July 2022 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for July 2022

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 July, the proportion of fatal overdoses averaged 7.9% of total overdoses. The monthly proportion of 2022 fatalities has fluctuated, however, including a low of 5.3% in May 2022 and a high of 8.0% in April. During the first seven months of 2022, the average number of overdoses per month was approximately 836 (57 fatal and 779 nonfatal cases). This compares to the monthly average for January – July 2021 of 695 (49 fatal and 678 nonfatal cases). The number of fatal overdoses in 2022 is 17% higher than during the same time in 2021.

From January 2022 to July 2022, there were an estimated 5,852 fatal and nonfatal drug overdoses statewide, of which 399 (6.8%) were suspected and confirmed fatal overdoses. The remaining 5,453 (93.2%) were nonfatal overdoses: 2,595 (44.3%) emergency department visits; 1,554 (26.6%) EMS patents who were not transported to the emergency room, 1,255 (21.4%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 49 (.8%) 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 OverdosesEmergency Department
Nonfatal
EMS Not Transported
to the ED Nonfatal
Reported
Community Reversals
Nonfatal
Law Enforcement
Without EMS 
Nonfatal (estimated)
Total Overdoses
January ’21512701641270612
February ’21412771181000536
March ’21583291721562717
April ’21463341901360706
May ’21474091631001720
June ’21544112231890877
July ’21444822251670918
August ’21504282322223935
September ’215947323427621,044
October ’21653832462082904
November ’21613082191952785
December ’215534419817611784
2021 Total6314,4482,3842,052239,538
2021 Total %6.6%46.6%25.0%21.5%0.2%100%
January ’22442962061781725
February ’22493331851534724
March ’22664572012029935
April ’22582901771897721
May ’224740224818612895
June ’226647925017711983
July ’22693382871705869
2022 Total3992,5951,5541,255495,852
2022 Total %6.8%44.3%26.6%21.4%0.8%100%
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses. Fatal overdoses in those categories have been removed.

Number of suspected and confirmed fatal overdoses

Fatal Drug Overdoses in Maine July 2022

Fatal Drug Overdoses in Maine January – July 2022

During the first 6 months of 2022, the proportion of fatal overdoses averaged 7.9% of total overdoses. From January to July 2022 there was a total 399 fatal drug overdoses consisting of 311 confirmed and 88 suspected drug deaths. The graph below shows the considerable monthly fluctuation since January 2020. Although the average since 2020 is 48, the range extends from 33 (October 2020) to 69 (July 2022). The proportion of fatal to nonfatal overdoses decreased from 9% to 7% between January and December of 2021. During 2022, the monthly proportions fluctuated from a low of 6% in January and May to 8% in April. The proportion of fatalities in January – July 2022 (399) is 17% higher than the first seven months of 2021 (341) For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.

*Note: The timing of the monthly overdose report has been substantially delayed during the last several months due to pandemic-related issues. The toxicology reports are currently returning to the Office of the Chief Medical Examiner in as much as 10 weeks following death; this is 3 to 4 times longer than the prepandemic turn around time. For more information see the full report.


Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The monthly 2022 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, 2021 and January-July 2022. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.

The cumulative January-July 2022 percentages of deaths in all counties except Cumberland and Penobscot fall within plus or minus 0%-1% of the 2020 census distribution. Cumberland County is 3% lower than the 202 census proportion in 2022 and Penobscot County is 4% higher. Comparing 2022 with 2021, all counties are within plus or minus 2% of 2021 proportions, except York, which is 5% higher in 2022.

County% of 2020
Census Population
Jan-Dec
2019
N=380
Jan-Dec 2020
N=504

Jan-Dec 2021
Est. N=631
Jan-Jul 2022
Est. N=399
Jul 2022
Est.
N=69
Androscoggin8%33…….(9%)52.(10%)69…..(11%)37 (9%)7 (10%)
Aroostook5%14…….(4%)17(3%)39……(6%)25 (6%)4 (6%)
Cumberland22%100…..(26%)97.(19%)114….(28%)75 (19%)11 (16%)
Franklin2%5……..(1%)8(2%)8…….(1%)9 (2%)0 (0%)
Hancock4%9…….(2%)13(3%)22……(3%)10 (3%)2 (3%)
Kennebec9%42……(11%)49.(10%)64….(10%)33 (8%)11 (16%)
Knox3%7…….(2%)16(3%)11……(2%)9 (2%)1 (1%)
Lincoln3%11…….(3%)9(2%)16……(3%)6 (2%)1 (1%)
Oxford4%9…….(2%)15(3%)28……(4%)18 (5%)2 (3%)
Penobscot11%53…..(14%)94.(19%)106…..(17%)61 (15%)9 (13%)
Piscataquis1%3…….(1%)10(2%)11……(2%)4 (1%)0 (0%)
Sagadahoc3%8……(2%)8….(1%)7……(1%)6 (2%)1 (1%)
Somerset4%16……(4%)13(3%)26…..(4%)19 (5%)5 (7%)
Waldo3%3…….(1%)9(2%)15…..(2%)14 (4%)3 (4%)
Washington2%10……(3%)20..(4%)25…..(4%)9 (2%)3 (4%)
York16%57….(15%)74.(15%)70….(11%)64 (16%)9 (13%)

Race, ethnicity, and other demographic indicators of decedents

During January – July of 2022, out of 397 confirmed and suspected fatal overdoses for which race was reported, 376 (95%) of the victims were identified as White, 10 (3%) as Black or African American, 4 (1%) as American Indian/Alaska Native, and 1 (<1%) Hawaiian/Pacific Islander. Out of the 387 fatal overdoses for whom ethnicity was reported, 381 (98%) were reported as not Hispanic, and 6 (2%) were identified as Hispanic. Out of the 399 cases for which military background was reported, 30 (8%) were identified as having a military background. Prior overdose history was reported for 145 (36%) of the victims. Transient housing status was reported for 46 (12%) of the victims. The largest totals of undomiciled persons (January-July2022) were found in Cumberland County (20, 43%), and Penobscot County (11, 24%), which under 5 each in York, Androscoggin, Aroostook, Kennebec, and Somerset Counties.

Demographic Indicator% of 2020
Census Population
Jan-Dec
2021 Est.
N=627 Race
N=621 Ethnicity
Jan-Jul
2022 Est.
N=327 Race
N=320 Ethnicity
Race and Ethnicity
White91%585 (93%)376 (95%)
Black or African American2%21 (3%)10 (3%)
American Indian/Alaska Native1%14 (2%)4 (1%)
Other race,
2+ races combined, non-hispanic
7%7 (1%)6 (1%)
Not Hispanic98%611 (99%)381 (98%)
Hispanic2%10 (2%)6 (2%)
Military Background30 (8%)
Prior Overdose History145 (36%)
Undomiciled/Transient Housing Status46 (12%)
*Table totals may not add up to 100% due to rounding.

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 72% in the first seven months of 2022. The cumulative age distribution in January – July 2022 compared to 2021 shows 1 fewer decedent under age 18, no change in the proportion of those aged 18-39, a 1% decrease in those aged 40-59, and a 2% increase in the proportion 60 and above.

% of 2020
Census
Population
Jan-Dec
2019
N=380
Jan-Dec 2020
N=504

Jan-Dec 2021
Est. N=631
Jan-Jul 2022
Est. N=399
Jul 2022
Est. N=69
Percent Males49%258..(68%)357(71%)451.(71%)286(72%)46 (67%)
Percent under 1819%0….(0%)2(<1%)2..(<1%)1…..(<1%)0 (0%)
Percent 18-3926%171..(45%)213..(42%)247.(39%)165(39%)36 (52%)
Percent 40-5927%175..(46%)235..(47%)316.(50%)186..(49%)27 (39%)
Percent 60+29%33….(9%)54(11%)66..(10%)47…..(12%)6 (9%)
*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. Both EMS and police responded to most fatal overdoses, that is, 75% in the first seven months of 2022. In the first seven months of 2022, law enforcement was more likely to respond to a scene alone (19%) than EMS (5%). The overwhelming majority (95%) of drug overdoses were ruled, or suspected of being, accidental manner of death.

During 2022, 27% 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 slightly 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 13% 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 320 suspected and confirmed drug death cases with EMS records during January – July of 2022, 164 (51%) of victims were already deceased when EMS arrived. Of the remaining 156 (49%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 130 who were still alive when EMS arrive, only 52 (16%) remained alive long enough to be transported but died during transport or at the emergency room and 104 (67%) did not survive to be transported. This is likely due to the high number of cases with fentanyl as a cause of death. Fentanyl acts more quickly than other opioids and there is less time for victims to be found alive.

Jan-Dec 2020
N=504

Jan-Dec 2021
Est. N=631
Jan-Jul 2022
Est. N=399
July 2022
Est. N=69
Public safety response
……EMS alone28(6%)30….(5%)21….(5%)3 (4%)
……Law enforcement alone107.(21%)104..(16%)76(19%)16 (23%)
……EMS and law enforcement365.(72%)485..(77%)299(75%)50 (72%)
……Private transport to the Emergency. Dept.7….(1%)3…..(<1)0 (0%)
Naloxone administration
Naloxone administration reported at the scene83.(22%)187..(30%)107..(27%)14 (20%)
……Bystander only11(2%)36….(6%)25(6%)5 (7%)
……Law enforcement only8(2%)22….(3%)15….(4%)1 (2%)
……EMS only55..(11%)84..(13%)31(8%)4 (6%)
……EMS and law enforcement4(1%)20….(3%)8….(2%)2 (3%)
……EMS and bystander8..(2%)15….(2%)18….(5%)2 (3%)
……Law enforcement and bystander0..(0%)5…..(1%)4….(1%)0 (0%)
……EMS, bystander, and law enforcement…….2..(<1%)4….(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 325 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 256 (79%), the slightly higher than the rate in 2021 (77%) and 12% 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 2% of 2022 deaths, 3% of 2021 deaths, compared to 11% in 2020. Methamphetamine was cited as a cause in 35% of the overdoses, a substantial increase from 27% in 2021. Cocaine-involved fatalities January – July constituted 26% of cases, a slight increase from 25% in 2021 and 23% in 2020. Fentanyl is found in combination with cocaine in 21% of 2022 cases, and in combination with methamphetamine in 29%. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 325 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 18 (6%) of confirmed overdose deaths, and 6 (2%) with tramadol listed along with fentanyl. 

Cause of death (alone or in
combination with other drugs)
Sample size for complete cases only
Jan-Dec 2020
N=504

Jan-Dec 2021
N=627
Jan-Jul 2022
N=325
July 2022
N=8
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)489..(77%)256..(79%)8 (100%)
……Heroin57..(11%)22….(3%)7….(2%)0 (0%)
Nonpharmaceutical Stimulants
……Cocaine118.(23%)156..(25%)85.(26%)2 (25%)
……Methamphetamine/amphetamine99.(20%)172..(27%)114.(35%)3 (38%)
Pharmaceutical opioids**118.(23%)130..(21%)65..(20%)0 (0%)
Key combinations
……Fentanyl and heroin47(9%)20….(3%)7….(2%)0 (0%)
……Fentanyl and cocaine97.(19%)127..(20%)68..(21%)2 (25%)
……Fentanyl and methamphetamine/amphetamine70.(14%)133..(21%)93..(29%)3 (38%)
……Fentanyl and xylazine0(0%)53….(8%)18….(6%)0 (0%)
……Fentanyl and tramadol0(0%)24….(4%)6….(2%)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

TREAT ME

TREAT ME is a project of the Maine Chapter, American Academy of Pediatrics, the purpose of which is to offer, at no cost, quality education for primary pediatric providers focused on treatment of adolescent substance use disorder.  This learning collaborative is organized by the Chapter, the Maine Medical Association Center for Quality Improvement, DayOne and the Opioid Response Network in collaboration with OCFS, DHHS and the Governor’s Office of Policy Innovation and the Future.  An Advisory Committee has met for the past year to provide input into the structure and content of the education.  The education was be offered through both live events and asynchronous recordings.  All asynchronous recordings will be completed by Sept. 22 and the first will be available in October.  The first monthly webinar will be presented on Nov. 17 and two live half-day sessions will be offered in 2023.

Recruitment of participants has begun.  The faculty for the course has been drawn primarily from the Adolescent Addiction program at Boston Children’s Hospital and similar programs at Boston Medical Center and Yale.  The program will complement educational sessions held during the past 12 months by OCFS and the SBIRT initiatives on-going within DHHS. For more information and enrollment information, contact dee.kerry@maineaap.org.

TREAT ME funded by the Maine Health Access Foundation with support from the State of Maine and the Opioid Response Network.