estimate overdose numbersUnduplicated monthly estimate
based on 4th quarter 2020
Unduplicated monthly estimate
based on Jan-Apr 2021
Number of EMS runs in which naloxone was administered110580
Number of emergency department visits likely involving a drug overdose2277278
Number of overdose reversals reported by community naloxone distributors and users of the OD-ME app, minus the number of fatal overdoses in which bystanders administered naloxone (163-2=161)3161121
Number of incidents in which law enforcement administered naloxone and victim survived.45242
1.) Sources: Maine EMS; Maine Office of Chief Medical Examiner. 2) Source: Maine CDC, Syndromic Surveillance. 3.) Sources: Maine Naloxone Distribution Initiative, OD-ME Mobile App. 4) Sources: Maine Office of the Attorney General; OD MAP Initiative. *April reversal reporting was delayed.

Highlight of the month regarding substance use disorder public policy response

The MaineMOM Initiative

In 2020, MaineCare was awarded a five-year, $5 million grant, Maine Maternal Opioid Misuse (MaineMOM), to improve care for pregnant and postpartum women with Opioid Use Disorder (OUD) and their infants by developing a MaineCare service to integrate maternal and substance use disorder treatment services.  The MaineMOM team has onboarded key grant staff, including a leading state and national expert in perinatal substance use care as the MaineMOM clinical advisor.  

Beginning this summer, MaineCare will pilot these integrated services at 16 health care sites at MaineHealth, Northern Light, MaineGeneral, MidCoast Hospital, Pines Health Services and Penobscot Community Health Center, with an aim to reach nearly 300 women by July 2022.  This summer, MaineCare will also begin a public awareness campaign aimed at increasing awareness to pregnant women’s treatment options and available services.  This campaign and MaineMOM will utilize the current Maine CDC Public Health Nursing CradleME referral system as one of many ways to connect individuals to MaineMOM treatment sites and other social and health-related resources.

To expand access to this robust care model, MaineCare will propose amendments to Maine’s Medicaid State Plan to include these services as a covered MaineCare service in early 2022.  The MaineMOM effort is highly collaborative and is focused on developing a sustainable and accessible family-centered treatment model.  The team has worked across Departments within the State of Maine, with recovery centers statewide, with community members and with health and social service providers to achieve this aim.  

The MaineMOM initiative is consistent with Strategy 21 in the updated Opioid Response Strategic Action Plan (SAP):  Dedicate staff and funding to support the screening, support and recovery of pregnant women with substance use disorder and support substance-exposed infants. Within that strategy, current activity b. specifically references this program.  

For more information regarding the State of Maine’s response to the drug crisis in Maine see the Leadership section of the Maine Drug Data Hub.