Download the entire PDF report here: Maine Monthly Overdose Report for April 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 April, the proportion of fatal overdoses averaged 7.3% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.5% in March and a high of 7.3% in April. During April 2023, there were an estimated 776 fatal and nonfatal drug overdoses statewide, of which 57 (7.3%) were suspected and confirmed fatal overdoses. The remaining 719 (93.7%) were nonfatal overdoses: 275 (35.4%) emergency department visits; 214 (27.6%) EMS patents who were not transported to the emergency room, 202 (26.0%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 28 (3.6%) 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 | 44 | 304 | 206 | 178 | 39 | 771 |
| Feb ’22 | 48 | 341 | 185 | 153 | 37 | 764 |
| Mar ’22 | 65 | 465 | 201 | 202 | 30 | 963 |
| Apr ’22 | 58 | 297 | 178 | 189 | 26 | 748 |
| May ’22 | 46 | 405 | 248 | 186 | 41 | 926 |
| Jun ’22 | 66 | 492 | 250 | 177 | 44 | 1029 |
| Jul ’22 | 64 | 357 | 287 | 183 | 40 | 931 |
| Aug ’22 | 61 | 393 | 272 | 255 | 37 | 1019 |
| Sep ’22 | 55 | 467 | 256 | 153 | 33 | 964 |
| Oct ’22 | 65 | 289 | 238 | 177 | 27 | 796 |
| Nov ’22 | 67 | 295 | 206 | 200 | 20 | 787 |
| Dec ’22 | 76 | 376 | 212 | 198 | 14 | 875 |
| 2022 Total | 715 | 4,481 | 2,739 | 2,251 | 388 | 10,573 |
| 2022 Total % | 6.8% | 42.4% | 25.9% | 21.3% | 3.7% | 100% |
| Jan ’23 | 52 | 298 | 221 | 184 | 31 | 786 |
| Feb ’23 | 50 | 354 | 186 | 192 | 22 | 804 |
| Mar ’23 | 42 | 383 | 246 | 237 | 33 | 941 |
| Apr ’23 | 57 | 275 | 214 | 202 | 28 | 776 |
| 2023 Total | 201 | 1,310 | 867 | 815 | 114 | 3,307 |
| 2023 Total % | 6.1% | 39.6% | 26.2% | 24.6% | 3.4% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine April 2023
Fatal Drug Overdoses in Maine Jan – Apr 2023
During 2023, the proportion of fatal overdoses averaged 6.1% of total overdoses. From January to April 2023 there was a total 201 fatal drug overdoses consisting of 174 confirmed and 27 suspected drug deaths. In April 2023 there were 57 fatal drug overdoses consisting of 46 confirmed and 11 suspected cases. The graph below shows the considerable monthly fluctuation since January of 2022. The range extends from 76 (December 2022) to 42 (March 2023). During 2023, the monthly proportions fluctuated from a low of 4.5% in March and a high of 7.3% in April. During the first four months of 2023, fatal overdoses comprised 6.1% of all overdoses; this proportion slightly lower than the 6.8% for 2022. There were 201 confirmed and suspected fatal overdoses in the first four months of 2023; this is 6.7% lower than the 215 fatal overdoses during the same time period in 2022.
For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.
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 – April 2023 as well as 2022.
| Maine EMS | Law Enforcement | |
| Fatal Overdose Response 2022 | 578 | 666 |
| Nonfatal Overdose Response 2022 | 9,374 | 1,471 |
| Total Overdose Response 2022 | 9,952 | 2,137 |
| Fatal Overdose Response Jan – Apr 2023 | 156 | 189 |
| Nonfatal Overdose Response Jan – Apr 2023 | 2,990 | 404 |
| Total Overdose Response Jan- Apr 2023 | 3,146 | 593 |
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 April 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 – April percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Penobscot County is 4 percentage points higher; Androscoggin County is 3 percentage points higher, and Cumberland County is 2 percentage points higher than the 2020 census proportion. York County is 5 percentage points lower, and Sagadahoc County is 2 percentage points lower than the 2020 census proportion.
Nonfatal Drug Overdoses in Maine, April 2023
Nonfatal Drug Overdoses in Maine, Jan 2023 – Apr 2023
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=9374 | Jan-Apr 2023 Est. N=2990 | Apr 2023 Est. N=691 |
|---|---|---|---|---|
| Androscoggin | 8% | 1,055 (11%) | 334 (11%) | 78 (11%) |
| Aroostook | 5% | 490 (5%) | 118 (4%) | 23 (3%) |
| Cumberland | 22% | 2,194 (23%) | 714 (24%) | 160 (23%) |
| Franklin | 2% | 139 (1%) | 47 (2%) | 11 (2%) |
| Hancock | 4% | 287 (3%) | 86 (3%) | 23 (3%) |
| Kennebec | 9% | 922 (10%) | 305 (10%) | 76 (11%) |
| Knox | 3% | 245 (3%) | 103 (3%) | 28 (4%) |
| Lincoln | 3% | 161 (2%) | 49 (2%) | 9 (1%) |
| Oxford | 4% | 410 (4%) | 113 (4%) | 27 (4%) |
| Penobscot | 11% | 1,292 (14%) | 439 (15%) | 110 (16%) |
| Piscataquis | 1% | 90 (1%) | 42 (1%) | 9 (1%) |
| Sagadahoc | 3% | 130 (1%) | 39 (1%) | 11 (2%) |
| Somerset | 4% | 392 (4%) | 152 (5%) | 30 (4%) |
| Waldo | 3% | 199 (2%) | 75 (3%) | 14 (2%) |
| Washington | 2% | 221 (2%) | 52 (2%) | 15 (2%) |
| York | 16% | 1,147 (12%) | 332 (11%) | 67 (10%) |
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-December 2023 percentages of deaths in most counties fall within plus or minus 0 to 2 percentage points of the 2020 census distribution. Androscoggin and Penobscot Counties are 4 percentage points higher, and Cumberland, Piscataquis and Washington Counties are 3 percentage points higher. York County is 6 percentage points lower, and Sagadahoc County is 3 percentage points lower than the 2020 census proportion.
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=715 | Jan-Apr 2023 Est. N=201 | Apr 2023 Est. N=57 |
|---|---|---|---|---|
| Androscoggin | 8% | 69 (10%) | 25 (12%) | 4 (7%) |
| Aroostook | 5% | 47 (7%) | 6 (3%) | 1 (2%) |
| Cumberland | 22% | 130 (18%) | 50 (25%) | 14 (25%) |
| Franklin | 2% | 14 (2%) | 0 (0%) | 0 (0%) |
| Hancock | 4% | 24 (3%) | 5 (2%) | 1 (2%) |
| Kennebec | 9% | 54 (8%) | 23 (11%) | 3 (5%) |
| Knox | 3% | 20 (3%) | 4 (2%) | 4 (7%) |
| Lincoln | 3% | 14 (2%) | 3 (1%) | 2 (4%) |
| Oxford | 4% | 36 (5%) | 6 (3%) | 3 (5%) |
| Penobscot | 11% | 107 (15%) | 31 (15%) | 6 (11%) |
| Piscataquis | 1% | 9 (1%) | 8 (4%) | 3 (5%) |
| Sagadahoc | 3% | 10 (1%) | 0 (0%) | 0 (0%) |
| Somerset | 4% | 35 (5%) | 6 (3%) | 1 (2%) |
| Waldo | 3% | 21 (3%) | 3 (1%) | 1 (2%) |
| Washington | 2% | 24 (3%) | 11 (5%) | 4 (7%) |
| York | 16% | 100 (14%) | 20 (10%) | 10 (18%) |
Race, ethnicity, and other demographic indicators of decedents
During the four months of 2023, out of 195 confirmed and suspected fatal overdoses for which race was reported, 181 (93%) of the victims were identified as White, 6 (3%) as Black or African American, and 3 (2%) as American Indian/Alaska Native. Out of the 195 fatal overdoses for whom ethnicity was reported, 194 (99%) were reported as not Hispanic, and 1 (1%) were identified as Hispanic.
Out of the 195 cases for which military background was reported in January – April 2023, 11 (6%) were identified as having a military background. Out of the 52 cases in April 2023 where military background was reported, 1 (2%) were identified as having a military background.
Prior overdose history was reported for 83 (41%) of the victims during January-April 2023.
Of 201 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 21 (10%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (8, 38%), Penobscot County and Androscoggin County (4, 19%), and Kennebec County (3, 14%). In April 2023, 7 decedents (12%) were identified as undomiciled.
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2022 Est. Race N=712 Ethnicity N=698 | Jan-Apr 2023 Est. Race N=195 Ethnicity N=195 | Apr 2023 Est. Race N=52 Ethnicity N=50 |
|---|---|---|---|---|
| Race and Ethnicity | ||||
| White | 91% | 669 (94%) | 181 (93%) | 48 (92%) |
| Black or African American | 2% | 16 (2%) | 6 (3%) | 1 (2%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 3 (2%) | 2 (4%) |
| Other race, 2+ races combined, non-hispanic | 7% | 13 (2%) | 5 (3%) | 1 (2%) |
| Not Hispanic | 98% | 691 (99%) | 194 (99%) | 50 (100%) |
| Hispanic | 2% | 7 (1%) | 1 (1%) | 0 (0%) |
| Military Background | 81 (11%) | 11 (6%) | 1 (2%) | |
| Prior Overdose History | 268 (37%) | 83 (41%) | 24 (42%) | |
| Undomiciled/Transient Housing Status | 81 (11%) | 21 (10%) | 7 (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 in recent years from 68% in 2019 to 71% in 2020 and 2021 and 73% in 2022. It has slightly decreased during the first quarter of 2023 to 72%. The cumulative age distribution in January – April 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 0 deaths in 2022, a 5 percentage point decrease in the proportion of those aged 18-39, a 3 percentage point increase in those aged 40-59, and a 3 percentage point increase in the proportion 60 and above.
| % of 2020 Census Population | Jan-Dec 2022 Est. N=715 | Jan-Apr 2023 Est. N=201 | Apr 2023 Est N=57 | |
|---|---|---|---|---|
| Percent Males | 49% | 521…(73%) | 148 (74%) | 44 (77%) |
| Percent under 18 | 19% | 3…(<1%) | 1 (<1%) | 1 (2%) |
| Percent 18-39 | 26% | 291…(41%) | 72 (36%) | 24 (42%) |
| Percent 40-59 | 27% | 332..(46%) | 98 (49%) | 26 (46%) |
| Percent 60+ | 29% | 89…(12%) | 30 (15%) | 6 (11%) |
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 (22%) than EMS (5%). The overwhelming majority (93%) of drug overdoses were ruled, or suspected of being, accidental manner of death.
During 2023, 24% 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 lower than the 30% recorded in 2021 and 25% recorded in 2022. 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% (27) 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 156 suspected and confirmed drug death cases with EMS involvement during the first four months of 2023, 89 (57%) of victims were already deceased when EMS arrived. In the remaining 67 (43%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 67 who were still alive when EMS arrived, only 22 (33%) remained alive long enough to be transported but died during transport or at the emergency room and 44 (66%) 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=715 | Jan – Apr 2023 Est. N=201 | Apr 2023 Est. N=57 | |
|---|---|---|---|
| Public safety response | |||
| ……EMS alone | 39….(5%) | 11 (5%) | 6 (1%) |
| ……Law enforcement alone | 127…(18%) | 44 (22%) | 11 (19%) |
| ……EMS and law enforcement | 539…(75%) | 145 (72%) | 40 (70%) |
| ……Private transport to the Emergency. Dept. | 13…..(2%) | 1 (<1%) | 0 (0%) |
| Naloxone administration | |||
| Naloxone administration reported at the scene | 182..(25%) | 49 (24%) | 19 (33%) |
| ……Bystander only | 44…(6%) | 12 (6%) | 5 (9%) |
| ……Law enforcement only | 31….(4%) | 2 (1%) | 1 (2%) |
| ……EMS only | 48….(7%) | 18 (9%) | 4 (7%) |
| ……EMS and law enforcement | 11….(2%) | 3 (1%) | 1 (2%) |
| ……EMS and bystander | 32….(4%) | 10 (5%) | 5 (9%) |
| ……Law enforcement and bystander | 5….(1%) | 4 (2%) | 2 (4%) |
| ……EMS, bystander, and law enforcement | 6….(1%) | 1 (<1%) | 1 (2%) |
| ……Naloxone administered by unspecified person | 0…(0%) | 0 (0%) | 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 139 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 114 (82%).
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% (6) of 2023 deaths and 3% (19) of 2022 deaths, compared to 11% (57) in 2020. Methamphetamine was cited as a cause of death in 32% (44) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – April constituted 30% (42) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 89% (42) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 84% (37) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 139 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 13 (9%) 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=715 | Jan-Apr 2023 N=139 | *Apr 2023 N=11 |
|---|---|---|---|
| Nonpharmaceutical opioids | |||
| ……Fentanyl or fentanyl analogs | 560..(78%) | 114 (82%) | 10 (91%) |
| ……Heroin | 19….(3%) | 6 (4%) | 0 (0%) |
| Nonpharmaceutical Stimulants | |||
| ……Cocaine | 211.(30%) | 47 (34%) | 3 (27%) |
| ……Methamphetamine | 233.(33%) | 44 (32%) | 6 (55%) |
| Pharmaceutical opioids** | 155..(22%) | 28 (20%) | 2 (18%) |
| Key combinations | |||
| ……Fentanyl and heroin | 18….(3%) | 6 (4%) | 0 (0%) |
| ……Fentanyl and cocaine | 171..(24%) | 42 (30%) | 3 (27%) |
| ……Fentanyl and methamphetamine | 189..(26%) | 37 (27%) | 5 (45%) |
| ……Fentanyl and xylazine | 46….(6%) | 13 (9%) | 0 (0%) |
| ……Fentanyl and tramadol | 10….(1%) | 1 (1%) | 0 (0%) |
**Nonpharmaceutical tramadol is now being combined with fentanyl in pills and powders for illicit drug use. When found in combination with fentanyl, and in the absence of a known prescription, tramadol is no longer counter as a pharmaceutical opioid.
Highlight of the Month
annual opioid response summit
Governor Janet T. Mills will host her 5th Annual Opioid Response Summit on Thursday, July 20, 2023 at the Cross Insurance Arena in Portland. The Annual Summit provides an opportunity for persons in recovery, advocates, policy and law makers, treatment providers and public health and public safety partners to come together to review the current data on substance use disorders in the state and to review community, state and federal efforts to address the epidemic. The four previous summits have featured presentations on a wide variety of prevention, treatment, harm-reduction and recovery related topics including:
- Recovery friendly workplaces
- Recovery community centers
- Recovery coaching
- The role of youth voices in the recovery movement
- The role of OPTIONS Behavioral Health Liaisons
- Stigma reduction
- The role of Maine’s Treatment and Recovery Courts
- SUD treatment options
- Harm-reduction
- The importance of data in opioid policy discussion
- Medication for residents of jails/prisons
- Overdose prevention
Previous Summit speakers have included novelist Sam Quinones, ONDCP Director Rahul Gupta, DEA Administrator Ann Milgram, Surgeon General Vivek Murthy, DHHS Secretary Xavier Becerra, former ONDCP Director Michael Botticelli and national recovery advocate Ryan Hampton.
This year’s Summit will focus on prevention and the theme is, The Power of Prevention: Focus on Families. Registration materials will be available in early June. Speakers include national prevention expert Carleton Hall, author Alison Jones Webb and Elizabeth Conolly from the Office of National Drug Control Policy. New breakout topics will include the plans for use of the settlement funds by the Maine Recovery Council and the updates to the Opioid Response Strategic Action Plan. And addiction researchers from Jackson Lab will present promising work being done across the globe, offering hope to individuals and families experiencing addiction. One special feature of the Summits is the opening of each plenary talk and each breakout session with a person with lived experience talking about that experience and their subsequent recovery.
In addition to the annual summits, opioid response monthly webinars have been offered for the last two years on the first Friday of each month. The webinars are presented from 11:30am to 12:30pm and are offered without charge. The next webinar on June 2 will explore the impact of substance use disorders on families with children, drawing from the recommendations of the Child Death and Serious Injury Review Panel in its annual report released earlier this month. Presenters include Mark Moran, LCSW, Chair of the Panel and Todd Landry, PhD and Bobbi Johnson from the Office of Child and Family Services. The Program will be moderated by Gordon Smith, J.D., Director of Opioid Response for the state.