August 2021 Monthly Overdose Report

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

Fatal Drug Overdoses in Maine January – August 2021

The August 2021 total of 46 fatal drug overdoses consists of 13 confirmed drug deaths and 33 suspected drug deaths. The cumulative January – August total is 399, which is 17% higher than the same period in 2020. 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 59. 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 August 2021.

Comprehensive total of fatal and nonfatal overdoses

During August 2021, there were an estimated 802 fatal and nonfatal drug overdoses statewide, of which 46 (6%) were suspected and confirmed fatal overdoses. The remaining 756 (94%) were nonfatal overdoses: 392 (49%) emergency department visits; 204 (25%) EMS patents who were not transported to the emergency room, 157 (20%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 3 (<1%) law enforcement reversals without EMS present. The minimum total of reported nonfatal overdose incidents for January – August 2021 was 5,809 which was compiled by deduplicating data derived from multiple statewide sources. 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 OverdosesEmergency Department
EMS Not Transported
Community Reversals
Law Enforcement
Without EMS 
Nonfatal (estimated)
Total Overdoses
Total %7%48%25%20%<1%100%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for August 2021.
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses. Fatal overdoses in those categories have been removed.

Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The August 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, 2020, and January-August 2021. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.

The cumulative January-August 2021 percentages of deaths in many counties fall within plus or minus 0%-1% of the 2019 census distribution, including Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Piscataquis, Somerset, and Waldo. Counties that are 2% or more higher than the census proportions include Androscoggin (+5%), Kennebec (+3%), Penobscot (+5%), and Washington (+2%). Counties that are 2% or more lower than the census proportion include Cumberland (-5%), Sagadahoc (-2%), and York (-3%).

CountyPercent of 2019
Census Population
Jan-Dec 2020
Aug 2021
Est. N=46
Cumulative Jan-Aug 2021
Est. N=399
Androscoggin8%33…….(9%)52.(10%) 7..(15%)50….(13%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for August 2021.

Race, ethnicity, and other demographic indicators of decedents

During January – August of 2021, out of 397 confirmed and suspected fatal overdoses where race was reported, 371 (93%) of the victims were identified as White, 17 (4%) as Black or African American, and 9 (2%) as American Indian/Alaska Native. Out of the 393 fatal overdoses where ethnicity was reported, 391 (99%) were reported as not Hispanic, and 2 (1%) were identified as Hispanic. Out of the 393 cases, 27 (7%) were identified as having a military background. Prior overdose history was reported for 138 (35%) of the victims. Transient housing status was reported for 31 (8%) of the victims.

Demographic IndicatorNumber of decedents
Percent of decedents
Race and Ethnicity
Black or African American174%
American Indian/Alaska Native92%
Not Hispanic39199%
Military Background276%
Prior Overdose History13835%
Person Experiencing Homelessness318%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for August 2021.

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 stayed roughly the same since 2019. In the first eight months of 2021, it was 273 68%, which is slightly lower than the 71% level in 2020 and the same as the level in 2019. The cumulative age distribution in January – August 2021 compared to 2020 and 2019 shows increasingly more decedents in older categories. The percentage of those 18-39 decreased by 5%. The percentage of those 40-59 rose by 2%, and the percentage of those over 60 rose 3%. There has been 1 decedents under 18 in 2021.

Jan-Dec 2020
Jan-Aug 2021
Est. N=399
Est. N=46
Percent Males258..(68%)357(71%)273.(68%)31(67%)
Percent under 180….(0%)2(<1%)1..(<1%)0…..(0%)
Percent 18-39171..(45%)213..(42%)160.(40%)18(39%)
Percent 40-59175..(46%)235..(47%)192.(48%)21(46%)
Percent 60+33….(9%)54(11%)46..(12%)7(15%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for August 2021.
*Systematic gender data are not reported on the death certificate.

Basic incident patterns in fatal overdoses

The following table highlights some event characteristics among suspected and confirmed overdoses. Roughly similar to 2020, during January – August of 2021, both EMS and police responded to most fatal overdoses, 77%. Law enforcement was more likely to respond to a scene alone (19%) than EMS (4%). The overwhelming majority (95%) of drug overdoses were ruled as accidental manner of death.

Based on the death investigation records, during January – August of 2021, naloxone was administered to 39% of the victims at the scene or in the ambulance, whether by EMS, bystanders, or law enforcement. 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. 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 10% of the fatal overdoses, often in addition to EMS and/or law enforcement.

Based on 321 suspected and confirmed drug death cases with EMS records during January – August of 2021, 150 (47%) of victims were already deceased when EMS arrived. Of the remaining 171 (53%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of the 171 cases who were still alive when EMS arrived, 53 were transported, and 118 did not survive to be transported. Thus, out of 321 fatal cases with EMS response, only 53 (17%) remained alive long enough to be transported, but died during transport or at the emergency room.

Jan-Dec 2020
Jan-Aug 2021
Est. N=399
Est. N=46
Public safety response
……EMS alone28(6%)17….(4%)3……(7%)
……Law enforcement alone107.(21%)75..(19%)8….(17%)
……EMS and law enforcement365.(72%)306..(77%)35(76%)
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%)127.(32%)16..(35%)
……Bystander only11(2%)23….(6%)1….(2%)
……Law enforcement only8(2%)16….(4%)3….(7%)
……EMS only55..(11%)58..(15%)8..(17%)
……EMS and law enforcement4(1%)15….(4%)0….(0%)
……EMS and bystander8..(2%)13….(3%)4….(9%)
……Law enforcement and bystander0..(0%)2..(<1%)0….(0%)
……EMS, bystander, and law enforcement…….1..(<1%)0….(0%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for August 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 was the most frequent cause of death mentioned on the death certificate so far for 2021 at 240 (75%), 8% higher than 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 5% of 2021 deaths, compared to 11% last year. Methamphetamine was cited as a cause in 25% of the overdoses, which is slightly more than 2020. Cocaine-involved fatalities January – August constituted 22% of cases, slightly less than the 23% in 2020. Fentanyl is found in combination with cocaine in 18% of 2021 cases, and in combination with methamphetamine in 19%. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 240 confirmed deaths caused by fentanyl from January – August, the number and percent of cases with xylazine listed as an additional cause of death is 31 (10%) of confirmed overdose deaths, and 16 (5%) with tramadol listed as one of the causes of death. 

Cause of death (alone or in
combination with other drugs)
Jan-Dec 2020
Jan-Aug 2021
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)240..(75%)7….(5%)
Nonpharmaceutical Stimulants
Pharmaceutical opioids**118.(23%)75.(24%)2..(15%)
Key combinations
……Fentanyl and heroin47(9%)16….(5%)0(0%)
……Fentanyl and cocaine97.(19%)59..(18%)2..(15%)
……Fentanyl and methamphetamine/amphetamine70.(14%)61..(19%)0(0%)
……Fentanyl and xylazine0(0%)31..(10%)1(8%)
……Fentanyl and tramadol0(0%)16….(5%)1(8%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for August 2021.
**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 regarding substance use disorder public policy response

Get Maine Naloxone

At the beginning of September, the Maine Office of Behavioral Health in partnership with the University of Maine launched a new website to guide users in the process of obtaining naloxone (Narcan®) in the State of Maine: The website highlights pathways for individuals, organizations, businesses, and emergency responders to obtain naloxone to have on hand in case of an emergency or to obtain for the purpose of community redistribution. It also contains information regarding how to respond to an overdose emergency, frequently asked questions about naloxone, and links to the OD-ME mobile application for overdose emergency response, which was developed in 2019. In the future, an interactive GIS dashboard will provide guide users to the closest location to obtain naloxone. 

This website is part of the broader mission of the Maine Naloxone Distribution Initiative to get naloxone (Narcan®) into the hands of individuals that have the greatest chance of responding to an overdose emergency event. From the start of distribution in July of 2019 through July of 2021, the Maine Naloxone Distribution Initiative has distributed nearly 101,000 doses of naloxone into the community and has reported 2,285 opioid overdose reversals. The website will expand naloxone access in Maine and allow users to quickly obtain initial or refill doses of this lifesaving overdose reversal medication.

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.