Download the entire PDF report here: Maine Monthly Overdose Report for January 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 January, the proportion of fatal overdoses averaged 6.7% of total overdoses. The monthly proportion of 2022 fatalities fluctuated, however, including a low of 5.1% in May 2022 and a high of 9.0% in December.
During January 2023, there were an estimated 744 fatal and nonfatal drug overdoses statewide, of which 50 (6.7%) were suspected and confirmed fatal overdoses. The remaining 694 (93.3%) were nonfatal overdoses: 288 (38.7%) emergency department visits; 220 (29.6%) EMS patents who were not transported to the emergency room, 184 (24.7%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 2 (0.3%) 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 | |
| January ’22 | 44 | 296 | 206 | 178 | 1 | 725 |
| February ’22 | 48 | 333 | 185 | 153 | 4 | 723 |
| March ’22 | 65 | 457 | 201 | 202 | 7 | 932 |
| April ’22 | 58 | 290 | 178 | 189 | 7 | 722 |
| May ’22 | 46 | 402 | 248 | 186 | 12 | 894 |
| June ’22 | 66 | 482 | 250 | 177 | 10 | 985 |
| July ’22 | 64 | 348 | 287 | 183 | 4 | 886 |
| August ’22 | 61 | 385 | 272 | 255 | 7 | 980 |
| September ’22 | 55 | 458 | 256 | 153 | 6 | 928 |
| October ’22 | 65 | 283 | 238 | 177 | 6 | 769 |
| November ’22 | 67 | 286 | 206 | 200 | 5 | 764 |
| December ’22 | 76 | 352 | 212 | 198 | 4 | 842 |
| 2022 Total | 715 | 4,372 | 2,739 | 2,251 | 73 | 10,150 |
| 2022 Total % | 7.0% | 43.1% | 27.0% | 22.2% | 0.7% | 100% |
| January ’23 | 50 | 288 | 220 | 184 | 2 | 744 |
| 2023 Total | 50 | 288 | 220 | 184 | 2 | 744 |
| 2023 Total % | 6.7% | 38.7% | 29.6% | 24.7% | 0.3% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine January 2023
Fatal Drug Overdoses in Maine January – December 2022
During 2022, the proportion of fatal overdoses averaged 7.0% of total overdoses. From January to December 2022 there was a total 715 fatal drug overdoses consisting of 706 confirmed and 9 suspected drug deaths. The graph below shows the considerable monthly fluctuation since January 2020. Although the average is, the range extends from 76 (December 2022) to 44 (January 2022). During 2022, the monthly proportions fluctuated from a low of 5.1% in May and 9.0% in December. 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 2023 as well as 2022.
| Maine EMS | Law Enforcement | |
| Fatal Overdose Response 2022 | 579 | 667 |
| Nonfatal Overdose Response 2022 | 9194 | 1471 |
| Total Overdose Response 2022 | 9773 | 2138 |
| Fatal Overdose Response Jan .2023 | 37 | 48 |
| Nonfatal Overdose Response Jan. 2023 | 754 | 98 |
| Total Overdose Response Jan. 2023 | 791 | 146 |
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 January 2023 monthly totals can be compared to the percentage of census population in the left column or to the percentages of nonfatal overdoses in the center column. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. The 2022 percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. York County is 3 percentage points lower; Sagadahoc County is 2 percentage points lower than the 2020 census proportion. Androscoggin County and Penobscot County are 4 percentage points higher while Cumberland County is 2 percentage points higher than the 2020 census proportion.
Nonfatal Drug Overdoses in Maine, January 2023
Nonfatal Drug Overdoses in Maine, January 2022 – December 2022
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=9194 | Jan 2023 Est. N=791 |
|---|---|---|---|
| Androscoggin | 8% | 1084 (12%) | 84 (11%) |
| Aroostook | 5% | 517 (6%) | 41 (5%) |
| Cumberland | 22% | 2248 (24%) | 181 (23%) |
| Franklin | 2% | 145 (2%) | 10 (1%) |
| Hancock | 4% | 304 (3%) | 32 (4%) |
| Kennebec | 9% | 960 (10%) | 87 (11%) |
| Knox | 3% | 255 (3%) | 33 (4%) |
| Lincoln | 3% | 164 (2%) | 9 (1%) |
| Oxford | 4% | 434 (5%) | 36 (5%) |
| Penobscot | 11% | 1365 (15%) | 103 (13%) |
| Piscataquis | 1% | 92 (1%) | 12 (2%) |
| Sagadahoc | 3% | 132 (1%) | 9 (1%) |
| Somerset | 4% | 414 (5%) | 34 (4%) |
| Waldo | 3% | 218 (2%) | 22 (3%) |
| Washington | 2% | 234 (3%) | 15 (2%) |
| York | 16% | 1207 (13%) | 83 (10%) |
County Distribution of Suspected and Confirmed Fatal Overdoses
The following table shows the frequency distribution of deaths at the county level. The monthly 2023 totals can be compared either to the percent of the census population on the far left or the percent of all Maine drug deaths for 2022. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.
The cumulative January-December 2022 percentages of deaths in most counties fall within plus or minus 0 to 1 percentage points of the 2020 census distribution. Cumberland County is 4 percentage points lower, Sagadahoc County and York County are 2 percentage points lower than the 2020 census proportion in 2022. Androscoggin County and Aroostook County are 2 percentage points higher and Penobscot County is 4 percentage points higher than the 2020 census proportion.
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=715 | Jan 2023 Est. N=50 |
|---|---|---|---|
| Androscoggin | 8% | 79 (10%) | 9 (18%) |
| Aroostook | 5% | 47 (7%) | 1 (2%) |
| Cumberland | 22% | 130 (18%) | 16 (32%) |
| Franklin | 2% | 14 (2%) | 0 (0%) |
| Hancock | 4% | 24 (3%) | 1 (2%) |
| Kennebec | 9% | 55 (8%) | 4 (8%) |
| Knox | 3% | 20 (3%) | 0 (0%) |
| Lincoln | 3% | 14 (2%) | 1 (2%) |
| Oxford | 4% | 36 (5%) | 2 (4%) |
| Penobscot | 11% | 106 (15%) | 4 (8%) |
| Piscataquis | 1% | 9 (1%) | 1 (2%) |
| Sagadahoc | 3% | 10 (1%) | 0 (0%) |
| Somerset | 4% | 35 (5%) | 3 (6%) |
| Waldo | 3% | 21 (3%) | 1 (2%) |
| Washington | 2% | 24 (3%) | 3 (6%) |
| York | 16% | 101 (14%) | 4 (8%) |
Race, ethnicity, and other demographic indicators of decedents
During 2022, out of 712 confirmed and suspected fatal overdoses for which race was reported, 664 (93%) of the victims were identified as White, 16 (2%) as Black or African American, and 14 (2%) as American Indian/Alaska Native. Out of the 698 fatal overdoses for whom ethnicity was reported, 691 (99%) were reported as not Hispanic, and 7 (1%) were identified as Hispanic.
Out of the 715 cases for which military background was reported, 53 (7%) were identified as having a military background.
Prior overdose history was reported for 268 (37%) of the victims.
Of 715 decedents, transient housing status was reported for 80 (11%) of the victims. The largest totals of undomiciled persons (January – December 2022) were found in Cumberland County (31, 39%), Penobscot County (20, 25%), and Androscoggin County (10, 13%).
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2022 Est. Race N=712 Ethnicity N=698 | Jan 2023 Race N=48 Ethnicity = 48 |
|---|---|---|---|
| Race and Ethnicity | |||
| White | 91% | 664 (93%) | 43 (90%) |
| Black or African American | 2% | 16 (2%) | 3 (6%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 0 (0%) |
| Other race, 2+ races combined, non-hispanic | 7% | 12 (2%) | 2 (4%) |
| Not Hispanic | 98% | 691 (99%) | 48 (100%) |
| Hispanic | 2% | 7 (1%) | 0 (0%) |
| Military Background | 81 (11%) | 1 (2%) | |
| Prior Overdose History | 268 (37%) | 20 (40%) | |
| Undomiciled/Transient Housing Status | 81 (11%) | 6 (12%) |
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 from 68% in 2019 to 71% in 2020 and 2021, and to 73% in 2022. The cumulative age distribution in January – December 2022 compared to 2021 shows 2 deaths under 18 in 2021 and 3 deaths in 2022, a 2 percentage point increase in the proportion of those aged 18-39, a 4 percentage point decrease in those aged 40-59, and a 3 percentage point increase in the proportion 60 and above.
| % of 2020 Census Population | Jan-Dec 2022 Est. N=715 | Jan 2023 Est. N=50 | |
|---|---|---|---|
| Percent Males | 49% | 521…(73%) | 34 (68%) |
| Percent under 18 | 19% | 3…..(<1%) | 0 (0%) |
| Percent 18-39 | 26% | 291…(41%) | 17 (34%) |
| Percent 40-59 | 27% | 332..(46%) | 25 (50%) |
| Percent 60+ | 29% | 89…..(12%) | 8 (16%) |
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, that is, 75% in 2022. In 2022, law enforcement was more likely to respond to a scene alone (18%) than EMS (6%). The overwhelming majority (95%) of drug overdoses were ruled, or suspected of being, accidental manner of death.
During 2022, 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, but lower than the 30% recorded in 2021. 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 11% (82) of the fatal overdoses, often in addition to EMS and/or law enforcement. The 2020 drug death report documents only 4% of victims who had received bystander-administered naloxone and increased to only 9% of victims in 2021.
Based on 579 suspected and confirmed drug death cases with EMS involvement during January – December of 2022, 302 (52%) of victims were already deceased when EMS arrived. In the remaining 277 (48%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 277 who were still alive when EMS arrived, only 85 (31%) remained alive long enough to be transported but died during transport or at the emergency room and 192 (69%) 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 2022 Est. N=715 | Jan 2023 Est. N=50 | |
|---|---|---|
| Public safety response | ||
| ……EMS alone | 39….(6%) | 2 (4%) |
| ……Law enforcement alone | 127…(18%) | 13 (26%) |
| ……EMS and law enforcement | 540…(75%) | 35 (70%) |
| ……Private transport to the Emergency. Dept. | 13…..(2%) | 0 (0%) |
| Naloxone administration | ||
| Naloxone administration reported at the scene | 181..(25%) | 10 (20%) |
| ……Bystander only | 45…(6%) | 2 (4%) |
| ……Law enforcement only | 32….(5%) | 0 (0%) |
| ……EMS only | 55….(8%) | 5 (10%) |
| ……EMS and law enforcement | 11….(2%) | 1 (2%) |
| ……EMS and bystander | 26….(4%) | 1 (2%) |
| ……Law enforcement and bystander | 5….(1%) | 1 (2%) |
| ……EMS, bystander, and law enforcement | 6….(1%) | 0 (0%) |
| ……Naloxone administered by unspecified person | 10…(1%) | 0 (0%) |
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 706 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 551 (78%), this is a slightly higher than the rate in 2021 (77%) and 11 percentage points higher than the rate in 2020 (67%).
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 3% (19) of 2022 deaths and 3% (22) of 2021 deaths, compared to 11% (57) in 2020. Methamphetamine was cited as a cause of death in 33% (231) of the overdoses, an increase from 27% in 2021. Cocaine-involved fatalities January – December constituted 30% (211) of cases, an increase from 25% in 2021 and 23% in 2020. Fentanyl is found as a co-intoxicant with cocaine in 81% (171) of 2022 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 81% (187) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 706 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 45 (6%) of confirmed overdose deaths, and 9 (1%) with tramadol listed along with fentanyl.
| Cause of death (alone or in combination with other drugs) Sample size for complete cases only | Jan-Dec 2022 N=706 | *Jan 2023 N=4 |
|---|---|---|
| Nonpharmaceutical opioids | ||
| ……Fentanyl or fentanyl analogs | 551..(78%) | 4 (100%) |
| ……Heroin | 18….(3%) | 0 (0%) |
| Nonpharmaceutical Stimulants | ||
| ……Cocaine | 209.(30%) | 2 (50%) |
| ……Methamphetamine | 230.(33%) | 3 (75%) |
| Pharmaceutical opioids** | 147..(21%) | 0 (0%) |
| Key combinations | ||
| ……Fentanyl and heroin | 17….(2%) | 0 (0%) |
| ……Fentanyl and cocaine | 169..(24%) | 2 (50%) |
| ……Fentanyl and methamphetamine | 186..(27%) | 3 (75%) |
| ……Fentanyl and xylazine | 45….(6%) | 0 (0%) |
| ……Fentanyl and tramadol | 9….(1%) | 0 (0%) |
**Nonpharmaceutical tramadol is now being combined with fentanyl in pills and powders for illicit drug use. When found in combination with fentanyl, and in the absence of a known prescription, tramadol is no longer counter as a pharmaceutical opioid.
Highlight of the month regarding substance use disorder public policy response
Medication for Opioid Use Disorder in Maine Jails and Department of Corrections Facilities
This month, we highlight the work going on inside Maine’s county jails and Department of Correction facilities to ensure that jail and prison residents with substance use disorders are offered treatment with one or more of the standard medications available to treat such disorders. In Feb. 2019, newly inaugurated Governor Janet T. Mills signed Executive Order II, AN ORDER TO IMPLEMENT IMMEDIATE RESPONSES TO MAINE’S OPIOID EPIDEMIC. Among other provisions, the Order directed the Director of Opioid Response to use funds available to the office of Substance Abuse and Mental Health Services (now the Office of Behavioral Health) to encourage every county jail to have MAT (medication-assisted treatment) services available for persons incarcerated who are suffering from a substance use disorder, and help such individuals released from jails to continue to receive support services and to assist the Department of Corrections pilot program to provide MAT to inmates, focusing first on those patients with a release date within four years, and help individuals released from the Department to continue to receive like support services.
Led by the Department of Corrections and with the cooperation of Maine’s sheriffs and jail administrators, the efforts begun in 2019 have resulted to date in over 2000 individuals receiving medication for substance use disorders in Maine’s prisons and jails. The Department of Corrections has treated over 1,000 individuals and at any one time, between 400 and 600 residents in DOC facilities are receiving such medication. While taking longer to achieve uniform application, all of Maine’s jails now have MOUD (medications for opioid use disorder) programs and in the fourth quarter of 2021, 1,151 residents were receiving medication, 273 having been induced for the first time once in jail (others were continued on the medication as they had an existing prescription when entering the facility).
The Office of Behavioral Health provides some financial support for the medication effort in seven of the county jails and provided a portion of the initial funds for the DOC pilot. The pilot quickly expanded eligibility from those residents being released within 90 days to those being released within 180 days and eventually to all residents with a SUD diagnosis, regardless of their release date.
While most of the medication offered is Suboxone, a combination of the synthetic opioid buprenorphine and naloxone, some jails and facilities are able to offer additional medication such as Sublocade (an injectible form of buprenorphine) and methadone. The goal of the Mills Administration is to have all forms of medication offered with the understanding that all forms of recovery, including abstinence without medication, are supported and encouraged. Well over fifty percent of the incarcerated population have a substance use disorder. About 40% of DOC residents across all the facilities are now receiving medication for this diagnosis and also offered counseling.The Department of Corrections program was recognized nationally in 2022 by the Office of National Drug Control Policy and the Director, Rahul Gupta, M.D, visited the Maine State Prison in July, 2022 to personally talk with residents and staff about the program. More recently, the national publication, POLITICO, published an extensive article on the program: Maine’s Prisons Taught Washington a Crucial Lesson in Fighting Opioids.