June 2021 Monthly Overdose Report

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

Fatal Drug Overdoses in Maine January – June 2021

The June 2021 total of 60 fatal drug overdoses consists of 13 confirmed drug deaths and 47 suspected drug deaths. The cumulative January – June total is 310, which is 21% 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 51.8, and the range is 42 to 60. 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 June 2021.

Comprehensive total of fatal and nonfatal overdoses

During June 2021, there were an estimated 880 fatal and nonfatal drug overdoses statewide, of which 60 (7%) were suspected and confirmed fatal overdoses. The remaining 820 (93%) were nonfatal overdoses: 387 (44%) emergency department; 213 (24%) EMS not transported, 215 (25%) community reversals, and an estimated 5 (1%) law enforcement reversals without EMS. The minimum total of reported nonfatal overdose incidents for January – June 2021 was 3,759 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
EMS Not Transported
Reported Community Reversals
Law Enforcement Without EMS 
Nonfatal (estimated)
Total Overdoses
Total %8%47%25%21%1%100%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for June 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 June 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-June 2021. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. In general, the cumulative percentages for January – June fall within 0%-1% of the 2019 census distribution in many counties including those of Franklin, Hancock, Knox, Lincoln, Oxford, Piscataquis, and Waldo. Counties that are 2% or higher than the census include Androscoggin (5%), Aroostook (2%), Kennebec (3%), Penobscot (5%), and Washington (2%). Counties that are 2% or more lower than the census include Cumberland (-4%), Sagadahoc (-2%), Somerset (-2%) and York (-3%).

CountyPercent of 2019
Census Population
Jan-Dec 2020
June 2021
Est. N=60
Cumulative Jan-Jun 2021
Est. N=310
Androscoggin8%33…….(9%)52.(10%) 8.(13%)40….(13%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for June 2021.

Race, ethnicity, and other demographic indicators of decedents

During the first six months of 2021, out of 310 confirmed and suspected fatal overdoses, 289 (93%) of the victims were identified as White, 13 (4%) as Black or African American, and 6 (2%) as American Indian/Alaska Native. Out of the 305 fatal overdoses where ethnicity was reported, 302 (99%) were reported as not Hispanic, and 3 (1%) were identified as Hispanic. Out of the 310 cases, 20 (6%) were identified as having a military background. Prior overdose history was reported for 103 (33%) of the victims. Transient housing status was reported for 26 (8%) of the victims.

Demographic IndicatorNumber of decedents
Percent of decedents
Race and Ethnicity
Black or African American134%
American Indian/Alaska Native62%
Not Hispanic30299%
Military Background206%
Prior Overdose History10333%
Person Experiencing Homelessness268%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for June 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 increased since 2019. In the first six months of 2021, it was 70%, which is slightly lower than the 71% level in 2020 and slightly higher than the 68% level in 2019. The cumulative age distribution in January – June 2021 compared to 2019 shows the percentage of those 18-39 decreased by 5%. The percentage of those 40-59 rose by 3%, and the percentage of those over 60 also rose 2%. There has been 3 decedents under 18 in 2021.

Jan-Dec 2020
Jan-Jun 2021
Est. N=310
Est. N=60
Percent Males258..(68%)357(71%)217.(70%)43(71%)
Percent under 180….(0%)2(<1%)3….(1%)1…..(2%)
Percent 18-39171..(45%)213..(42%)124.(40%)21(34%)
Percent 40-59175..(46%)235..(47%)151.(49%)31(51%)
Percent 60+33….(9%)54(11%)33..(11%)7(12%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for June 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 the first six months 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 (95%) of drug overdoses were ruled as accidental manner of death.

Based on the death investigation records, during June, naloxone was administered to 36% of the victims at the scene or in the ambulance, whether by EMS, bystanders, or law enforcement, slightly less than the first six months of 2021 combined (39%) but greater than 2020 (33%). 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 June decedents had naloxone prescriptions, but 7 did in 2020 and 4 in the first six months of 2021.

Based on 251 suspected and confirmed drug death cases with EMS records during the first six months of 2021, 114 (45%) of victims were already deceased when EMS arrived. Of the remaining 137 (54%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of the 137 cases who were still alive when EMS arrived, 43 were transported, and 94 did not survive to be transported. Thus, out of 252 cases with EMS records, only 43 (17%) remained alive long enough to be transported, but died during transport or at the emergency room.

Jan-Dec 2020
Jan-Jun 2021
Est. N=310
Est. N=60
Public safety response
……EMS alone28(6%)16….(5%)4……(7%)
……Law enforcement alone107.(21%)49..(19%)15(25%)
……EMS and law enforcement365.(72%)235..(76%)41(68%)
Manner of death (suspected or confirmed)
Naloxone administration
Naloxone administration at the scene and/or
(presumably) in ambulance during transport to
emergency room
Naloxone administration reported at the scene83.(22%)98.(32%)16..(26%)
……Bystander only11(2%)17….(6%)5….(8%)
……Law enforcement only8(2%)14….(5%)1….(2%)
……EMS only55..(11%)47..(15%)9..(15%)
……EMS and law enforcement4(1%)13….(4%)1….(2%)
……EMS and bystander8..(2%)6….(2%)0….(0%)
……Law enforcement and bystander0..(0%)1..(<1%)0….(0%)
……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 June 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 is the most frequent cause of death to date in 2021, at 62%, slightly lower than in 2020. Fentanyl is nearly always found in combination with multiple other drugs. Heroin involvement has been declining during the last several years; it represents only 5% of 2021 deaths, compared to 11% last year. Illicit stimulants have been increasing in recent years, and in the first six months of 2021, methamphetamine caused 22% of the overdoses, which is slightly more than 2020. Cocaine-involved fatalities constituted 17% of cases, slightly lower than 23% in 2020. Fentanyl is found in combination with cocaine in 15% of cases, and fentanyl and methamphetamine as a combination in 17% of cases. Pharmaceutical opioids were identified as a cause of death in 18%, all in combination with other drugs, 5% lower than in 2020.

Cause of death (alone or in
combination with other drugs)
Jan-Dec 2020
Jan-Jun 2021
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)192..(62%)8..(62%)
Nonpharmaceutical Stimulants
Pharmaceutical opioids**118.(23%)57.(18%)2(215)
Key combinations
……Fentanyl and cocaine97.(19%)45..(15%)1….(7%)
……Fentanyl and methamphetamine/amphetamine70.(14%)53..(17%)3.(23%)
……Fentanyl and xylazine0(0%)27(11%)4..(31%)
……Fentanyl and tramadol0(0%)17….(5%)1….(7%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for June 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.

Highlight of the month regarding substance use disorder public policy response

Accidental Drug Overdose Death Review Panel

On June 21, 2021, Governor Janet T. Mills signed into law L.D. 1718, An Act to Establish the Accidental Drug Overdose Death Review Panel.  The legislation was sponsored by Rep. Richard Evans of Dover-Foxcroft who is a physician.   Because the bill included an emergency preamble and passed with more than a two-thirds majority, the law took effect immediately.  The law establishes an Accidental Drug Overdose Death Review Panel to review a subset of deaths caused by accidental drug overdoses and to recommend to state, county and local agencies methods of preventing deaths as the result of such overdoses, including modification or enactment of laws rules, policies and procedures.  Despite the title of the bill, the panel also has the authority to review nonfatal overdoses, when such review promotes the purpose of the panel.  The panel is made of up fifteen (15) individuals representing a number of state offices, law enforcement agencies and including impacted family members and persons in recovery.  The panel also will include one or more physicians who treat substance use disorder, an EMS representative and a harm reduction specialist.  The panel will be chaired by the state’s Director of Opioid Response and the first meeting is expected to be held by September 1, 2021 once all the appointments are made.  The panel will be staffed by the research team at the Margaret Chase Smith Policy Center at the University of Maine.

The panel will operate similar to the processes followed by other fatality review panels in the state such as the Maternal and Infant Death Review Panel.  Provisions in the law allow these panels to collect materials that might otherwise be confidential and to deliberate in private when necessary.  Several other states have similar panels which have been considered to be an effective strategy in preventing overdose deaths. 

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.