February 2021 Monthly Overdose Report

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

Fatal Drug Overdoses in Maine January – February 2021

The February 2021 total of 45 fatal drug overdoses consists of 27 confirmed drug deaths and 18 suspected drug deaths. The graph below shows the considerable monthly fluctuation over the past year. Although the 2020 average is 42, the range extends from 34 to 53. The January 2021 number of fatal drug overdoses is currently 54 confirmed and one suspected. 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 February 2021.

Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The February 2021 totals can be compared either to the percent of the census population on the left or the percent of all Maine drug deaths for 2020 also on the left. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. In general, the percentages for February for most counties accord with both the 2020 patterns and the census distribution. Cumberland and York are lower than their share of the population, Kennebec and Penobscot are higher.

CountyPercent of 2019
Census Population
Jan-Dec 2020
Est. N=503
January 2021
Est. N=55
February 2021
Est. N=45
Cumulative Jan-Feb 2021
Est. N=100
Androscoggin8%51.(10%)8 .(14%)5 .(11%)13..(13%)
Aroostook5%17(3%)1 (2%)2 ..(4%)3….(3%)
Cumberland22%98.(19%)10 .(18%)9 (20%)19..(19%)
Franklin2%8(2%)0 (0%)2.. (4%)2(2%)
Hancock4%13(3%)2 (4%)3.. (7%)5(5%)
Kennebec9%48.(10%)6 ..(11%)6 (13%)12.(12%)
Knox3%17(3%)0 (0%)0.. (0%)0(0%)
Lincoln3%9(2%)3 (5%)1.. .(2%)4(4%)
Oxford4%14(3%)3 (5%)4.. (9%)7(7%)
Penobscot11%94.(19%)7 .(13%)5..(11%)12.(12%)
Piscataquis1%10(2%)1 (2%)0.. (0%)1….(1%)
Sagadahoc3%7….(1%)1 (2%)1 (2%)2(2%)
Somerset4%13(3%)1 (2%)2.. (4%)3(3%)
Waldo3%9(2%)2 ..(4%)1 (2%)3(3%)
Washington2%20..(4%)2 ..(4%)1(2%)3(3%)
York15%75.(15%)8 (15%)3.. (7%)11..(11%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for February 2021.

Age and gender composition of decedents

The following table displays the age and gender composition of the monthly fatal overdose population. The larger number of males in 2021 at 66% is slightly lower than most of Maine’s drug death periods in the past, but can be expected to trend toward the 2020 average of 71%. The cumulative age distribution in 2021 is nearly identical to 2020, and is clustered in two middle categories from 18-39 and 40-59. There are no decedents that were under 18, and only 10% over 60.

Jan-Dec 2020
Est. N=503
January 2021
Est. N=55
February 2021
Est. N=45
Jan-Feb 2021
Est. N=100
Percent Males356(71%)34(62%)32.(71%)66.(66%)
Percent under 181(<1%)0..(0%)0(0%)0(0%)
Percent 18-39213(42%)20(36%)22.(49%)42.(42%)
Percent 40-59235(47%)30(55%)18.(40%)48.(48%)
Percent 60+52.(10%)5..(9%)5..(11%)10..(10%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for February 2021.

Basic incident patterns in fatal overdoses

The following table highlights some event characteristics among suspected and confirmed overdoses. Similar to 2020, in January and February 2021, both EMS and police responded to most fatal overdoses, 79%. Law enforcement is more likely to respond to a scene alone than EMS. The overwhelming majority of 2021 drug overdoses were ruled as accidental manner of death (93%). Naloxone was administered to 28% of the victims in 2021, which is nearly half (46%) of those who were still alive when first responders arrived. Most naloxone doses were administered by EMS personnel (79%), with some doses given by law enforcement or bystanders or a combination. Unfortunately, many victims (39%) have already died before first responders arrive. Further, non-opioid drugs will not respond to naloxone administration. Although most overdose cases have bystanders present at the scene, the details about who was present at the time of the overdose are usually unclear.

Jan-Dec 2020
Est. N=503
Est. N=55
Est. N=45
Jan-Feb 2021
Est. N=100
EMS or law enforcement response
……EMS response alone29(6%)4(4%)2…..(4%)6(6%)
……Law enforcement response alone108.(21%)11.(20%)8….(18%)19.(19%)
……Both EMS and law enforcement361.(72%)44(80%)35(78%)79.(79%)
Found deceased by first responders———22(44%)15(33%)39.(39%)
Manner of death (suspected or confirmed)
Naloxone administration74.(15%)14(25%)14(31%)28.(28%)
……Bystander only11(2%)1(2%)1…..(2%)2(2%)
……Law enforcement only8(2%)3(5%)1…..(2%)4(4%)
……EMS only42..(8%)7..(13%)11(24%)18.(18%)
……EMS and law enforcement4(1%)2(4%)0…..(0%)2(2%)
……EMS and bystander9..(2%)1(2%)1…..(2%)2(2%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for February 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 is the most frequent cause of death to date in 2021, at 74%, 7% higher than in 2020. Heroin involvement has been declining during the last several years; it represents only 10% of 2021 deaths. Illicit stimulants have been increasing in recent years, and in January and February cocaine-involved fatalities constituted 27% of cases and methamphetamine 23%. Amphetamine is a metabolite of methamphetamine, and is frequently found with it. Fentanyl is found in combination with cocaine in 16% of cases, and fentanyl and methamphetamine as a combination in 23% of cases. Pharmaceutical opioids were identified as a cause of death in 23%, all in combination with other drugs.

Cause of death (alone or in
combination with other drugs)
Jan-Dec 2020
January 2021
February 2021
Jan-Feb 2021
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs337.(67%)39..(72%)21..(78%)60..(74%)
Nonpharmaceutical Stimulants
Pharmaceutical opioids119.(24%)15..(28%)4..(15%)19.(23%)
Key combinations
……Fentanyl and cocaine97.(19%)9(17%)4..(15%)13.(16%)
……Fentanyl and methamphetamine/amphetamine72.(14%)12..(22%)4..(15%)16.(20%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for February 2021.

Five partially overlapping metrics that estimate the number of nonfatal overdoses in a given month

There is not a precise way to calculate nonfatal overdoses. Several metrics can be used to estimate numbers of nonfatal overdoses from different perspectives (see the chart below). This includes, for example, counting the number of responses by EMS in which the EMT or paramedic suspects an overdose and administers naloxone. However, many persons involved with an overdose event do not call 911. One syringe access program in Maine estimates that as many as 74% of overdose events do not include a 911 call. Put another way, the 911 calls may represent only 26% of the overdoses, whereas 74% constitute “private overdoses.” Some of these persons will unfortunately die. In about 15% of EMS overdose cases, the patient is revived, but refuses to be transported to the emergency room. Some may receive naloxone, but are found later not to have had an overdose, but were unconscious or had stopped breathing for another reason.

Metrics frequently used to estimate overdose numbersUnduplicated monthly estimate
based on 4th quarter 2020
Unduplicated monthly estimate
based on Jan-Feb 2021
Number of EMS runs in which naloxone was administered110574
Number of emergency department visits likely involving a drug overdose2277256
Number of overdose reversals reported by community naloxone distributors and users of the OD-ME app, minus the number of fatal overdoses in which bystanders administered naloxone (163-2=161)3161151
Number of incidents in which law enforcement administered naloxone and the victim survived.45213
1.) Sources: Maine EMS; Maine Office of Chief Medical Examiner. 2) Source: Maine CDC, Syndromic Surveillance. 3.) Sources: Maine Naloxone Distribution Initiative, OD-ME Mobile App. 4) Sources: Maine Office of the Attorney General; OD MAP Initiative.

Highlight of the month regarding substance use disorder public policy response

Our highlighted project this month is the Opioid Data Sharing Committee and the newly created Maine Drug Data Hub website: https://mainedrugdata.org.  The Committee will be holding its 8th monthly meeting this month.  Co-chaired by Rebecca Taylor, Deputy Director of Research and Evaluation at the Office of Behavioral Health and Gordon Smith, Director of Opioid Response, and staffed by the University of Maine research team, the committee’s purpose is to identify all the potential statewide sources of data on opioids (and other drugs as well), analyze the data, and where valuable, work with the source of the data to establish regular and timely reporting to the website’s data hub, also managed by the University of Maine.  The new website will be utilized to publicly report the data, including this new Maine Monthly Overdose Report.  Since its establishment in mid-January, the website has already attracted approximately 73,000 “hits,” or website interactions, and about 3,000 unique visitors.  The website now includes data from over 25 sources.

The Opioid Data Sharing Committee will be featuring one category of the data each month, and exploring its relevance and promise for understanding the drug-related issues Maine is facing, e.g. law enforcement; judicial systems; corrections; prescription monitoring; treatment; syringe exchange program data; naloxone distribution data; and overdose data.  The goal is to improve transparency and public engagement, as well as to provide a readily accessible source for information needed both by the public and by policy makers, supporting Maine’s efforts to make its policy decisions data-driven and evidence-based.

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.