July 2021 Monthly Overdose Report

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

Fatal Drug Overdoses in Maine January – July 2021

The July 2021 total of 52 fatal drug overdoses consists of 10 confirmed drug deaths and 42 suspected drug deaths. The cumulative January – July total is 360, which is 15% higher than the same period in 2020. The graph below shows the considerable monthly fluctuation since January 2020. Although the 2020 average is 42, the range extends from 34 to 53. The average so far for 2021 is 51, and the range is 42 to 59. 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 July 2021.


Comprehensive total of fatal and nonfatal overdoses

During July 2021, there were an estimated 887 fatal and nonfatal drug overdoses statewide, of which 52 (6%) were suspected and confirmed fatal overdoses. The remaining 835 (94%) were nonfatal overdoses: 449 (51%) emergency department visits; 214 (24%) EMS patents who were not transported to the emergency room, 167 (19%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 5 (1%) law enforcement reversals without EMS present. The minimum total of reported nonfatal overdose incidents for January – July 2021 was 5,012 which was compiled by deduplicating data derived from multiple statewide sources. 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
Nonfatal
EMS Not Transported
Nonfatal
Reported
Community Reversals
Nonfatal
Law Enforcement
Without EMS 
Nonfatal (estimated)
Total Overdoses
January552551631275605
February422591171005523
March573921691585782
April473201871395697
May483131571015626
June593872132155880
July524492141675887
Total3602,4191,220978354,100
Total %7%48%24%20%<1%100%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for July 2021.
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses. Fatal overdoses in those categories have been removed.

Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The July 2021 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 2019, 2020, and January-July 2021. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. The cumulative January-July 2021 percentages stayed the same from June to July for most counties. However, between June and July there was a significant increase for Penobscot County and a corresponding decrease for Cumberland County, as well as a slight increase for Kennebec, Piscataquis, Sagadahoc, Somerset, and York. Cumberland County, with 22% of the census population, had 26% of the drug deaths in 2019, 19% in 2020, 17% January through July 2021, and 12% in July alone. By contrast, Penobscot County, with 11% of the census population, had 14% of the drug deaths in 2019, 19% in 2020, 17% January through July 2021, and 25% of the July drug deaths.

CountyPercent of 2019
Census Population
Jan-Dec
2019
N=380
Jan-Dec 2020
N=504
July 2021
Est. N=52
Cumulative Jan-Jul 2021
Est. N=360
Androscoggin8%33…….(9%)52.(10%) 2(4%)42….(12%)
Aroostook5%14…….(4%)17(3%)3(6%)16……(5%)
Cumberland22%100…..(26%)97.(19%)6.(12%)61….(17%)
Franklin2%5……..(1%)8(2%)1(2%)6…..(2%)
Hancock4%9…….(2%)13(3%)1(2%)13…..(4%)
Kennebec9%42……(11%)49.(10%)7.(12%)41(12%)
Knox3%7…….(2%)16(3%)2(4%)7….(2%)
Lincoln3%11…….(3%)9(2%)2(4%)13….(4%)
Oxford4%9…….(2%)15(3%)1(2%)15….(4%)
Penobscot11%53…..(14%)94.(19%)13.(25%)60..(17%)
Piscataquis1%3…….(1%)10(2%)2(4%)5….(1%)
Sagadahoc3%8……(2%)8….(1%)1(2%)4….(1%)
Somerset4%16……(4%)13(3%)3(3%)8….(2%)
Waldo3%3…….(1%)9(2%)0..(0%)9….(3%)
Washington2%10……(3%)20..(4%)0..(0%)13(4%)
York15%57….(15%)74.(15%)8.(15%)44..(12%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for July 2021.

Race, ethnicity, and other demographic indicators of decedents

During January – July of 2021, out of 357 confirmed and suspected fatal overdoses where race was reported, 327 (92%) of the victims were identified as White, 17 (5%) as Black or African American, and 10 (3%) as American Indian/Alaska Native. Out of the 352 fatal overdoses where ethnicity was reported, 349 (99%) were reported as not Hispanic, and 3 (1%) were identified as Hispanic. Out of the 357 cases, 23 (6%) were identified as having a military background. Prior overdose history was reported for 119 (33%) of the victims. Transient housing status was reported for 29 (8%) of the victims.

Demographic IndicatorNumber of decedents
N=357
Percent of decedents
Race and Ethnicity
White32792%
Black or African American175%
American Indian/Alaska Native103%
Not Hispanic34999%
Hispanic31%
Military Background236%
Prior Overdose History11933%
Person Experiencing Homelessness298%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for July 2021.

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 stayed roughly the same since 2019. In the first six months of 2021, it was 217 70%, which is slightly lower than the 71% level in 2020 and slightly higher than the 68% level in 2019. In July, it decline to 58%. The cumulative age distribution in January – July 2021 compared to 2019 has stayed likewise roughly similar. The percentage of those 18-39 decreased by 3%. The percentage of those 40-59 rose by 2%, and the percentage of those over 60 rose 1%. There has been 2 decedents under 18 in 2021.

Jan-Dec
2019
N=380
Jan-Dec 2020
N=504
Cumulative
Jan-Jul 2021
Est. N=357
July
2021
Est. N=52
Percent Males258..(68%)357(71%)244.(68%)30(58%)
Percent under 180….(0%)2(<1%)2….(1%)0…..(0%)
Percent 18-39171..(45%)213..(42%)144.(40%)22(42%)
Percent 40-59175..(46%)235..(47%)172.(48%)25(48%)
Percent 60+33….(9%)54(11%)39..(11%)5(10%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for July 2021.
*Systematic gender data are not reported on the death certificate.

Basic incident patterns in fatal overdoses

The following table highlights some event characteristics among suspected and confirmed overdoses. Roughly similar to 2020, during January – July of 2021, both EMS and police responded to most fatal overdoses, 76%. Law enforcement was more likely to respond to a scene alone (19%) than EMS (5%). The overwhelming majority (96%) of drug overdoses were ruled as accidental manner of death.

Based on the death investigation records, during January – July of 2021, naloxone was administered to 38% of the victims at the scene or in the ambulance, whether by EMS, bystanders, or law enforcement. This may be due to the greater availability of police trained to administer it through programs like the Attorney General’s Naloxone Distribution Initiative or ODMAP. It may also be due to the greater availability in the community due to the Maine Naloxone Distribution Initiative. None of the July decedents had naloxone prescriptions, but 7 did in 2020 and 4 in the first six months of 2021.

Based on 289 suspected and confirmed drug death cases with EMS records during January – July of 2021, 136 (47%) of victims were already deceased when EMS arrived. Of the remaining 153 (53%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of the 153 cases who were still alive when EMS arrived, 49 were transported, and 104 did not survive to be transported. Thus, out of 289 cases with EMS response, only 49 (17%) remained alive long enough to be transported, but died during transport or at the emergency room.

Jan-Dec 2020
N=504
Cumulative
Jan-Jul 2021
Est. N=357
July
2021
Est. N=52
Public safety response
……EMS alone28(6%)16….(5%)4……(8%)
……Law enforcement alone107.(21%)67..(19%)7….(14%)
……EMS and law enforcement365.(72%)273..(77%)40(77%)
Manner of death (suspected or confirmed)
……Accident457.(91%)344..(96%)51..(98%)
……Suicide33(7%)9….(3%)1…..(2%)
……Undetermined14(2%)4….(1%)0…..(0%)
Naloxone administration
Naloxone administration at the scene and/or
(presumably) in ambulance during transport to
emergency room
127.(33%)135..(38%)19..(37%)
Naloxone administration reported at the scene83.(22%)112.(31%)14..(27%)
……Bystander only11(2%)22….(6%)4….(8%)
……Law enforcement only8(2%)13….(4%)0….(0%)
……EMS only55..(11%)51..(14%)6..(12%)
……EMS and law enforcement4(1%)16….(5%)2….(4%)
……EMS and bystander8..(2%)8….(2%)1….(2%)
……Law enforcement and bystander0..(0%)2..(<1%)1….(2%)
……EMS, bystander, and law enforcement…….1..(<1%)0….(0%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for July 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 was the most frequent cause of death so far for 2021 at 232 (77%), a full 10% higher than 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 6% of 2021 deaths, compared to 11% last year. Methamphetamine was cited as a cause in 25% of the overdoses, which is slightly more than 2020. Cocaine-involved fatalities January – July constituted 22% of cases, slightly less than the 23% in 2020. Fentanyl is found in combination with cocaine in 19% of 2021 cases, and in combination with methamphetamine in 19%. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 302 confirmed deaths caused by fentanyl January – July, the number and percent of cases with xylazine listed as an additional cause of death is 30 (10%) of confirmed overdose deaths, and 15 (5%) with tramadol listed as one of the causes of death. 

Cause of death (alone or in
combination with other drugs)
Jan-Dec 2020
N=504
Cumulative
Jan-Jun 2021
N=302
July
2021
N=10***
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)232..(77%)8..(80%)
……Heroin57..(11%)17….(6%)2..(20%)
Nonpharmaceutical Stimulants
……Cocaine118.(23%)65..(22%)3..(30%)
……Methamphetamine/amphetamine99.(20%)74..(25%)1(10%)
Pharmaceutical opioids**118.(23%)69.(23%)3..(30%)
Key combinations
……Fentanyl and heroin47(9%)21….(6%)2.(20%)
……Fentanyl and cocaine97.(19%)56..(19%)3.(30%)
……Fentanyl and methamphetamine/amphetamine70.(14%)58..(19%)1..(10%)
……Fentanyl and xylazine0(0%)30..(10%)1..(10%)
……Fentanyl and tramadol0(0%)15….(5%)0….(0%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for July 2021.
**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. ***Only 10 July cases out of 52 were completed at the time this report.  The totals for each of these categories are too small to be statistically meaningful.


Highlight of the month regarding substance use disorder public policy response

Department of Corrections Efforts to Provide Medically Assisted Treatment to All Residents in DOC Custody

In 2019 the Department of Corrections (DOC) began its pilot to provide Medically Assisted Treatment (MAT) to all residents in their custody.  Since implementing the MAT pilot, the program has provided MAT to over 1200 residents, with 780 of the residents being released with continuity of care plans in place following discharge.  It is anticipated that 800 current residents could be receiving treatment by the end of the year, as the intent is to have MAT universally available to any adult with a Substance Use Disorder (SUD) diagnosis, regardless of the length of their sentence.  That this effort grew during the global pandemic, at a time when many of the county jail programs were contracting, is a credit to Commissioner Liberty, Deputy Commissioner Thornell and the entire DOC team.  They presented a breakout session on the program at the July 15 Governor’s Opioid Summit. 

There is currently a strong effort to get contracts in place to assist the jail medical/MAT providers.  The State is furnishing Narcan to residents when they are released by the DOC, as well as by a number of jails.  For example, Aroostook County Sheriff Gillen and his staff and medical/MAT team has provided MAT services to 151 residents in the jail in the previous 12 months (during the pandemic).  They currently have 32 inmates on MAT.

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.