Download the entire PDF report here: Maine Monthly Overdose Report for August 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 August, the proportion of fatal overdoses averaged 5.8% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.1% in March and a high of 8.1% in April. During August 2023, there were an estimated 782 fatal and nonfatal drug overdoses statewide, of which 45 (5.8%) were suspected and confirmed fatal overdoses. The remaining 737 (94.2%) were nonfatal overdoses: 324 (41.4%) emergency department visits; 247 (31.6%) EMS patents who were not transported to the emergency room, 152 (19.4%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 14 (1.8%) 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 | 45 | 295 | 206 | 178 | 39 | 763 |
| Feb ’22 | 48 | 333 | 185 | 153 | 37 | 756 |
| Mar ’22 | 65 | 458 | 201 | 202 | 30 | 956 |
| Apr ’22 | 60 | 290 | 178 | 189 | 26 | 743 |
| May ’22 | 47 | 402 | 248 | 186 | 41 | 924 |
| Jun ’22 | 66 | 482 | 250 | 177 | 44 | 1013 |
| Jul ’22 | 66 | 347 | 287 | 183 | 40 | 923 |
| Aug ’22 | 64 | 385 | 272 | 255 | 37 | 1013 |
| Sep ’22 | 55 | 458 | 256 | 153 | 33 | 955 |
| Oct ’22 | 65 | 283 | 238 | 177 | 27 | 790 |
| Nov ’22 | 66 | 287 | 206 | 200 | 20 | 779 |
| Dec ’22 | 76 | 362 | 212 | 198 | 14 | 862 |
| 2022 Total | 723 | 4,382 | 2,739 | 2,251 | 388 | 10,483 |
| 2022 Total % | 6.9% | 41.8% | 26.1% | 21.5% | 3.7% | 100% |
| Jan ’23 | 54 | 296 | 219 | 184 | 44 | 797 |
| Feb ’23 | 49 | 348 | 226 | 192 | 27 | 842 |
| Mar ’23 | 40 | 382 | 256 | 237 | 54 | 969 |
| Apr ’23 | 63 | 270 | 218 | 202 | 27 | 780 |
| May ’23 | 49 | 295 | 221 | 165 | 30 | 760 |
| Jun ’23 | 58 | 378 | 228 | 219 | 26 | 909 |
| Jul ’23 | 51 | 336 | 248 | 173 | 18 | 826 |
| Aug ’23 | 45 | 324 | 247 | 152 | 14 | 782 |
| 2023 Total | 409 | 2,629 | 1,863 | 1,524 | 240 | 6,665 |
| 2023 Total % | 6.1% | 39.4% | 28.0% | 22.9% | 3.6% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine August 2023
Fatal Drug Overdoses in Maine Jan – Aug 2023
During 2023, the proportion of fatal overdoses averaged 6.1% of total overdoses. From January to August 2023 there was a total 409 fatal drug overdoses consisting of 377 confirmed and 32 suspected drug deaths. In August 2023 there were 45 fatal drug overdoses consisting of 18 confirmed and 27 suspected cases. The graph below shows the considerable monthly fluctuation since January of 2022. The range extends from 76 (December 2022) to 40 (March 2023). During 2023, the monthly proportions fluctuated from a low of 4.1% in March and a high of 8.1% in April. During the first eight months of 2023, fatal overdoses comprised 6.1% of all overdoses; this proportion slightly lower than the 6.9% for 2022. There were 409 confirmed and suspected fatal overdoses in the first eight months of 2023; this is 11.3% lower than the 461 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 – August 2023 as well as 2022.
| Maine EMS | Law Enforcement | |
| Fatal Overdose Response 2022 | 582 | 672 |
| Nonfatal Overdose Response 2022 | 9,376 | 1,471 |
| Total Overdose Response 2022 | 9,958 | 2,143 |
| Fatal Overdose Response Jan – Aug 2023 | 330 | 380 |
| Nonfatal Overdose Response Jan – Aug 2023 | 6,028 | 794 |
| Total Overdose Response Jan – Aug 2023 | 6,358 | 1,174 |
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 August 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 – July percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Androscoggin County and Penobscot County are 3 percentage points higher than the 2020 census proportion. York County is 4 percentage points lower than the 2020 census proportion.
Nonfatal Drug Overdoses in Maine, August 2023
Nonfatal Drug Overdoses in Maine, Jan 2023 – Aug 2023
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=9377 | Jan-Jul 2023 Est. N=6028 | Jul 2023 Est. N=779 |
|---|---|---|---|---|
| Androscoggin | 8% | 1055 (11%) | 644 (11%) | 88 (11%) |
| Aroostook | 5% | 490 (5%) | 284 (5%) | 43 (6%) |
| Cumberland | 22% | 2194 (23%) | 1391 (23%) | 184 (24%) |
| Franklin | 2% | 140 (1%) | 86 (1%) | 8 (1%) |
| Hancock | 4% | 287 (3%) | 187 (3%) | 18 (2%) |
| Kennebec | 9% | 922 (10%) | 607 (10%) | 80 (10%) |
| Knox | 3% | 245 (3%) | 209 (3%) | 27 (3%) |
| Lincoln | 3% | 162 (2%) | 110 (2%) | 15 (2%) |
| Oxford | 4% | 410 (4%) | 236 (4%) | 31 (4%) |
| Penobscot | 11% | 1293 (14%) | 869 (14%) | 119 (15%) |
| Piscataquis | 1% | 90 (1%) | 73 (1%) | 6 (1%) |
| Sagadahoc | 3% | 130 (1%) | 92 (2%) | 11 (1%) |
| Somerset | 4% | 392 (4%) | 284 (5%) | 30 (4%) |
| Waldo | 3% | 199 (2%) | 133 (2%) | 17 (2%) |
| Washington | 2% | 221 (2%) | 118 (2%) | 19 (2%) |
| York | 16% | 1147 (12%) | 705 (12%) | 83 (11%) |
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 – August 2023 percentages of deaths in most counties fall within plus or minus 0 to 2 percentage points of the 2020 census distribution. Androscoggin County and Penobscot County are 4 percentage points higher. York County is 5 percentage points lower than the 2020 census proportion.
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=723 | Jan-Jul 2023 Est. N=409 | Jul 2023 Est. N=45 |
|---|---|---|---|---|
| Androscoggin | 8% | 69 (10%) | 49 (12%) | 3 (7%) |
| Aroostook | 5% | 47 (7%) | 23 (6%) | 4 (9%) |
| Cumberland | 22% | 134 (19%) | 84 (21%) | 7 (16%) |
| Franklin | 2% | 13 (2%) | 8 (2%) | 3 (7%) |
| Hancock | 4% | 24 (3%) | 10 (2%) | 2 (4%) |
| Kennebec | 9% | 54 (7%) | 39 (10%) | 3 (7%) |
| Knox | 3% | 20 (3%) | 9 (2%) | 2 (4%) |
| Lincoln | 3% | 14 (2%) | 6 (1%) | 0 (0%) |
| Oxford | 4% | 36 (5%) | 12 (3%) | 2 (4%) |
| Penobscot | 11% | 109 (15%) | 62 (15%) | 7 (16%) |
| Piscataquis | 1% | 9 (1%) | 12 (3%) | 0 (0%) |
| Sagadahoc | 3% | 11 (2%) | 6 (1%) | 2 (4%) |
| Somerset | 4% | 35 (5%) | 22 (5%) | 6 (13%) |
| Waldo | 3% | 21 (3%) | 4 (1%) | 0 (0%) |
| Washington | 2% | 24 (3%) | 16 (4%) | 1 (2%) |
| York | 16% | 103 (14%) | 47 (11%) | 3 (7%) |
Race, ethnicity, and other demographic indicators of decedents
During the first eight months of 2023, out of 408 confirmed and suspected fatal overdoses for which race was reported, 366 (90%) of the victims were identified as White, 15 (4%) as Black or African American, and 8 (2%) as American Indian/Alaska Native. Out of the 400 fatal overdoses for whom ethnicity was reported, 396 (99%) were reported as not Hispanic, and 4 (1%) were identified as Hispanic.
Out of the 409 cases for which military background was reported in January – August 2023, 25 (6%) were identified as having a military background. Out of the 45 cases in July 2023 where military background was reported, 3 (7%) were identified as having a military background.
Prior overdose history was reported for 150 (37%) of the victims during January – August 2023.
Of 409 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 48 (12%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (15, 31%), Penobscot County (13, 27%) and Androscoggin County (8, 17%). In August 2023, 8 decedents (18%) were identified as undomiciled.
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2022 Est. Race N=720 Ethnicity N=706 | Jan-Aug 2023 Est. Race N=408 Ethnicity N=400 | Aug 2023 Est. Race N=45 Ethnicity N=45 |
|---|---|---|---|---|
| Race and Ethnicity | ||||
| White | 91% | 670 (90%) | 366 (90%) | 42 (93%) |
| Black or African American | 2% | 17 (2%) | 15 (4%) | 3 (7%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 8 (2%) | 0 (0%) |
| Other race, 2+ races combined, non-hispanic | 7% | 12 (2%) | 7 (2%) | 0 (0%) |
| Not Hispanic | 98% | 699 (99%) | 396 (99%) | 45 (100%) |
| Hispanic | 2% | 7 (1%) | 4 (1%) | 0 (0%) |
| Military Background | 81 (11%) | 25 (6%) | 3 (7%) | |
| Prior Overdose History | 269 (37%) | 150 (37%) | 14 (31%) | |
| Undomiciled/Transient Housing Status | 81 (11%) | 48 (12%) | 8 (18%) |
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, 73% in 2022, and 74% in the first eight months in 2023. The cumulative age distribution in January – August 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 1 deaths in 2023, a 4 percentage point decrease in the proportion of those aged 18-39, a 3 percentage point increase in those aged 40-59, and no change in the proportion 60 and above.
| % of 2020 Census Population | Jan-Dec 2022 Est. N=723 | Jan-Aug 2023 Est. N=409 | Aug 2023 Est. N=45 | |
|---|---|---|---|---|
| Percent Males | 49% | 527…(73%) | 303 (74%) | 35 (78%) |
| Percent under 18 | 19% | 3…(<1%) | 1 (<1%) | 0 (0%) |
| Percent 18-39 | 26% | 295…(41%) | 152 (37%) | 20 (44%) |
| Percent 40-59 | 27% | 333..(46%) | 201 (49%) | 20 (44%) |
| Percent 60+ | 29% | 92…(13%) | 55 (13%) | 5 (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 (74%) in 2023. In 2023, law enforcement was more likely to respond to a scene alone (19%) than EMS (6%). The overwhelming majority (93%) of drug overdoses were ruled, or suspected of being, accidental manner of death.
During 2023, 25% 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, the same as reported in 2022, and 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 14% (58) 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 330 suspected and confirmed drug death cases with EMS involvement during the first eight months of 2023, 185 (56%) of victims were already deceased when EMS arrived. In the remaining 145 (44%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 145 who were still alive when EMS arrived, only 42 (29%) remained alive long enough to be transported but died during transport or at the emergency room and 102 (70%) did not survive to be transported and 1 had an unknown status. 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=723 | Jan – Jul 2023 Est. N=409 | Jul 2023 Est. N=45 | |
|---|---|---|---|
| Public safety response | |||
| ……EMS alone | 38….(5%) | 26 (6%) | 5 (11%) |
| ……Law enforcement alone | 131…(18%) | 76 (19%) | 8 (18%) |
| ……EMS and law enforcement | 541…(75%) | 304 (75%) | 31 (69%) |
| ……Private transport to the Emergency. Dept. | 13…..(2%) | 2 (<1%) | 1 (2%) |
| Naloxone administration | |||
| Naloxone administration reported at the scene | 182..(25%) | 104 (25%) | 11 (24%) |
| ……Bystander only | 44…(6%) | 25 (6%) | 1 (2%) |
| ……Law enforcement only | 31….(4%) | 9 (2%) | 1 (2%) |
| ……EMS only | 49….(7%) | 31 (8%) | 3 (7%) |
| ……EMS and law enforcement | 11….(2%) | 4 (1%) | 1 (2%) |
| ……EMS and bystander | 26….(4%) | 24 (6%) | 3 (7%) |
| ……Law enforcement and bystander | 5….(1%) | 6 (1%) | 1 (2%) |
| ……EMS, bystander, and law enforcement | 6….(1%) | 3 (1%) | 3 (7%) |
| ……Naloxone administered by unspecified person | 0…(0%) | 1 (<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 377 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 296 (79%).
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% (9) 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% (119) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – August constituted 35% (133) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 82% (109) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 82% (98) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 377 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 33 (9%) of confirmed overdose deaths, and 2 (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=723 | Jan-Aug 2023 N=377 | *Aug 2023 N=13 |
|---|---|---|---|
| Nonpharmaceutical opioids | |||
| ……Fentanyl or fentanyl analogs | 560..(77%) | 296 (79%) | 14 (78%) |
| ……Heroin | 19….(3%) | 9 (2%) | 0 (0%) |
| Nonpharmaceutical Stimulants | |||
| ……Cocaine | 213.(29%) | 133 (35%) | 8 (44%) |
| ……Methamphetamine | 234.(32%) | 119 (32%) | 6 (33%) |
| Pharmaceutical opioids** | 156..(22%) | 67 (18%) | 5 (28%) |
| Key combinations | |||
| ……Fentanyl and heroin | 18….(2%) | 9 (2%) | 0 (0%) |
| ……Fentanyl and cocaine | 171..(24%) | 109 (29%) | 7 (39%) |
| ……Fentanyl and methamphetamine | 189..(26%) | 98 (26%) | 4 (22%) |
| ……Fentanyl and xylazine | 46….(6%) | 33 (9%) | 1 (6%) |
| ……Fentanyl and tramadol | 10….(1%) | 2 (1%) | 1 (6%) |
**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
UPDATE ON MAINE RECOVERY COUNCIL
The Maine Recovery Council was established in late November, 2022, to be the recipient of one-half of the funds received by the state through the national opioid litigation settlements. The Council consists of 15 appointees and its legal basis is found in both the Maine State Subdivision Memorandum of Understanding and Agreement Regarding Use of Settlement Funds (including Schedule A, Core Strategies and Schedule B, Approved Uses), as incorporated into the court orders establishing the settlements, and Public Law 2022 Chapter 661 (L.D. 1722) enacted by the legislature and signed into law as an emergency measure by Governor Janet T. Mills on April 25, 2022.
The core functions of the Council include doing a needs assessment, facilitating collaboration among state, subdivisions and stakeholders and distributing grants from the Maine Recovery Fund through a transparent process. Settlement proceeds will be received by the Fund every year for 18 years and as of Oct. 1, 2023, there is approximately $17 million available to spend.
In the last year, the Council has completed some critical administrative/organizational tasks such as establishing bylaws and a conflict-of-interest policy. In the future, the Council will be receiving public input into its spending plan with an expectation of starting to make funds available no later than early 2024.
The Council is also required to develop a centralized public dashboard or other repository for publication of expenditure data and will require outcome related data from any entity that receives funds from the Council. All the spending must be consistent with the opioid remediation uses set forth in schedules A and B of the Memorandum of Understanding filed in Maine Superior Court.Council appointments were made in 2022 by Governor Mills, Attorney General Aaron Frey, the President of the Maine Senate Troy Jackson and the Speaker of the House Ryan M. Fecteau and certain of the 39 subdivisions that will be receiving funds directly during the duration of the 18-year pay-out. The current members of the Council are as follows:
- Liz Blackwell-Moore, Public Health Director, Cumberland County
- Todd Brackett, Sheriff of Lincoln County
- Rep. Lydia Crafts, Maine State Representative for House District 46
- Joseph Everett, President & CEO, Opportunity Alliance, Portland
- Betsy Fitzgerald, former County Administrator, Washington County
- Courtney Gary-Allen, Organizing Director, Maine Recovery Advocacy Project
- Pat Kimball, retired and former President of Wellspring, Bangor
- Benjamin Mann, Deputy Commissioner of Finance, Maine DHHS
- Bruce Noddin, Executive Director/Founder, Maine Prisoner Re-entry Network
- Myles Ouellette, MBA, LADC, CCS Aroostook County
- Eric Small, Deputy Chief, Sanford Police Department
- Gordon Smith, J.D., Director of Opioid Response, Office of the Governor
- Kinna Thakarar, M.D., Infectious Disease and Addiction Medicine specialist
- Chasity Tuell, Director, Northern Maine Director of Harm Reduction Services, Maine Access Points
- Paul Vinsel, D.O., Physician specializing in Addiction Medicine, Tri-County Mental Health Services, Lewiston
Council Members serve two-year terms with a limit of two terms. Pat Kimball is the current chair and in that capacity also chairs the Executive Committee. The Council recently established subcommittees on Governance, Finance, and Grants and Programs. Administrative support currently provided to the Council by the Office of the Attorney General, the Council is currently in the process of contracting for additional administrative and consulting assistance.
The Council meets every month and all the meetings of the Council and its subcommittees are public meetings and at least a two-week notice is provided to the public. Currently, members of the public can attend meetings in-person or via a remote link to zoom. The second Thursday of each month, from 2:00 to 4:00pm is the current meeting time of the full council and the meetings are generally held at 109 Capital St. in Augusta.
More information on the Council and its work, including the opportunity to sign up for notices of meetings, and the opioid settlements generally can be found on the following websites:
www.maine.gov/ag/recovery-council
Communications can be sent to the Council at info.recoverycouncil@maine.gov