Download the entire PDF report here: Maine Monthly Overdose Report for August 2022
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 August, the proportion of fatal overdoses averaged 7.9% of total overdoses. The monthly proportion of 2022 fatalities has fluctuated, however, including a low of 5.3% in May 2022 and a high of 8.0% in April. During the first eight months of 2022, the average number of overdoses per month was approximately 836 (57 fatal and 779 nonfatal cases). This compares to the monthly average for January – August 2021 of 695 (49 fatal and 678 nonfatal cases). The number of fatal overdoses in 2022 is 17% higher than during the same time in 2021.
From January 2022 to August 2022, there were an estimated 6,818 fatal and nonfatal drug overdoses statewide, of which 463 (6.8%) were suspected and confirmed fatal overdoses. The remaining 6,355 (93.2%) were nonfatal overdoses: 2,983 (43.8%) emergency department visits; 1,826 (26.8%) EMS patents who were not transported to the emergency room, 1,496 (21.9%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 50 (.7%) 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 | |
| January ’21 | 51 | 270 | 164 | 127 | 0 | 612 |
| February ’21 | 41 | 277 | 118 | 100 | 0 | 536 |
| March ’21 | 58 | 329 | 172 | 156 | 2 | 717 |
| April ’21 | 46 | 334 | 190 | 136 | 0 | 706 |
| May ’21 | 47 | 409 | 163 | 100 | 1 | 720 |
| June ’21 | 54 | 411 | 223 | 189 | 0 | 877 |
| July ’21 | 44 | 482 | 225 | 167 | 0 | 918 |
| August ’21 | 50 | 428 | 232 | 222 | 3 | 935 |
| September ’21 | 59 | 473 | 234 | 276 | 2 | 1,044 |
| October ’21 | 65 | 383 | 246 | 208 | 2 | 904 |
| November ’21 | 61 | 308 | 219 | 195 | 2 | 785 |
| December ’21 | 55 | 344 | 198 | 176 | 11 | 784 |
| 2021 Total | 631 | 4,448 | 2,384 | 2,052 | 23 | 9,538 |
| 2021 Total % | 6.6% | 46.6% | 25.0% | 21.5% | 0.2% | 100% |
| January ’22 | 44 | 296 | 206 | 178 | 1 | 725 |
| February ’22 | 49 | 333 | 185 | 153 | 4 | 724 |
| March ’22 | 66 | 458 | 201 | 202 | 9 | 936 |
| April ’22 | 58 | 290 | 177 | 189 | 7 | 721 |
| May ’22 | 46 | 402 | 248 | 186 | 12 | 894 |
| June ’22 | 66 | 482 | 250 | 177 | 11 | 986 |
| July ’22 | 69 | 346 | 287 | 170 | 5 | 877 |
| August ’22 | 65 | 376 | 272 | 241 | 1 | 995 |
| 2022 Total | 463 | 2,983 | 1,826 | 1,496 | 50 | 6,818 |
| 2022 Total % | 6.8% | 43.8% | 26.8% | 21.9% | 0.7% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine August 2022
Fatal Drug Overdoses in Maine January – August 2022
During the first 8 months of 2022, the proportion of fatal overdoses averaged 6.8% of total overdoses. From January to August 2022 there was a total 463 fatal drug overdoses consisting of 337 confirmed and 126 suspected drug deaths. The graph below shows the considerable monthly fluctuation since January 2020. Although the average since 2020 is 50, the range extends from 33 (October 2020) to 69 (July 2022). The proportion of fatal to nonfatal overdoses decreased from 9% to 7% between January and December of 2021. During 2022, the monthly proportions fluctuated from a low of 6% in January and May to 8% in April. The proportion of fatalities in January – August 2022 (463) is 18.4% higher than the first eight months of 2021 (391) For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.
*Note: The timing of the monthly overdose report has been substantially delayed during the last several months due to pandemic-related issues. The toxicology reports are currently returning to the Office of the Chief Medical Examiner in as much as 10 weeks following death; this is 3 to 4 times longer than the prepandemic turn around time. For more information see the full report.
Distribution of drug deaths by Maine county
The following table shows the frequency distribution of deaths at the county level. The monthly 2022 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, 2021 and January-August 2022. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.
The cumulative January-August 2022 percentages of deaths in all counties except Androscoggin, Cumberland, Hancock and Penobscot fall within plus or minus 0%-1% of the 2020 census distribution. Cumberland County is 3% lower and Hancock County is 2% lower than the 2020 census proportion in 2022 and Penobscot County is 4% higher and Androscoggin County is 2% higher. Comparing 2022 with 2021, all counties are within plus or minus 2% of 2021 proportions, except York, which is 4% higher in 2022.
| County | % of 2020 Census Population | Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Aug 2022 Est. N=463 | Aug 2022 Est. N=65 |
|---|---|---|---|---|---|---|
| Androscoggin | 8% | 33…….(9%) | 52.(10%) | 69…..(11%) | 45 (10%) | 8 (12%) |
| Aroostook | 5% | 14…….(4%) | 17…(3%) | 39……(6%) | 29 (6%) | 4 (6%) |
| Cumberland | 22% | 100…..(26%) | 97.(19%) | 114….(28%) | 86 (19%) | 11 (17%) |
| Franklin | 2% | 5……..(1%) | 8…(2%) | 8…….(1%) | 9 (2%) | 0 (0%) |
| Hancock | 4% | 9…….(2%) | 13…(3%) | 22……(3%) | 11 (2%) | 1 (2%) |
| Kennebec | 9% | 42……(11%) | 49.(10%) | 64….(10%) | 40 (9%) | 8 (12%) |
| Knox | 3% | 7…….(2%) | 16…(3%) | 11……(2%) | 11 (2%) | 2 (3%) |
| Lincoln | 3% | 11…….(3%) | 9…(2%) | 16……(3%) | 8 (2%) | 2 (3%) |
| Oxford | 4% | 9…….(2%) | 15…(3%) | 28……(4%) | 19 (4%) | 1 (2%) |
| Penobscot | 11% | 53…..(14%) | 94.(19%) | 106…..(17%) | 71 (15%) | 10 (15%) |
| Piscataquis | 1% | 3…….(1%) | 10…(2%) | 11……(2%) | 6 (1%) | 2 (3%) |
| Sagadahoc | 3% | 8……(2%) | 8….(1%) | 7……(1%) | 7 (2%) | 1 (2%) |
| Somerset | 4% | 16……(4%) | 13…(3%) | 26…..(4%) | 22 (5%) | 3 (5%) |
| Waldo | 3% | 3…….(1%) | 9…(2%) | 15…..(2%) | 16 (4%) | 2 (3%) |
| Washington | 2% | 10……(3%) | 20..(4%) | 25…..(4%) | 14 (3%) | 5 (8%) |
| York | 16% | 57….(15%) | 74.(15%) | 70….(11%) | 69 (15%) | 5 (8%) |
Race, ethnicity, and other demographic indicators of decedents
During January – August of 2022, out of 460 confirmed and suspected fatal overdoses for which race was reported, 419 (91%) of the victims were identified as White, 12 (3%) as Black or African American, 5 (1%) as American Indian/Alaska Native, and 1 (<1%) Hawaiian/Pacific Islander. Out of the 449 fatal overdoses for whom ethnicity was reported, 442 (98%) were reported as not Hispanic, and 7 (2%) were identified as Hispanic. Out of the 463 cases for which military background was reported, 32 (7%) were identified as having a military background. Prior overdose history was reported for 170 (37%) of the victims. Transient housing status was reported for 52 (11%) of the victims. The largest totals of undomiciled persons (January – August 2022) were found in Cumberland County (22, 42%), and Penobscot County (12, 23%), with under 5 each in York, Androscoggin, Aroostook, Kennebec, and Somerset Counties.
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2021 Est. N=627 Race N=621 Ethnicity | Jan-Aug 2022 Est. N=460 Race N=449 Ethnicity |
|---|---|---|---|
| Race and Ethnicity | |||
| White | 91% | 585 (93%) | 419 (91%) |
| Black or African American | 2% | 21 (3%) | 12 (3%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 5 (1%) |
| Other race, 2+ races combined, non-hispanic | 7% | 7 (1%) | 6 (1%) |
| Not Hispanic | 98% | 611 (99%) | 442 (98%) |
| Hispanic | 2% | 10 (2%) | 7 (2%) |
| Military Background | 32 (7%) | ||
| Prior Overdose History | 170 (37%) | ||
| Undomiciled/Transient Housing Status | 52 (11%) |
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 from 68% in 2019 to 71% in 2020 and 2021, and to 72% in the first eight months of 2022. The cumulative age distribution in January – August 2022 compared to 2021 shows 1 fewer decedent under age 18, a 2% increase in the proportion of those aged 18-39, a 3% decrease in those aged 40-59, and a 2% increase in the proportion 60 and above.
| % of 2020 Census Population | Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Aug 2022 Est. N=464 | Aug 2022 Est. N=65 | |
|---|---|---|---|---|---|---|
| Percent Males | 49% | 258..(68%) | 357…(71%) | 451.(71%) | 332…(72%) | 47 (72%) |
| Percent under 18 | 19% | 0….(0%) | 2…(<1%) | 2..(<1%) | 1…..(<1%) | 0 (0%) |
| Percent 18-39 | 26% | 171..(45%) | 213..(42%) | 247.(39%) | 189…(41%) | 25 (38%) |
| Percent 40-59 | 27% | 175..(46%) | 235..(47%) | 316.(50%) | 218..(47%) | 32 (49%) |
| Percent 60+ | 29% | 33….(9%) | 54…(11%) | 66..(10%) | 55…..(12%) | 8 (12%) |
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, that is, 75% in the first eight months of 2022. In the first eight months of 2022, law enforcement was more likely to respond to a scene alone (19%) than EMS (5%). The overwhelming majority (98%) of drug overdoses were ruled, or suspected of being, accidental manner of death.
During 2022, 26% of fatal overdose cases had naloxone administered at the scene by EMS, bystanders, or law enforcement. This rate is higher than the 22% of fatal overdose cases in which naloxone was reportedly administered at the scene in 2020, but slightly 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 12% of the fatal overdoses, often in addition to EMS and/or law enforcement. The 2020 drug death report documents only 4% of victims who had received bystander-administered naloxone and increased to only 9% of victims in 2021.
Based on 372 suspected and confirmed drug death cases with EMS records during January – August of 2022, 191 (51%) of victims were already deceased when EMS arrived. Of the remaining 181 (49%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 181 who were still alive when EMS arrive, only 60 (16%) remained alive long enough to be transported but died during transport or at the emergency room and 121 (67%) did not survive to be transported. This is likely due to the high number of cases with fentanyl as a cause of death. Fentanyl acts more quickly than other opioids and there is less time for victims to be found alive.
| Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Aug 2022 Est. N=463 | Aug 2022 Est. N=65 | |
|---|---|---|---|---|
| Public safety response | ||||
| ……EMS alone | 28…(6%) | 30….(5%) | 23….(5%) | 4 (6%) |
| ……Law enforcement alone | 107.(21%) | 104..(16%) | 88…(19%) | 12 (18%) |
| ……EMS and law enforcement | 365.(72%) | 485..(77%) | 349…(75%) | 49 (75%) |
| ……Private transport to the Emergency. Dept. | — | 7….(1%) | 5…..(1%) | 1 (2%) |
| Naloxone administration | ||||
| Naloxone administration reported at the scene | 83.(22%) | 187..(30%) | 122..(26%) | 15 (23%) |
| ……Bystander only | 11…(2%) | 36….(6%) | 27…(6%) | 2 (3%) |
| ……Law enforcement only | 8…(2%) | 22….(3%) | 19….(4%) | 4 (6%) |
| ……EMS only | 55..(11%) | 84..(13%) | 34…(7%) | 3 (5%) |
| ……EMS and law enforcement | 4…(1%) | 20….(3%) | 10….(2%) | 2 (3%) |
| ……EMS and bystander | 8..(2%) | 15….(2%) | 20….(4%) | 2 (3%) |
| ……Law enforcement and bystander | 0..(0%) | 5…..(1%) | 5….(1%) | 1 (2%) |
| ……EMS, bystander, and law enforcement | —……. | 2..(<1%) | 4….(1%) | 0 (0%) |
| ……Naloxone administered by unspecified person | —……. | 3..(<1%) | 3..(<1%) | 1 (2%) |
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 325 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 265 (78%), the slightly higher than the rate in 2021 (77%) and 11% higher than the rate 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 2% of 2022 deaths, 3% of 2021 deaths, compared to 11% in 2020. Methamphetamine was cited as a cause in 35% of the overdoses, a substantial increase from 27% in 2021. Cocaine-involved fatalities January – August constituted 26% of cases, a slight increase from 25% in 2021 and 23% in 2020. Fentanyl is found in combination with cocaine in 21% of 2022 cases, and in combination with methamphetamine in 28%. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 338 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 18 (5%) of confirmed overdose deaths, and 6 (2%) with tramadol listed along with fentanyl.
| Cause of death (alone or in combination with other drugs) Sample size for complete cases only | Jan-Dec 2020 N=504 | Jan-Dec 2021 N=627 | Jan-Aug 2022 N=338 | Aug 2022 N=0 |
|---|---|---|---|---|
| Nonpharmaceutical opioids | ||||
| ……Fentanyl or fentanyl analogs | 336.(67%) | 489..(77%) | 265..(78%) | 0 (0%) |
| ……Heroin | 57..(11%) | 22….(3%) | 8….(2%) | 0 (0%) |
| Nonpharmaceutical Stimulants | ||||
| ……Cocaine | 118.(23%) | 156..(25%) | 89.(26%) | 0 (0%) |
| ……Methamphetamine | 99.(20%) | 172..(27%) | 117.(35%) | 0 (0%) |
| Pharmaceutical opioids** | 118.(23%) | 130..(21%) | 68..(20%) | 0 (0%) |
| Key combinations | ||||
| ……Fentanyl and heroin | 47…(9%) | 20….(3%) | 8….(2%) | 0 (0%) |
| ……Fentanyl and cocaine | 97.(19%) | 127..(20%) | 71..(21%) | 0 (0%) |
| ……Fentanyl and methamphetamine | 70.(14%) | 133..(21%) | 96..(28%) | 0 (0%) |
| ……Fentanyl and xylazine | 0…(0%) | 53….(8%) | 18….(5%) | 0 (0%) |
| ……Fentanyl and tramadol | 0…(0%) | 24….(4%) | 6….(2%) | 0 (0%) |
Highlight of the month regarding substance use disorder public policy response
Recovery Residences
This month we highlight the work of the Maine Association of Recovery Residences (MARR) and the continuing increases in the number of beds available for Mainers seeking a safe and drug-free environment in their early stage of recovery from substance use disorders. As of the end of September, 2022, there were 67 certified recovery residences in the state. Seventy-eight percent of these residences welcome residents on medication for opioid use disorders (MOUD). By the end of this calendar year, it is anticipated that over 70 certified houses will be open across the state. For the first time, two residences for men in Portland now offer housing to men on medication. The MARR website is updated on a daily basis and provides important information to those individuals seeking a bed. Financial assistance is available from the state through the Maine State Housing Authority in those instances where the residences are certified and accepting of individuals on medication. General Assistance is available through local communities for residences that are certified.
The MARR certification standards are consistent with the standards of the National Alliance of Recovery Residences, considered the gold standard for recovery residences. In addition to certified residences, there are approximately 60 additional recovery residences (sometimes referred to as sober homes) that are available in the state. While these facilities are not licensed or certified, they are required to meet local zoning requirements for any single family home.
In late September, MARR sponsored four workshops on stigma reduction presented by national consultant Tedra Cobb. These workshops were presented at recovery community centers in Portland, Bangor, Augusta and Bath.
For more information, go to http: www.mainerecoveryresidences.com