Download the entire PDF report here: Maine Monthly Overdose Report for July 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 July, the proportion of fatal overdoses averaged 6.6% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.1% in March and a high of 8.1% in April. During July 2023, there were an estimated 821 fatal and nonfatal drug overdoses statewide, of which 54 (6.6%) were suspected and confirmed fatal overdoses. The remaining 767 (93.4%) were nonfatal overdoses: 328 (40.0%) emergency department visits; 248 (30.0%) EMS patents who were not transported to the emergency room, 173 (21.1%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 18 (2.2%) 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 ’22 | 45 | 295 | 206 | 178 | 39 | 763 |
| Feb ’22 | 48 | 333 | 185 | 153 | 37 | 756 |
| Mar ’22 | 65 | 458 | 201 | 202 | 30 | 956 |
| Apr ’22 | 60 | 290 | 178 | 189 | 26 | 743 |
| May ’22 | 47 | 402 | 248 | 186 | 41 | 924 |
| Jun ’22 | 66 | 482 | 250 | 177 | 44 | 1013 |
| Jul ’22 | 66 | 347 | 287 | 183 | 40 | 923 |
| Aug ’22 | 64 | 385 | 272 | 255 | 37 | 1013 |
| Sep ’22 | 55 | 458 | 256 | 153 | 33 | 955 |
| Oct ’22 | 65 | 283 | 238 | 177 | 27 | 790 |
| Nov ’22 | 66 | 287 | 206 | 200 | 20 | 779 |
| Dec ’22 | 76 | 362 | 212 | 198 | 14 | 862 |
| 2022 Total | 723 | 4,382 | 2,739 | 2,251 | 388 | 10,483 |
| 2022 Total % | 6.9% | 41.8% | 26.1% | 21.5% | 3.7% | 100% |
| Jan ’23 | 54 | 296 | 219 | 184 | 44 | 797 |
| Feb ’23 | 49 | 347 | 226 | 192 | 27 | 841 |
| Mar ’23 | 40 | 382 | 256 | 237 | 54 | 969 |
| Apr ’23 | 63 | 270 | 218 | 202 | 27 | 780 |
| May ’23 | 50 | 295 | 221 | 165 | 30 | 761 |
| Jun ’23 | 56 | 377 | 228 | 219 | 26 | 906 |
| Jul ’23 | 54 | 328 | 248 | 173 | 18 | 821 |
| 2023 Total | 366 | 2,295 | 1,616 | 1,372 | 226 | 5,875 |
| 2023 Total % | 6.2% | 39.1% | 27.5% | 23.4% | 3.8% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine July 2023
Fatal Drug Overdoses in Maine Jan – Jul 2023
During 2023, the proportion of fatal overdoses averaged 6.2% of total overdoses. From January to July 2023 there was a total 366 fatal drug overdoses consisting of 315 confirmed and 51 suspected drug deaths. In July 2023 there were 54 fatal drug overdoses consisting of 13 confirmed and 41 suspected cases. The graph below shows the considerable monthly fluctuation since January of 2022. The range extends from 76 (December 2022) to 40 (March 2023). During 2023, the monthly proportions fluctuated from a low of 4.1% in March and a high of 8.1% in April. During the first seven months of 2023, fatal overdoses comprised 6.2% of all overdoses; this proportion slightly lower than the 6.9% for 2022. There were 366 confirmed and suspected fatal overdoses in the first seven months of 2023; this is 7.8% lower than the 397 fatal overdoses during the same time period in 2022.
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 – July 2023 as well as 2022.
| Maine EMS | Law Enforcement | |
| Fatal Overdose Response 2022 | 582 | 672 |
| Nonfatal Overdose Response 2022 | 9,376 | 1,471 |
| Total Overdose Response 2022 | 9,958 | 2,143 |
| Fatal Overdose Response Jan – Jul 2023 | 296 | 343 |
| Nonfatal Overdose Response Jan – Jul 2023 | 5,249 | 695 |
| Total Overdose Response Jan- Jul 2023 | 5,545 | 1,038 |
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 July 2023 monthly totals can be compared to the percentage of census population, the percentages of nonfatal overdoses in the center column, or the percentages of nonfatal overdoses during 2023. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. The January – July percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Androscoggin County and Penobscot County are 3 percentage points higher than the 2020 census proportion. York County is 4 percentage points lower than the 2020 census proportion.
Nonfatal Drug Overdoses in Maine, July 2023
Nonfatal Drug Overdoses in Maine, Jan 2023 – Jul 2023
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=9377 | Jan-Jul 2023 Est. N=5249 | Jul 2023 Est. N=870 |
|---|---|---|---|---|
| Androscoggin | 8% | 1055 (11%) | 556 (11%) | 96 (11%) |
| Aroostook | 5% | 490 (5%) | 241 (5%) | 52 (6%) |
| Cumberland | 22% | 2194 (23%) | 1207 (23%) | 196 (23%) |
| Franklin | 2% | 140 (1%) | 78 (1%) | 13 (1%) |
| Hancock | 4% | 287 (3%) | 169 (3%) | 30 (3%) |
| Kennebec | 9% | 922 (10%) | 527 (10%) | 81 (9%) |
| Knox | 3% | 245 (3%) | 182 (3%) | 31 (4%) |
| Lincoln | 3% | 162 (2%) | 95 (2%) | 14 (2%) |
| Oxford | 4% | 410 (4%) | 205 (4%) | 39 (4%) |
| Penobscot | 11% | 1293 (14%) | 750 (14%) | 124 (14%) |
| Piscataquis | 1% | 90 (1%) | 67 (1%) | 14 (2%) |
| Sagadahoc | 3% | 130 (1%) | 81 (2%) | 16 (2%) |
| Somerset | 4% | 392 (4%) | 254 (5%) | 25 (3%) |
| Waldo | 3% | 199 (2%) | 116 (2%) | 19 (2%) |
| Washington | 2% | 221 (2%) | 99 (2%) | 17 (2%) |
| York | 16% | 1147 (12%) | 622 (12%) | 103 (12%) |
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 all Maine drug deaths for 2022, or the percent of drug deaths in 2023. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.
The cumulative January-July 2023 percentages of deaths in most counties fall within plus or minus 0 to 2 percentage points of the 2020 census distribution. Androscoggin County is 5 percentage points higher and Penobscot County is 4 percentage points higher. York County is 4 percentage points lower than the 2020 census proportion.
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=723 | Jan-Jul 2023 Est. N=366 | Jul 2023 Est. N=54 |
|---|---|---|---|---|
| Androscoggin | 8% | 69 (10%) | 46 (13%) | 5 (9%) |
| Aroostook | 5% | 47 (7%) | 20 (5%) | 4 (7%) |
| Cumberland | 22% | 134 (19%) | 78 (21%) | 10 (19%) |
| Franklin | 2% | 13 (2%) | 5 (1%) | 1 (2%) |
| Hancock | 4% | 24 (3%) | 8 (2%) | 1 (2%) |
| Kennebec | 9% | 54 (7%) | 37 (10%) | 4 (7%) |
| Knox | 3% | 20 (3%) | 8 (2%) | 2 (4%) |
| Lincoln | 3% | 14 (2%) | 6 (1%) | 1 (2%) |
| Oxford | 4% | 36 (5%) | 10 (3%) | 2 (4%) |
| Penobscot | 11% | 109 (15%) | 54 (15%) | 7 (13%) |
| Piscataquis | 1% | 9 (1%) | 12 (3%) | 2 (4%) |
| Sagadahoc | 3% | 11 (2%) | 4 (1%) | 3 (6%) |
| Somerset | 4% | 35 (5%) | 16 (4%) | 4 (7%) |
| Waldo | 3% | 21 (3%) | 4 (1%) | 0 (0%) |
| Washington | 2% | 24 (3%) | 15 (4%) | 1 (2%) |
| York | 16% | 103 (14%) | 43 (12%) | 7 (13%) |
Race, ethnicity, and other demographic indicators of decedents
During the first seven months of 2023, out of 363 confirmed and suspected fatal overdoses for which race was reported, 327 (90%) of the victims were identified as White, 12 (3%) as Black or African American, and 7 (2%) as American Indian/Alaska Native. Out of the 356 fatal overdoses for whom ethnicity was reported, 353 (99%) were reported as not Hispanic, and 3 (1%) were identified as Hispanic.
Out of the 364 cases for which military background was reported in January – July 2023, 22 (6%) were identified as having a military background. Out of the 54 cases in July 2023 where military background was reported, 5 (9%) were identified as having a military background.
Prior overdose history was reported for 138 (38%) of the victims during January-July 2023.
Of 366 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 41 (11%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (14, 34%), Penobscot County (10, 24%) and Androscoggin County (6, 15%). In July 2023, 6 decedents (11%) were identified as undomiciled.
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2022 Est. Race N=720 Ethnicity N=706 | Jan-Jul 2023 Est. Race N=363 Ethnicity N=356 | Jul 2023 Est. Race N=54 Ethnicity N=53 |
|---|---|---|---|---|
| Race and Ethnicity | ||||
| White | 91% | 657 (91%) | 327 (90%) | 51 (94%) |
| Black or African American | 2% | 17 (2%) | 12 (3%) | 0 (0%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 7 (2%) | 1 (2%) |
| Other race, 2+ races combined, non-hispanic | 7% | 12 (2%) | 7 (2%) | 1 (2%) |
| Not Hispanic | 98% | 699 (99%) | 353 (99%) | 53 (100%) |
| Hispanic | 2% | 7 (1%) | 3 (1%) | 0 (0%) |
| Military Background | 81 (11%) | 22 (6%) | 5 (9%) | |
| Prior Overdose History | 269 (37%) | 138 (38%) | 25 (46%) | |
| Undomiciled/Transient Housing Status | 81 (11%) | 41 (11%) | 6 (11%) |
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 in recent years from 68% in 2019 to 71% in 2020 and 2021 and 73% in 2022 as well as the first seven months in 2023. The cumulative age distribution in January – July 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 1 deaths in 2023, a 5 percentage point decrease in the proportion of those aged 18-39, a 4 percentage point increase in those aged 40-59, and a 1 percentage point increase in the proportion 60 and above.
| % of 2020 Census Population | Jan-Dec 2022 Est. N=723 | Jan-Jul 2023 Est. N=366 | Jul 2023 Est. N=54 | |
|---|---|---|---|---|
| Percent Males | 49% | 527…(73%) | 269 (73%) | 36 (67%) |
| Percent under 18 | 19% | 3…(<1%) | 1 (<1%) | 0 (0%) |
| Percent 18-39 | 26% | 295…(41%) | 131 (36%) | 12 (22%) |
| Percent 40-59 | 27% | 333..(46%) | 182 (50%) | 37 (69%) |
| Percent 60+ | 29% | 92…(13%) | 52 (14%) | 5 (9%) |
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 (75%) in 2023. In 2023, law enforcement was more likely to respond to a scene alone (19%) than EMS (5%). The overwhelming majority (90%) of drug overdoses were ruled, or suspected of being, accidental manner of death.
During 2023, 25% of fatal overdose cases had naloxone administered at the scene by EMS, bystanders, or law enforcement. This rate is slightly higher than the 22% of fatal overdose cases in which naloxone was reportedly administered at the scene in 2020, the same as reported in 2022, and 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 16% (57) of the fatal overdoses, often in addition to EMS and/or law enforcement. This is higher than 2022 (12%), 2021 (9%), and 2020 (4%).
Based on 296 suspected and confirmed drug death cases with EMS involvement during the first seven months of 2023, 167 (56%) of victims were already deceased when EMS arrived. In the remaining 129 (44%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 129 who were still alive when EMS arrived, only 35 (27%) remained alive long enough to be transported but died during transport or at the emergency room and 93 (72%) did not survive to be transported and 1 had an unknown status. 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=723 | Jan – Jul 2023 Est. N=366 | Jul 2023 Est. N=54 | |
|---|---|---|---|
| Public safety response | |||
| ……EMS alone | 38….(5%) | 21 (6%) | 3 (6%) |
| ……Law enforcement alone | 131…(18%) | 68 (19%) | 6 (11%) |
| ……EMS and law enforcement | 541…(75%) | 275 (75%) | 45 (83%) |
| ……Private transport to the Emergency. Dept. | 13…..(2%) | 1 (<1%) | 0 (0%) |
| Naloxone administration | |||
| Naloxone administration reported at the scene | 182..(25%) | 93 (25%) | 17 (31%) |
| ……Bystander only | 44…(6%) | 24 (7%) | 4 (7%) |
| ……Law enforcement only | 31….(4%) | 8 (2%) | 2 (4%) |
| ……EMS only | 49….(7%) | 27 (7%) | 3 (6%) |
| ……EMS and law enforcement | 11….(2%) | 5 (1%) | 2 (4%) |
| ……EMS and bystander | 26….(4%) | 23 (6%) | 6 (11%) |
| ……Law enforcement and bystander | 5….(1%) | 8 (2%) | 2 (4%) |
| ……EMS, bystander, and law enforcement | 6….(1%) | 2 (<1%) | 1 (2%) |
| ……Naloxone administered by unspecified person | 0…(0%) | 1 (<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 315 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 252 (80%).
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% (9) of 2023 deaths and 3% (19) of 2022 deaths, compared to 11% (57) in 2020. Methamphetamine was cited as a cause of death in 32% (101) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – July constituted 34% (108) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 85% (92) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 82% (83) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 315 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 28 (9%) of confirmed overdose deaths, and 1 (<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=723 | Jan-Jul 2023 N=315 | *Jul 2023 N=13 |
|---|---|---|---|
| Nonpharmaceutical opioids | |||
| ……Fentanyl or fentanyl analogs | 560..(77%) | 252 (80%) | 9 (69%) |
| ……Heroin | 19….(3%) | 9 (3%) | 0 (0%) |
| Nonpharmaceutical Stimulants | |||
| ……Cocaine | 213.(29%) | 108 (34%) | 6 (46%) |
| ……Methamphetamine | 234.(32%) | 101 (32%) | 5 (38%) |
| Pharmaceutical opioids** | 156..(22%) | 56 (18%) | 4 (31%) |
| Key combinations | |||
| ……Fentanyl and heroin | 18….(2%) | 9 (3%) | 0 (0%) |
| ……Fentanyl and cocaine | 171..(24%) | 92 (29%) | 4 (31%) |
| ……Fentanyl and methamphetamine | 189..(26%) | 83 (26%) | 5 (38%) |
| ……Fentanyl and xylazine | 46….(6%) | 28 (9%) | 2 (15%) |
| ……Fentanyl and tramadol | 10….(1%) | 1 (<1%) | 1 (8%) |
**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
Maine Opioid Response: Strategic Action Plan 2023-2025
“Governor Mills’ strategic action plan for opioid response is one of the most comprehensive in the nation. Since day one, she has made this a priority in her administration.” Michael Botticelli, Former Director, White House Office of National Drug Control Policy
Governor Janet T. Mills presented her updated Opioid Response Strategic Action Plan on July 20 at her 5thAnnual Opioid Response Summit. Held at the Cross Insurance Arena in Portland, the Summit attracted 1400 attendees, all of whom received a copy of the updated Plan. A pdf version of the Plan can be found at on the Maine Drug Data Hub: Strategic Action Plan, 2023-2025. The updated Plan focuses on six areas: Prevention, Treatment, Harm-Reduction, Recovery, Public Safety and Leadership. Within the six areas, there are nine priorities, thirty-four strategies and dozens of activities under each of the strategies. The original Plan was adopted in September 2019 and updated mid-way through the global pandemic in 2021. Among the new provisions in the updated Plan are strategies and activities supporting Maine’s veterans, immigrant populations and faith-based treatment programs. Each section of the updated Plan begins with a “Progress Update” indicating what has been accomplished since 2019. The document opens with letters from Governor Mills and Gordon Smith, the state’s Director of Opioid Response. The Governor closes her letter with the following:
“There is no simple solution to ending the opioid epidemic, but this new strategic plan outlines the latest steps we are taking to save lives, to prevent substance use disorder, and to ensure that our people can achieve their full potential. I welcome your partnership and I thank you for all your efforts to support these goals.”
To address the ongoing crisis, the process of revising and updating the Plan began in 2022. Many partners, both external and internal, were engaged to comment on the existing plan and to make recommendations for the update. This updated plan is the result of this inclusive process which resulted in nearly one thousand comments being submitted for consideration.
This Plan will not be stagnant. We will continue to update the Plan as needed in order to serve the needs of Maine people. Our work is not done, but we are in a much better position now than during earlier times, partly because of the settlement funds coming into the state. But, most of all, we are in a better position because of the thousands of Mainers who are helping everyday to reduce the shame and stigma associated with substance use disorders and supporting persons who are on a pathway to recovery. This updated Strategic Action Plan provides us all with a roadmap to saving lives and preventing substance use disorders. Thank you for caring and for your support.