December 2023 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for December 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 December, the proportion of fatal overdoses averaged 6.7% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.3% in March and a high of 8.1% in April. During December 2023, there were an estimated 704 fatal and nonfatal drug overdoses statewide, of which 47 (6.7%) were suspected and confirmed fatal overdoses. The remaining 657 (93.3%) were nonfatal overdoses: 322 (45.7%) emergency department visits; 183 (26.0%) EMS patents who were not transported to the emergency room, 129 (18.3%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 23 (3.3%) 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	221	184	48	803
Feb ’23	49	348	185	192	30	804
Mar ’23	41	382	246	237	54	960
Apr ’23	63	270	217	202	29	781
May ’23	49	295	223	165	47	779
Jun ’23	58	378	209	219	35	899
Jul ’23	50	339	291	173	34	887
Aug ’23	40	330	247	152	22	791
Sep ’23	53	390	235	141	26	845
Oct ’23	55	316	254	147	17	789
Nov ’23	48	253	190	101	20	612
Dec ’23	47	322	183	129	23	704
2023 Total	607	3,919	2,701	2,042	385	9,654
2023 Total %	6.3%	40.6%	28.0%	21.2%	4.0%	100%

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Number of suspected and confirmed fatal overdoses

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 – December 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 2023	485	564
Nonfatal Overdose Response 2023	8,839	1,050
Total Overdose Response 2023	9,324	1,614

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 December 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 – December percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Penobscot County is 3 percentage points higher and Androscoggin County is 2 percentage points higher than the 2020 census proportion. York County is 4 percentage points lower and Sagadahoc County is 2 percentage points lower than the 2020 census proportion.

	% 2020 estimated Census population	Jan–Dec 2022 Est. N = 9377		Jan-Dec 2023 Est. N = 8839		Dec 2023 Est. N = 659
Androscoggin	8%	1055	11%	912	10%	75	11%
Aroostook	5%	490	5%	447	5%	41	6%
Cumberland	22%	2194	23%	2036	23%	153	23%
Franklin	2%	140	1%	138	2%	6	1%
Hancock	4%	287	3%	255	3%	15	2%
Kennebec	9%	922	10%	871	10%	67	10%
Knox	3%	245	3%	300	3%	14	2%
Lincoln	3%	162	2%	185	2%	14	2%
Oxford	4%	410	4%	355	4%	29	4%
Penobscot	11%	1293	14%	1253	14%	80	12%
Piscataquis	1%	90	1%	109	1%	9	1%
Sagadahoc	3%	130	1%	130	1%	12	2%
Somerset	4%	392	4%	431	5%	28	4%
Waldo	3%	199	2%	193	2%	18	3%
Washington	2%	221	2%	193	2%	22	3%
York	16%	1147	12%	1031	12%	76	12%

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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. Penobscot County is 4 percentage points higher than the 2020 census proportion, Androscoggin County is 3 percentage points higher and Piscataquis County as well as Washington County are 2 percentage points higher than the 2020 census proportion. York County is 5 percentage points lower and Lincoln County and Sagadahoc County are 2 percentage points lower than the 2020 census proportion.

	% 2020 estimated Census population	Jan–Dec 2022		Jan-Dec 2023		Dec-23
		N = 723		Est. N = 605		Est N = 47
Androscoggin	8%	69	10%	69	11%	4	9%
Aroostook	5%	47	7%	39	6%	5	11%
Cumberland	22%	134	19%	117	19%	6	13%
Franklin	2%	13	2%	6	1%	0	0%
Hancock	4%	24	3%	22	4%	2	4%
Kennebec	9%	54	7%	61	10%	5	11%
Knox	3%	20	3%	16	3%	1	2%
Lincoln	3%	14	2%	7	1%	1	2%
Oxford	4%	36	5%	24	4%	5	11%
Penobscot	11%	109	15%	93	15%	10	21%
Piscataquis	1%	9	1%	16	3%	1	2%
Sagadahoc	3%	11	2%	7	1%	2	4%
Somerset	4%	35	5%	29	5%	1	2%
Waldo	3%	21	3%	10	2%	0	0%
Washington	2%	24	3%	25	4%	1	2%
York	16%	103	14%	64	11%	3	6%

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Race, ethnicity, and other demographic indicators of decedents

During 2023, out of 606 confirmed and suspected fatal overdoses for which race was reported, 537 (89%) of the victims were identified as White, 24 (4%) as Black or African American, and 11 (2%) as American Indian/Alaska Native. Out of the 590 fatal overdoses for whom ethnicity was reported, 583 (99%) were reported as not Hispanic, and 7 (1%) were identified as Hispanic.

Out of the 607 cases for which military background was reported in January – December 2023, 34 (6%) were identified as having a military background. Out of the 47 cases in December 2023 where military background was reported, 4 (9%) were identified as having a military background.

Of 607 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 72 (13%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (25, 35%), Penobscot County (16, 22%), Androscoggin County (11, 15%), and Kennebec County (7, 10%). In December 2023, 6 decedents (13%) were identified as undomiciled.

Demographic Indicator	% of 2020 Census Population	Jan-Dec 2022 Race N=720 Ethnicity N=706	Jan-Dec 2023 Est. Race N=558 Ethnicity N=544	Dec 2023 Est. Race N=47 Ethnicity N=45
Race and Ethnicity
White	91%	670 (90%)	537 (89%)	43 (91%)
Black or African American	2%	17 (2%)	24 (4%)	1 (2%)
American Indian/Alaska Native	1%	14 (2%)	11 (2%)	1 (2%)
Other race, 2+ races combined, non-hispanic	7%	12 (2%)	11 (2%)	0 (0%)
Not Hispanic	98%	699 (99%)	583 (99%)	45 (100%)
Hispanic	2%	7 (1%)	7 (1%)	0 (0%)
Military Background		81 (11%)	34 (6%)	4 (9%)
Undomiciled/Transient Housing Status		81 (11%)	72 (13%)	6 (13%)

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 73% in 2023. The cumulative age distribution in 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 3 deaths under 18 in 2023, a 5 percentage point decrease in the proportion of those aged 18-39, a 2 percentage point increase in those aged 40-59, and a 2 percentage point increase in those 60 and above.

	% 2020 estimated Census population	Jan–Dec 2022		Jan–Dec 2023		Dec-23
		N = 723		Est. N= 607		Est. N = 47
Males	49%	527	73%	442	73%	32	68%
Under 18	19%	3	0%	3	0%	0	0%
18–39	26%	295	41%	221	36%	16	34%
40–59	27%	333	46%	293	48%	16	34%
60+	29%	92	13%	90	15%	15	32%

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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 (73%) 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. Of the 607 confirmed or suspected fatal overdoses in 2023, 206 (34%) had a history of prior overdose.

During 2023, 25% 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, and the same as the proportion in 2022 (25%). 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% (82) 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 483 suspected and confirmed drug death cases with EMS involvement during 2023, 266 (55%) of victims were already deceased when EMS arrived. In the remaining 217 (44%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 217 who were still alive when EMS arrived, only 64 (29%) remained alive long enough to be transported but died during transport or at the emergency room and 151 (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		Jan–Dec 2023		Dec-23
	N = 723		Est. N = 607		Est N = 47
EMS response alone	38	5%	36	6%	4	9%
Law enforcement alone	131	18%	117	19%	10	21%
EMS and law enforcement	541	75%	446	73%	32	68%
Private transport to Emergency Dept.	13	2%	5	1%	1	2%
Naloxone administration reported at the scene	182	25%	154	25%	12	26%
Bystander only administered	44	6%	40	7%	4	9%
Law enforcement only administered	31	4%	15	2%	0	0%
EMS only administered	49	7%	43	7%	6	13%
EMS and law enforcement administered	11	2%	15	2%	2	4%
EMS and bystander administered	26	4%	34	6%	0	0%
Law enforcement and bystander administered	5	1%	12	2%	0	0%
EMS, bystander, and law enforcement administered	6	1%	4	1%	0	0%
Naloxone administered by unspecified person	0	0%	1	0%	0	0%
History of prior overdose	269	37%	206	34%	10	21%

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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 560 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 435 (78%).

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% (12) of 2023 deaths and 3% (19) of 2022 deaths, compared to 11% (57) in 2020. Methamphetamine was cited as a cause of death in 31% (173) of the overdoses, a slight decrease from 32% in 2022. Cocaine-involved fatalities in 2023 constituted 37% (209) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 85% (177) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 83% (143) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 560 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 49 (9%) of confirmed overdose deaths, and 3 (1%) with tramadol listed along with fentanyl. 

Cause of death (alone or in combination with other drugs) Sample size for confirmed cases only	Jan–Dec 2022		Jan–Dec 2023		Dec-23
	N = 723		Est. N = 560		Est. N = 15
Fentanyl or fentanyl analogs	560	77%	435	78%	11	73%
Heroin	19	3%	12	2%	0	0%
Cocaine	213	29%	209	37%	8	53%
Methamphetamine	234	32%	173	31%	2	13%
Pharmaceutical opioids**	156	22%	103	18%	4	27%
Fentanyl and heroin	18	2%	12	2%	0	0%
Fentanyl and cocaine	171	24%	177	32%	7	47%
Fentanyl and methamphetamine	189	26%	143	26%	1	7%
Fentanyl and xylazine	46	6%	49	9%	2	13%
Fentanyl and tramadol	10	1%	3	1%	0	0%

Highlight of the Month

State Continues opioid response by investing more funds in treatment, harm-reduction, and recovery support

Continuing to build on investments made since early 2019, Governor Janet T. Mills in her State of the State, Part 1, message to the Maine Legislature on Jan. 30 announced several new opioid response initiatives. Here are relevant excerpts from that message:

     Over the past five years, we have used every proven tool we have to respond to the opioid epidemic. Our focus has been on stopping deadly drugs from getting onto our streets, on saving lives by distributing naloxone statewide, on expanding treatment and recovery programs, especially in rural areas; and by preventing substance use disorder before people begin to use drugs….

I propose that we build on this important work in three ways:

First, my administration will use $750,000 of existing state funding to add nine new recovery coaches to our OPTIONS teams. We are already using state funds to double the number of behavioral health clinicians on those teams and this latest investment will further strengthen the OPTIONS initiative statewide.

Second, I am announcing that my administration will use $1.25 million in federal funds to further boost our distribution of naloxone access across Maine, which we know is saving lives.

And third, I am proposing we dedicate $4 million through the supplemental budget to expand Medication Assisted Treatment in county jails in Maine—to provide more support to more people.

Thanks to Commissioner Randy Liberty, the Department of Corrections has become a national model for programs, including Medication Assisted Treatment, that people need to turn their lives around. Let’s keep investing in those programs, reduce recidivism, and protect public safety.

We have also hired additional peer outreach workers, and we are purchasing and distributing provider test strips for xylazine, as well as funding education and outreach, to ensure that people can recognize the new and deadly drug being sold on our streets—a drug that has no overdose reversal.

We are also making progress in expanding prevention programs in Maine schools to keep our young people from using drugs in the first place…my administration has partnered with the Maine Prevention Network, as well as local community leaders and philanthropic organizations, to begin establishing prevention programs in middle schools across Maine. We are on track to achieve our goal of establishing a prevention program in every school in our state by 2026, solidifying our “whole community” approach to combatting substance use disorder from an early age.

In all, we are on track to see a more than 16% reduction in fatal overdose deaths in 2023, the first time in five years we’ve recorded an annual decrease. I believe that the investments we have made in prevention, treatment and recovery services have contributed to that decrease.

This welcome news should bring us all a sense of relief, but our cautious optimism should not become complacency.

Every life lost to a fatal overdose is one too many. The people we lost in 2023 were fathers and mothers, sons and daughters, classmates and co-workers, who did not live to realize their full potential.

We must use all state and federal funding, and funding from the Maine Recovery Council, to strengthen prevention, treatment and recovery services in Maine.

I have long said that there is no simple solution to the opioid epidemic, but this most recent data gives us a reason to hope that we may be finally beginning to turn back the tide.

Janet T. Mills

Governor, State of Maine

Jan. 30, 2024

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