Download the entire PDF report: Maine Monthly Overdose Report for February 2024
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.
Overview: Composite total of fatal and nonfatal overdoses
During February 2024, there were 734 suspected and confirmed fatal and nonfatal overdoses. Of those 734, there were, 47 (6.4%) suspected and confirmed fatal overdoses. The remaining 687 (93.6%) were nonfatal overdoses: 304 (41.5%) emergency department visits; 221 (30.1%) EMS patents who were not transported to the emergency room, 136 (18.5%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 26 (3.5%) 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 ’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 | 340 | 291 | 173 | 34 | 887 |
| Aug ’23 | 40 | 330 | 247 | 152 | 22 | 791 |
| Sep ’23 | 53 | 390 | 235 | 141 | 26 | 845 |
| Oct ’23 | 54 | 317 | 254 | 147 | 17 | 789 |
| Nov ’23 | 48 | 254 | 190 | 101 | 20 | 613 |
| Dec ’23 | 46 | 325 | 183 | 129 | 23 | 706 |
| 2023 Total | 605 | 3,925 | 2,701 | 2,042 | 385 | 9,658 |
| 2023 Total % | 6.3% | 40.6% | 28.0% | 21.1% | 4.0% | 100% |
| Jan ’24 | 47 | 269 | 209 | 139 | 27 | 691 |
| Feb ’24 | 47 | 304 | 221 | 136 | 26 | 734 |
| 2024 Total | 94 | 573 | 430 | 275 | 53 | 1425 |
| 2024 Total % | 6.6% | 40.2% | 30.2% | 19.3% | 3.7% | 100% |
Number of suspected and confirmed fatal overdoses
During January — February 2024, fatal overdoses constituted 6.6% of all overdoses, slightly higher than the 6.3% for the year in 2023. The total number of confirmed and suspected fatal overdoses January — February 2024 is 94, 8.7% lower than the total confirmed fatal overdoses for the same period in 2023, 103. 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, fatal overdoses comprised 6.3% of all overdoses; this proportion lower than the 6.9% for 2022. There were 605 confirmed and suspected fatal overdoses in 2023; this is 16.3% lower than the 723 fatal overdoses during 2022. The total number of nonfatal overdoses January through February is 1,331, 11.5% lower than the total confirmed nonfatal overdoses for the same period in 2023, 1,504.
For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.
Fatal Drug Overdoses in Maine February 2024
Fatal Drug Overdoses in Maine Jan – Feb 2024
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 – February 2024 as well as January – December 2023.
| Maine EMS | Law Enforcement | |
| Fatal Overdose Response 2023 | 479 | 561 |
| Nonfatal Overdose Response 2023 | 8,841 | 1,053 |
| Total Overdose Response 2023 | 9,330 | 1,614 |
| Fatal Overdose Response Jan – Feb 2024 | 72 | 90 |
| Nonfatal Overdose Response Jan – Feb 2024 | 1376 | 160 |
| Total Overdose Response Jan – Feb 2024 | 1448 | 250 |
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 February 2024 monthly totals can be compared to the percentage of census population on the far left, the percentage of nonfatal overdoses for the year in 2023, or the January – February 2024 year-to-date total. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. The January – February percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Cumberland County and Penobscot County are 3 percentage points higher than the 2020 census proportion. Androscoggin County, Aroostook County, and Kennebec County are 2 percentage points higher than the 2020 census proportion. York County is 6 percentage points lower and Sagadahoc County is 2 percentage points lower than the 2020 census proportion.
Nonfatal Drug Overdoses in Maine, February 2024
Nonfatal Drug Overdoses in Maine, Jan 2024 – Feb 2024
| % 2020 estimated Census population | Jan–Dec 2023 | Jan-Feb 2024 | Feb 2024 | ||||
| Est. N = 8841 | Est. N = 1376 | Est. N = 693 | |||||
| Androscoggin | 8% | 912 | 10% | 135 | 10% | 68 | 10% |
| Aroostook | 5% | 447 | 5% | 93 | 7% | 50 | 7% |
| Cumberland | 22% | 2038 | 23% | 347 | 25% | 179 | 26% |
| Franklin | 2% | 138 | 2% | 27 | 2% | 9 | 1% |
| Hancock | 4% | 255 | 3% | 43 | 3% | 25 | 4% |
| Kennebec | 9% | 871 | 10% | 145 | 11% | 79 | 11% |
| Knox | 3% | 300 | 3% | 38 | 3% | 15 | 2% |
| Lincoln | 3% | 185 | 2% | 25 | 2% | 13 | 2% |
| Oxford | 4% | 355 | 4% | 51 | 4% | 30 | 4% |
| Penobscot | 11% | 1253 | 14% | 187 | 14% | 96 | 14% |
| Piscataquis | 1% | 109 | 1% | 14 | 1% | 7 | 1% |
| Sagadahoc | 3% | 130 | 1% | 12 | 1% | 7 | 1% |
| Somerset | 4% | 431 | 5% | 67 | 5% | 34 | 5% |
| Waldo | 3% | 193 | 2% | 26 | 2% | 13 | 2% |
| Washington | 2% | 193 | 2% | 27 | 2% | 13 | 2% |
| York | 16% | 1031 | 12% | 139 | 10% | 55 | 8% |
Age and Gender Composition of Nonfatal Overdose Victims with EMS Response
The following table displays the age composition of individuals suspected of experiencing nonfatal overdoses involving EMS response in February 2024, January – February 2024, as well as January – December 2023. Overdose reversal totals reported by community partners and emergency departments are not categorized and reported by age; only EMS case data include age frequencies at a monthly cadence. The February 2024 monthly totals can be compared to the percentage of census population on the far left, the percentage of nonfatal overdoses for the year in 2023, or the January – February 2024 year-to-date total. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. The age distribution for January – February 2024 compared to the 2020 census proportion shows a disproportionately large impact of suspected nonfatal overdose victims with EMS involvement in those aged 25-44. Suspected nonfatal overdoses were 13 percentage points lower than the estimated census proportion in the population under the age of 18, 3 percentage points lower than the proportion of the population 45-54, 4 percentage points lower than the proportion of the population aged 55-64, and 13 parentage points lower than the proportion of the population 65 and older.
| % 2020 estimated Census population | Jan–Dec 2023 | Jan – Feb 2024 | Feb – 2024 | ||||
| Est. N = 8786 | Est. N= 1373 | Est. N = 684 | |||||
| < 18 | 18% | 409 | 5% | 72 | 5% | 36 | 5% |
| 18-24 | 7% | 877 | 10% | 141 | 10% | 67 | 10% |
| 25-34 | 12% | 1945 | 22% | 289 | 21% | 135 | 20% |
| 35-44 | 12% | 2375 | 27% | 367 | 27% | 182 | 27% |
| 45-54 | 12% | 1343 | 15% | 208 | 15% | 115 | 17% |
| 55-64 | 16% | 1074 | 12% | 158 | 12% | 76 | 11% |
| > 64 | 23% | 763 | 9% | 138 | 10% | 73 | 11% |
The following table displays the reported genderof individuals suspected of experiencing nonfatal overdoses involving EMS response in February 2024, January – February 2024, as well as January – December 2023. Overdose reversal totals reported by community partners and emergency departments, as well as fatal overdoses are not categorized by gender; only EMS case data include gender categories at a monthly cadence. The February 2024 monthly totals can be compared to the percentage of census population on the far left, the percentage of nonfatal overdoses for the year in 2023, or the January – February 2024 year-to-date total. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. Males represent 49% of the 2020 estimated census population and 60% of the nonfatal overdose victims with EMS involvement during January – February 2024.
| % 2020 estimated Census population | Jan–Dec 2023 | Jan – Feb 2024 | Feb 2024 | ||||
| Est. N = 8798 | Est. N= 1337 | Est. N = 661 | |||||
| Male | 49% | 5297 | 60% | 797 | 60% | 385 | 58% |
| Female | 51% | 3476 | 40% | 539 | 40% | 276 | 42% |
| Transgender | Not collected | 25 | 0.3% | 1 | 0% | 0 | 0% |
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 drug deaths in 2023, or the year-to-date totals. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.
The cumulative January – February 2024 percentages of deaths in most counties fall within plus or minus 0 to 2 percentage points of the 2020 census distribution. Aroostook County is 4 percentage points higher than the 2020 census proportion. Androscoggin County and Knox County are 3 percentage points higher than the 2020 census proportions. York County and Cumberland County are 5 percentage points lower than the 2020 census proportion and Sagadahoc County is 3 percentage points lower.
| % 2020 estimated Census population | Jan–Dec 2023 | Jan – Feb 2024 | Feb 2024 | ||||
| Est. N = 603 | Est. N = 94 | Est. N = 47 | |||||
| Androscoggin | 8% | 69 | 11% | 10 | 11% | 3 | 6% |
| Aroostook | 5% | 39 | 6% | 8 | 9% | 4 | 9% |
| Cumberland | 22% | 115 | 19% | 16 | 17% | 10 | 21% |
| Franklin | 2% | 6 | 1% | 1 | 1% | 0 | 0% |
| Hancock | 4% | 22 | 4% | 3 | 3% | 1 | 2% |
| Kennebec | 9% | 60 | 10% | 10 | 11% | 5 | 11% |
| Knox | 3% | 16 | 3% | 6 | 6% | 3 | 6% |
| Lincoln | 3% | 7 | 1% | 3 | 3% | 0 | 0% |
| Oxford | 4% | 25 | 4% | 5 | 5% | 2 | 4% |
| Penobscot | 11% | 91 | 15% | 8 | 9% | 5 | 11% |
| Piscataquis | 1% | 17 | 3% | 1 | 1% | 1 | 2% |
| Sagadahoc | 3% | 7 | 1% | 0 | 0% | 0 | 0% |
| Somerset | 4% | 29 | 5% | 4 | 4% | 2 | 4% |
| Waldo | 3% | 10 | 2% | 5 | 5% | 5 | 11% |
| Washington | 2% | 26 | 4% | 4 | 4% | 1 | 2% |
| York | 16% | 64 | 11% | 10 | 11% | 5 | 11% |
Race, ethnicity, and other demographic indicators of decedents
During January – February 2024, out of 90 confirmed and suspected fatal overdoses for which race was reported, 83 (90%) of the victims were identified as White, 0 (0%) as Black or African American, and 4 (4%) as American Indian/Alaska Native. Out of the 92 fatal overdoses for whom ethnicity was reported, 87 (97%) were reported as not Hispanic, and 3 (3%) were identified as Hispanic.
Out of the 93 cases for which military background was reported in January – February 2024, 5 (5%) were identified as having a military background. Out of the 46 cases in February 2024 where military background was reported, 3 (7%) were identified as having a military background.
Of 94 total suspected and confirmed overdose cases in 2024, undomiciled or transient housing status was reported for 9 (10%) of the victims. The largest totals of undomiciled persons were found in Androscoggin County (4, 44%) with several other counties each having one undomicilied decedent. In February 2024, 5 fatal overdose victims (11%) were identified as undomiciled.
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2023 Est. Race N=608 Ethnicity N=592 | Jan-Feb 2024 Est. Race N=92 Ethnicity N=90 | February 2024 Est. Race = 46 Ethnicity = 44 |
|---|---|---|---|---|
| Race and Ethnicity | ||||
| White | 91% | 550 (91%) | 83 (90%) | 41 (89%) |
| Black or African American | 2% | 24 (4%) | 0 (0%) | 0 (0%) |
| American Indian/Alaska Native | 1% | 12 (2%) | 4 (4%) | 2 (4%) |
| Other race, 2+ races combined, non-hispanic | 7% | 11 (2%) | 2 (2%) | 0 (0%) |
| Not Hispanic | 98% | 583 (99%) | 87 (97%) | 39 (93%) |
| Hispanic | 2% | 7 (1%) | 3 (3%) | 3 (7%) |
| Military Background | 33 (5%) | 5 (5%) | 3 (7%) | |
| Undomiciled/Transient Housing Status | 73 (13%) | 9 (10%) | 5 (11%) |
Age and sex composition of decedents
The following table displays the age and sex composition of the February 2024 fatal overdose population, the 2024 year-to-date fatal overdose population, the 2023 year-to-date fatal overdose population, and the 2020 estimated census population. When comparing theFebruary 2024 data with 2024 year-to-date, 2023, as well as the census population proportion, caution must be exercised as the small number of cases in each month is vulnerable to random fluctuation that may not reflect a significant statistical trend. The cumulative proportion of males is slightly lower in Jan – Feb 2024 (67%) as in 2023 (73%). The age distribution for 2024 year-to-date compared to the 2020 census proportion shows a disproportionately large impact of fatal overdoses in those aged 35-64. Fatal overdoses were 6 percentage points lower than the estimated census proportion of the population aged 18-24, and 17 percentage points lower than the estimated proportion of the population 65 and older.
| % 2020 estimated Census population | Jan–Dec 2023 | Jan – Feb 2024 | Feb 2024 | ||||
| Est. N = 605 | Est. N= 94 | Est. N = 47 | |||||
| Male | 49% | 441 | 73% | 63 | 67% | 30 | 64% |
| < 18 | 18% | 3 | 0% | 1 | 1% | 1 | 2% |
| 18-24 | 7% | 28 | 5% | 1 | 1% | 0 | 0% |
| 25-34 | 12% | 84 | 14% | 11 | 12% | 6 | 13% |
| 35-44 | 12% | 198 | 33% | 29 | 31% | 12 | 26% |
| 45-54 | 12% | 135 | 22% | 28 | 30% | 14 | 30% |
| 55-64 | 16% | 119 | 20% | 18 | 19% | 9 | 19% |
| > 64 | 23% | 38 | 6% | 6 | 6% | 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 (72%) during January – February 2024. In 2024, law enforcement was more likely to respond to a scene alone (23%) than EMS (4%). The overwhelming majority (86%) of drug overdoses were ruled, or suspected of being, accidental manner of death. Of the 94 confirmed or suspected fatal overdoses in 2024, 68 (40%) had a history of prior overdose.
During 2024, 20% of fatal overdose cases had naloxone administered at the scene by EMS, bystanders, or law enforcement. This rate is lower than the 22% of fatal overdose cases in which naloxone was reportedly administered at the scene in 2023 (26%). 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 5% (5) of the fatal overdoses, often in addition to EMS and/or law enforcement. This is lower than 2023 (13%), 2022 (12%), 2021 (9%), and higher than 2020 (4%).
Based on 72 suspected and confirmed drug death cases with EMS involvement during 2024, 39 (54%) of victims were already deceased when EMS arrived. In the remaining 33 (46%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 33 who were still alive when EMS arrived, only 11 (33%) remained alive long enough to be transported but died during transport or at the emergency room and 22 (67%) did not survive to be transported. 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 2023 | Jan – Feb 2024 | Feb 2024 | ||||
| Est. N = 605 | Est. N = 94 | Est. N = 47 | ||||
| EMS response alone | 37 | 6% | 4 | 4% | 2 | 4% |
| Law enforcement alone | 119 | 20% | 22 | 23% | 9 | 19% |
| EMS and law enforcement | 441 | 73% | 68 | 72% | 36 | 77% |
| Private transport to Emergency Dept. | 5 | 1% | 0 | 0% | 0 | 0% |
| Naloxone administration reported at the scene | 156 | 26% | 19 | 20% | 11 | 23% |
| Bystander only administered | 39 | 6% | 3 | 3% | 2 | 4% |
| Law enforcement only administered | 15 | 2% | 2 | 2% | 2 | 4% |
| EMS only administered | 43 | 7% | 11 | 12% | 6 | 13% |
| EMS and law enforcement administered | 10 | 2% | 0 | 0% | 0 | 0% |
| EMS and bystander administered | 30 | 5% | 1 | 1% | 1 | 2% |
| Law enforcement and bystander administered | 8 | 1% | 0 | 0% | 0 | 0% |
| EMS, bystander, and law enforcement administered | 4 | 1% | 0 | 0% | 0 | 0% |
| Naloxone administered by unspecified person | 4 | 1% | 0 | 0% | 0 | 0% |
| History of prior overdose | 204 | 34% | 38 | 40% | 16 | 34% |
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 59 confirmed cases in 2024, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 45 (76%).
Fentanyl is nearly always found in combination with multiple other drugs. Heroin involvement, declining rapidly in recent years, was reported as a cause of death in 2 (3%) of 2024 deaths. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 59 confirmed deaths in 2024, there were 10 cases (17%) with xylazine listed in addition to fentanyl as a cause of death and 0 cases (0%) with tramadol listed along with fentanyl.
Stimulants continue to increase as a cause of death, usually in combination with other drugs, particularly fentanyl. Cocaine-involved fatalities constituted 22 (37%) of confirmed cases in 2024, the same as 2023 and an increase from 29% in 2022. Fentanyl is mentioned as a cause in combination with cocaine in 17 cases, 77% of 2024 cocaine cases. Methamphetamine was cited as a cause of death in 24 (46%) of the confirmed fatal overdoses in 2024, higher than 2023 (33%) and 2022 (32%); 21 (78%) of the methamphetamine deaths also involved fentanyl as a co-intoxicant cause of death. Cocaine and methamphetamine are named together on 5 (8%) death certificates in 2024, in most of those cases (4, 80%) as co-intoxicants of fentanyl.
| Cause of death (alone or in combination with other drugs) Sample size for confirmed cases only | Jan – Dec 2023 | Jan – Feb 2024 | Feb 2024 | |||
| Est. N = 605 | Est. N = 59 | Est. N = 17 | ||||
| Fentanyl or fentanyl analogs | 469 | 78% | 45 | 76% | 11 | 65% |
| Heroin | 12 | 2% | 2 | 3% | 1 | 6% |
| Cocaine | 224 | 37% | 22 | 37% | 5 | 29% |
| Methamphetamine | 196 | 32% | 27 | 46% | 8 | 47% |
| Pharmaceutical opioids** | 109 | 18% | 4 | 7% | 2 | 12% |
| Fentanyl and heroin | 12 | 2% | 2 | 3% | 1 | 6% |
| Fentanyl and cocaine | 191 | 32% | 17 | 29% | 4 | 24% |
| Fentanyl and methamphetamine | 162 | 27% | 21 | 36% | 6 | 35% |
| Fentanyl and xylazine | 59 | 10% | 10 | 17% | 3 | 18% |
| Fentanyl and tramadol | 3 | 0% | 0 | 0% | 0 | 0% |
Highlight of the Month
Certified Comprehensive BEHAVIORAL Health Centers (CCBHC)
The development of CCBHCs is one of the many responses the State of Maine is providing to the mental health and substance use epidemic. Operated through a federal HHS partnership across SAMHSA, the Centers for Medicaid and Medicare Services, and the Office of the Assistant Secretary for Planning and Evaluation, Maine is one of many states taking advantage of this program.
Directly or through formal partnerships, CCBHCs will provide:
- Crisis Services
- Outpatient Mental Health and Substance Use Services
- Person and Family-Centered Treatment Planning
- Community-Based Mental Health Care for Veterans
- Peer Family Support and Counseling Services
- Targeted Care Management
- Outpatient Primary Care Screening and Monitoring
- Psychiatric Rehabilitation Service
- Screening, Diagnosis and Risk Assessment
Designed to ensure access to coordinated comprehensive behavioral health care, CCBHCs are required to service anyone who requests care for mental health or substance use, regardless of ability to pay, place of residence or age. This includes developmentally appropriate care for children and youth.
CCBHCs must meet standards for the range of services they provide and are required to get patients into care quickly. The CCBHC model requires:
- Crisis Services to be available 24 hours a day, 7 days a week.
- Comprehensive behavioral health services to be available so people who need care don’thave to piece together the behavioral health support they need across multiple providers.
- Care coordination to be provided to help patients navigate behavioral health care, physical and health care, social services and other systems they are involved in.
Several behavioral health organizations in Maine have been successful in acquiring planning grants to establish such clinics. Phase I of this work will begin in 2024 and transition to Phase II in 2027. DHHS has been holding bi-monthly stakeholder meetings for consumers, health care providers and community partners to provide input and participate in the decision making process. For more information, contact the CCBHC Program Lead, Liz Remillard at liz.remillard@maine.gov or at 207-446-2714.