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 OverdosesEmergency Department
EMS Not Transported
to the ED Nonfatal
Community Reversals
Law Enforcement
Without EMS 
Nonfatal (estimated)
Total Overdoses
Jan ’224529520617839763
Feb ’224833318515337756
Mar ’226545820120230956
Apr ’226029017818926743
May ’224740224818641924
Jun ’2266482250177441013
Jul ’226634728718340923
Aug ’2264385272255371013
Sep ’225545825615333955
Oct ’226528323817727790
Nov ’226628720620020779
Dec ’227636221219814862
2022 Total7234,3822,7392,25138810,483
2022 Total %6.9%41.8%26.1%21.5%3.7%100%
Jan ’235429622118448803
Feb ’234934818519230804
Mar ’234138224623754960
Apr ’236327021720229781
May ’234929522316547779
Jun ’235837820921935899
Jul ’235033929117334887
Aug ’234033024715222791
Sep ’235339023514126845
Oct ’235531625414717789
Nov ’234825319010120612
Dec ’234732218312923704
2023 Total6073,9192,7012,0423859,654
2023 Total %6.3%40.6%28.0%21.2%4.0%100%
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses. Fatal overdoses in those categories have been removed.

Number of suspected and confirmed fatal overdoses

Fatal Drug Overdoses in Maine December 2023

Fatal Drug Overdoses in Maine Jan – Dec 2023

During 2023, the proportion of fatal overdoses averaged 6.3% of total overdoses. From January to December 2023, there were a total 607 fatal drug overdoses consisting of 560 confirmed and 47 suspected drug deaths. In December, 2023 there were 47 fatal drug overdoses consisting of 15 confirmed and 32 suspected cases. The graph below shows the considerable monthly fluctuation since January of 2022. The range extends from 76 (December 2022) to 41 (March 2023). During 2023, the monthly proportions fluctuated from a low of 4.3% in March and a high of 8.1% in April. During 2023, fatal overdoses comprised 6.3% of all overdoses; this proportion lower than the 6.9% for 2022. There were 607 confirmed and suspected fatal overdoses in 2023; this is 16.0% lower than the 723 fatal overdoses during the same time period in 2022. The total number of nonfatal overdose January-December, 2023 is 9,047, 7.3% lower than the total confirmed nonfatal overdoses for the same period in 2022, 9,760.

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 – December 2023 as well as 2022.

Maine EMSLaw Enforcement
Fatal Overdose
Response 2022
Nonfatal Overdose
Response 2022
Total Overdose
Response 2022
Fatal Overdose
Response 2023
Nonfatal Overdose
Response 2023
Total Overdose
Response 2023
*Please note numbers will fluctuate from month-to-month as public safety agencies catch up their reporting . Due to methodological convention, alcohol-only cases are excluded from this table.  However, we recognize that alcohol is a large part of substance misuse epidemic. Cases with both drugs and alcohol are included. 

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.

Nonfatal Drug Overdoses in Maine, December 2023

Nonfatal Drug Overdoses in Maine, Jan 2023 – Dec 2023

 % 2020 estimated Census populationJan–Dec 2022 Est. N = 9377Jan-Dec 2023 Est. N = 8839Dec 2023 Est. N = 659

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 populationJan–Dec 2022Jan-Dec 2023Dec-23
N = 723Est. N = 605Est N = 47

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
Race N=720
Ethnicity N=706
2023 Est.
Race N=558
Ethnicity N=544
2023 Est.
Race N=47
Ethnicity N=45
Race and Ethnicity
White91%670 (90%)537 (89%)43 (91%)
Black or African American2%17 (2%)24 (4%)1 (2%)
American Indian/Alaska Native1%14 (2%)11 (2%)1 (2%)
Other race,
2+ races combined, non-hispanic
7%12 (2%)11 (2%)0 (0%)
Not Hispanic98%699 (99%)583 (99%)45 (100%)
Hispanic2%7 (1%)7 (1%)0 (0%)
Military Background81 (11%)34 (6%)4 (9%)
Undomiciled/Transient Housing Status81 (11%)72 (13%)6 (13%)
*Table totals may not add up to 100% due to rounding.

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 populationJan–Dec 2022Jan–Dec 2023Dec-23
N = 723Est. N= 607Est. N = 47
Under 1819%30%30%00%

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 2022Jan–Dec 2023Dec-23
N = 723Est. N = 607Est N = 47
EMS response alone385%366%49%
Law enforcement alone13118%11719%1021%
EMS and law enforcement54175%44673%3268%
Private transport to Emergency Dept.132%51%12%
Naloxone administration reported at the scene18225%15425%1226%
Bystander only administered446%407%49%
Law enforcement only administered314%152%00%
EMS only administered497%437%613%
EMS and law enforcement administered112%152%24%
EMS and bystander administered264%346%00%
Law enforcement and bystander administered51%122%00%
EMS, bystander, and law enforcement administered61%41%00%
Naloxone administered by unspecified person00%10%00%
History of prior overdose26937%20634%1021%

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 onlyJan–Dec 2022Jan–Dec 2023Dec-23
N = 723Est. N = 560Est. N = 15
Fentanyl or fentanyl analogs56077%43578%1173%
Pharmaceutical opioids**15622%10318%427%
Fentanyl and heroin182%122%00%
Fentanyl and cocaine17124%17732%747%
Fentanyl and methamphetamine18926%14326%17%
Fentanyl and xylazine466%499%213%
Fentanyl and tramadol101%31%00%

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