Focus Area 2023-2025: Harm Reduction

  • Harm reduction work by the OPTIONS program (website: https://www.knowyouroptions.me
  • Doses of State-supplied naloxone distributed
  • The lives saved by reported overdose reversals using State-supplied naloxone
  • The expansion of safe use supplies and access to sterile syringes
  • Nonfatal overdoses reported by public health and public safety

The State of Maine is increasing public awareness of overdose prevention and the use of naloxone

Through the OPTIONS media campaign, the Eyes Open overdose prevention campaign, and the Have it On Hand naloxone education campaign the state is increasing public awareness of the opioid epidemic and overdose prevention through evidence-based harm reduction strategies, overdose education, and naloxone awareness. (Strategy 18.a)

OPTIONS YouTube Channel

Eyes Open for ME website

Have it on Hand website

The Good Samaritan law: On May 23, 2019, Governor Janet Mills signed into law LD 329, An Act To Exempt from Criminal Liability Persons Reporting a Drug-related Medical Emergency. The law exempts individuals from arrest or prosecution for the possession of illicit drugs and drug paraphernalia as well as violations of probation if they are in good faith calling 9-1-1 to seek medical assistance for another person experiencing a drug-related overdose.

This is essential as calling 9-1-1 and getting transported to the hospital results in the greatest change of survival during and overdose emergency.

Despite fatal drug overdoses increasing, emergency department visits for overdoses have remained fairly consistent over time. However, in 2020, getting transported and treated at the hospital provided a 98.94% average survival rate which indicates the importance of calling emergency medical services during an overdose emergency. (Strategy 20.b)

This metric tracks suspected fatal and nonfatal overdoses in emergency departments. This metric is an indicator of fatal and nonfatal opioid overdoses, both accidental and intentional. This data is provided by ME CDC.

Source: Maine Center for Disease Control and Prevention, Drug Overdose Morbidity and Mortality Dashboard.

Priority E of Maine’s Opioid Response Strategic Action Plan is to reduce the number of fatal and nonfatal overdoses.

There are many organizations distributing and administering naloxone in the State of Maine in an effort to mitigate the opioid overdose crisis. Law enforcement officers carry naloxone through a program administered by the Maine Office of the Attorney General to allow officers arriving first at the scene to begin to medically treat an overdose. EMS routinely carry naloxone to respond to opioid-related emergencies. Recently, in 2019 with the creation of the Maine Naloxone Distribution Initiative, public health and harm reduction organizations began distributing state-supplied naloxone to clinical sites, community organizations, and end-users throughout the State of Maine.

Both nationally and in the State of Maine, nonfatal and fatal drug overdoses are being driven higher by the lethality of co-intoxicants in the drug supply. The most notable of these is nonpharmaceutical fentanyl and its analogs such as acetylfentanyl, furanylfentanyl, and carfentanil. Despite this, the ratio of fatal compared to nonfatal overdoses in the State of Maine has remained around 7% fatal and 93% nonfatal since 2021.

This metric tracks the composite number of fatal and nonfatal drug overdoses in the State of Maine. The data is provided by the Maine Office of the Attorney General, Office of the Chief Medical Examiner, OD MAP, Maine EMS, Maine CDC, and the Maine Naloxone Distribution Initiative. This data is updated monthly. All overdoses have been deduplicated. EMS overdoses are those where patients are not transported to the Emergency Department. Law enforcement overdoses are those cases where EMS did not also respond. MNDI overdoses are those reported by the Maine Naloxone Distribution Initiative and have been reversed using State-supplied naloxone in the community. (Priority E)

Source: Office of the Maine Attorney General and OD MAP provides law enforcement data. Maine EMS provides EMS data. Maine CDC provides Emergency Department data. University of Maine, Margaret Chase Smith Policy Center provides Maine Naloxone Distribution Initiative data.

Maine EMS plays an integral role in reducing fatal overdoses by responding to opioid-related emergencies with naloxone to prevent drug deaths.

Maine EMS responds to a variety of opioid-associated resuscitative emergencies involving patient conditions including chronic pain management for musculoskeletal pain or cancer-related pain, illicit drug use, and intentional overdose. By administering naloxone in the out-of-hospital setting, opioid-related overdoses are reversed and lives are saved.

This metric tracks the incidents responded to by Maine EMS that require the administration of naloxone. This metric is an indicator of fatal and nonfatal opioid overdoses, both accidental and intentional. This data is provided by Maine EMS. The data is updated monthly. Data for latest month is provisional. Naloxone administrations can occur for non opioid-related incidents as a treatment to respond to unconscious patients.

Click map to enlarge

Source: University of Maine, Margaret Chase Smith Policy Center, Maine Naloxone Distribution Initiative.

Source: Maine EMS

Source: Maine EMS.


Maine EMS provides emergency medical assistance to individuals experiencing overdoses due to a variety of substances.

EMS Overdose Incidents Requiring Naloxone Administration by County, 2022

Source: Margaret Chase Smith Policy Center, University of Maine.

This metric is an indicator of fatal and nonfatal drug overdoses, both accidental and intentional. This data is provided by Maine EMS. The data is updated monthly. Data for the latest month is provisional. The data in the chart below include alcohol, pharmaceutical and nonpharmaceutical drugs, hallucinogens, and accidental child poisonings. Naloxone administrations can occur for non opioid-related incidents as a treatment to respond to unconscious patients.

Source: Maine EMS

Utilizing the OPTIONS initiative (Overdose Prevention Through Intensive Outreach, Naloxone, and Safety) the State times to provide education and trainings regarding overdose prevention and treatment resources at syringe service providers and naloxone distribution sites throughout the Maine. (Strategy 20.a)

The OPTIONS initaitve embeds licensed behavioral health clinicians within law enforcement agencies in each of Maine’s 16 counties. These clinicians, known as OPTIONS Liaisons, provide trainings regarding overdose education, anti-stigma, and other harm reduction based trainings to community members, public safety personnel, and health care providers. (Strategy 20.b; 20.c)

The following metric tracks trainings and people trained by OPTIONS behavioral health liaisons. Project-to-date (Oct ’20 – Aug ’23) Liaisons have conducted 782 trainings and trained 9,096 people. This data is updated monthly.

Source: University of Maine, Margaret Chase Smith Policy Center.

Through the licensing of addition Certified Syringe Service Providers and the use of mobile distribution and outreach in both rural and urban areas the State will ensure the availability of harm reduction resources for individuals at the highest risk of overdose. (Strategy 20.d)

Maine Drug Data Hub Syringe Service Programs Dashboard

Syringe access helps prevent HIV and other bloodborne pathogens while helping to reduce overdose deaths.

As of spring 2022, 18 Syringe Access Programs are licensed to operate in the State of Maine, located in Augusta, Bangor, Calais, Ellsworth, Lewiston, Machias, Portland, Sanford, and Waterville. Research shows that Syringe Access Programs can reduce new Hepatitis C and HIV cases by an estimated 50% and they reduce overdose deaths by providing overdose education, naloxone, and fentanyl testing supplies to their enrollees.

This metric tracks the location of Syringe Access Programs (SAP) in the State of Maine, the number of enrollees in SAPs, and the number of syringe exchanges occurring at SAPs. This metric is an indicator of the number of individuals seeking harm reduction supplies as well as the points of contact SAPs have with persons who use drugs. The data is provided by ME CDC and is updated annually. The annual report consists of data from November through October. Individuals may be enrolled in multiple programs and data is not unduplicated. Exchanges do not equal the number of syringes distributed or received. Please note, due to challenges in data collecting and reporting caused by to the COVID-19 pandemic, the syringe service program data from 2020 reflected below is incomplete. (Strategy 20.d)

Source: Maine Center for Disease Control and Prevention, Syringe Service Programs in Maine Annual Report, 2021.

Source: Maine Center for Disease Control and Prevention, Syringe Service Programs in Maine Annual Report, 2021.

Source: Maine Center for Disease Control and Prevention, Syringe Service Programs in Maine Annual Report, 2021.

Syringe Access Programs refer enrollees to other services including substance-use disorder treatment, housing, and medical care.

The State of Maine is expanding syringe access and the number of syringe access providers throughout Maine. Syringe access facilities provide an important link to health services for their surrounding communities including bloodborne pathogen testing, treatment for Hepatitis C and HIV, housing, medication for opioid use disorder, and primary care facilities.

This metric is an indicator of individual and community health and wellness linkages provided by Syringe Access Programs. The data is provided by ME CDC and is updated annually. The annual report consists of data from November through October. Individuals may be enrolled in multiple programs and data is not unduplicated. Please note, due to challenges in data collecting and reporting caused by the COVID-19 pandemic, the syringe service program data reflected below is incomplete. (Strategy 20.a; 20.d)

Source: Maine Center for Disease Control and Prevention, Syringe Service Programs in Maine Annual Report, 2021. Please note that due to the COVID-19 pandemic syringe access programs were impacted in their reporting, staffing, and operations during both 2020 and 2021. Please see the 2020 and 2021 annual report for more details on referral reporting.

L.D. 1333 authorized Maine EMS clinicians to dispense naloxone to persons experiencing substance use disorder, their family, and/or their friends. The Department of Public Safety received a $6 million Department of Justice Comprehensive Opioid, Stimulant, and Substance Abuse Site-based Program (COSSAP) grant that funds the ongoing statewide response to the opioid epidemic that will fund this initiative among other projects. Maine EMS, working alongside the Maine Naloxone Distribution Initiative, began distributing naloxone to individuals on overdose related response calls in January of 2022.

The following metric tracks doses of naloxone distributed by the Maine Naloxone Distribution Initiative to Maine EMS and doses of naloxone distributed by Maine EMS clinicians to people in need and affected others. This data is reported monthly. (Strategy 20.h)

Source: Maine EMS.

The Maine Naloxone Distribution Initiative (MNDI) ensures widespread distribution and ease of access of naloxone for the general public

The MNDI (website: https://www.getmainenaloxone.org) is a tier-based naloxone distribution network that began distributing naloxone throughout the State of Maine in 2019. The Tier One naloxone distributors have contracts with the State to order and distribute naloxone both directly to end users and to a network of Tier Two naloxone distributors that have naloxone on hand in case of an overdose emergency or they redistribute the naloxone to end users in the community. Tier Two distributors consist of a variety of organizations and individuals including businesses, schools, community organizations, public health organizations, ME EMS, OPTIONS Liaisons, and Syringe Access Providers.

The following metric tracks the doses of State-supplied naloxone distributed broadly into Maine communities as well as the reported opioid overdose reversals reported by community partners. To date, State-supplied naloxone has reversed a reported 7,173 overdoses. The data is provided by public health and harm reduction partners. The data is updated monthly. (Strategy 21.a)

Source: University of Maine, Margaret Chase Smith Policy Center, Maine Naloxone Distribution Initiative.

The Overdose Prevention Through Intensive Outreach, Naloxone, and Safety (OPTIONS) initiative

Through the OPTIONS initiative (website: https://www.knowyouroptions.me) behavioral health mobile response teams are deployed in each of Maine’s 16 counties. These licensed behavioral health clinicians, who are embedded in a law enforcement department within the county they serve, educate and engage individuals at high risk for overdose in harm reduction strategies including the distribution and use of naloxone. They also offer referrals to treatment and recovery services. Visit the above website to find your local OPTIONS liaisons and know your options today. (Strategy 21.a)

The following metric tracks the doses of State-supplied naloxone distributed by OPTIONS behavioral health liaisons. Project-to-date (Oct ’20 – Aug ’23) Liaisons have distributed a total of 15,228 doses of naloxone. This data is updated monthly.

Source: University of Maine, Margaret Chase Smith Policy Center.

The State is increasing the awareness, understanding, utilization, and access of harm reduction strategies and resources

The Overdose Prevention Through Intensive Outreach, Naloxone, and Safety (OPTIONS) initiative

The OPTIONS initaitve embeds licensed behavioral health clinicians within law enforcement agencies in each of Maine’s 16 counties. These clinicians, known as OPTIONS Liaisons, provide trainings regarding overdose education, anti-stigma, and other harm reduction based trainings to community members, public safety personnel, and health care providers. (Strategy 17.a; 17.b)

The following metric tracks trainings and people trained by OPTIONS behavioral health liaisons. Project-to-date (Oct ’20 – Aug ’23) Liaisons have conducted 782 trainings and trained 9,096 people. This data is updated monthly.

Source: University of Maine, Margaret Chase Smith Policy Center.

The OPTIONS program engages people experiencing homelessness and housing instability in harm reduction strategies as well as options for treatment and recovery

The State of Maine is committed to providing resources, education, and supports for people experiencing homelessness and housing instability. For persons experiencing housing instability and houselessness, OPTIONS Liaisons are an important linkage to services for addressing problematic substance use and substance use disorder. (Strategy 22.a)

Source: University of Maine, Margaret Chase Smith Policy Center.