June 2022 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for June 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 June, the proportion of fatal overdoses averaged 7% of total overdoses, the same level as the average for the first six months of 2022, and the same level as during 2021. The monthly proportion of 2022 fatalities has fluctuated, however, including a low of 5% in May 2022 and a high of 8% in April. During the first half of 2022, the average number of overdoses per month was approximately 820 (55 fatal and 766 nonfatal cases). This compares to the monthly average for January – June 2021 of 695 (50 fatal and 645 nonfatal cases). The number of fatal overdoses in 2022 is 9.7% higher than during the same time in 2021.

From January 2022 to June 2022, there were an estimated 4,922 fatal and nonfatal drug overdoses statewide, of which 329 (7%) were suspected and confirmed fatal overdoses. The remaining 4,593 (93%) were nonfatal overdoses: 2,247 (46%) emergency department visits; 1,267 (26%) EMS patents who were not transported to the emergency room, 1,074 (22%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 5 (<1%) 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
EMS Not Transported
to the ED Nonfatal
Community Reversals
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 ’22442962061771724
February ’22493331851521720
March ’22654582012020926
April ’22592901771863715
May ’22494012481790877
June ’22694692501770965
2022 Total32922471,2671,07454,922
2022 Total %6.7%45.7%25.7%21.8%0.1%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 June 2022

Fatal Drug Overdoses in Maine January – June 2022

During the first 6 months of 2022, the proportion of fatal overdoses averaged 6.7% of total overdoses. From January to June 2022 there was a total 329 fatal fatal drug overdoses consisting of 262 confirmed and 67 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 (June 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 – June 2022 (329) is 9% higher than the first six months of 2021 (307) 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-June 2022. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.

The cumulative January-June 2022 percentages of deaths in many counties fall within plus or minus 0%-1% of the 2020 census distribution, including Androscoggin, Aroostook, Franklin, Knox, Lincoln, Oxford, Piscataquis, Sagadahoc, Somerset, Waldo, Washington, and York. The only county that is 2% or more higher than the 2020 census proportions in 2022 is Penobscot (+5%). Counties that are 2% or more lower than the 2020 census proportion in 2022 are Cumberland (-3%), Hancock (-2%), and Kennebec (-2%).

County% of 2020
Census Population
Jan-Dec 2020

Jan-Dec 2021
Est. N=631
Jan-Jun 2022
Est. N=329
Jun 2022
Androscoggin8%33…….(9%)52.(10%)69…..(11%)30 (9%)7 (10%)
Aroostook5%14…….(4%)17(3%)39……(6%)21 (6%)5 (7%)
Cumberland22%100…..(26%)97.(19%)114….(28%)62 (19%)12 (17%)
Franklin2%5……..(1%)8(2%)8…….(1%)9 (3%)1 (1%)
Hancock4%9…….(2%)13(3%)22……(3%)8 (2%)3 (4%)
Kennebec9%42……(11%)49.(10%)64….(10%)23 (7%)8 (12%)
Knox3%7…….(2%)16(3%)11……(2%)8 (2%)2 (3%)
Lincoln3%11…….(3%)9(2%)16……(3%)5 (2%)1 (1%)
Oxford4%9…….(2%)15(3%)28……(4%)16 (5%)4 (6%)
Penobscot11%53…..(14%)94.(19%)106…..(17%)52 (16%)8 (12%)
Piscataquis1%3…….(1%)10(2%)11……(2%)4 (1%)0 (0%)
Sagadahoc3%8……(2%)8….(1%)7……(1%)5 (2%)0 (0%)
Somerset4%16……(4%)13(3%)26…..(4%)13 (4%)1 (1%)
Waldo3%3…….(1%)9(2%)15…..(2%)12 (4%)2 (3%)
Washington2%10……(3%)20..(4%)25…..(4%)6 (2%)1 (1%)
York16%57….(15%)74.(15%)70….(11%)55 (17%)14 (20%)

Race, ethnicity, and other demographic indicators of decedents

During January – June of 2022, out of 327 confirmed and suspected fatal overdoses for which race was reported, 311 (95%) of the victims were identified as White, 9 (3%) as Black or African American, 3 (1%) as American Indian/Alaska Native, and 1 (<1%) Hawaiian/Pacific Islander. Out of the 320 fatal overdoses for whom ethnicity was reported, 316 (99%) were reported as not Hispanic, and 4 (1%) were identified as Hispanic. Out of the 329 cases for which military background was reported, 28 (9%) were identified as having a military background. Prior overdose history was reported for 124 (38%) of the victims. Transient housing status was reported for 42 (13%) of the victims: 19 in Cumberland County, 10 in Penobscot County, 4 in York County, 2 in Androscoggin County, 2 in Aroostook County, 2 in Kennebec County, 1 in Franklin County, 1 in Somerset County, and one from out of state.

Demographic Indicator% of 2020
Census Population
2021 Est.
N=627 Race
N=621 Ethnicity
2022 Est.
N=327 Race
N=320 Ethnicity
Race and Ethnicity
White91%585 (93%)311 (95%)
Black or African American2%21 (3%)9 (3%)
American Indian/Alaska Native1%14 (2%)3 (1%)
Other race,
2+ races combined, non-hispanic
7%7 (1%)4 (1%)
Not Hispanic98%611 (99%)316 (99%)
Hispanic2%10 (2%)4 (1%)
Military Background28 (9%)
Prior Overdose History124 (38%)
Undomiciled/Transient Housing Status42 (13%)
*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 73% in 2022. The cumulative age distribution in January – June 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
Jan-Dec 2020

Jan-Dec 2021
Est. N=631
Jan-Jun 2022
Est. N=329
Jun 2022
Est. N=69
Percent Males49%258..(68%)357(71%)451.(71%)240(73%)48 (70%)
Percent under 1819%0….(0%)2(<1%)2..(<1%)1…..(<1%)1 (1%)
Percent 18-3926%171..(45%)213..(42%)247.(39%)128(39%)27 (39%)
Percent 40-5927%175..(46%)235..(47%)316.(50%)160..(49%)34 (49%)
Percent 60+29%33….(9%)54(11%)66..(10%)40…..(12%)7 (10%)
*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, 77% in both 2021 and the first six months of 2022. In the first six months of 2022, law enforcement was more likely to respond to a scene alone (18%) than EMS (5%). The overwhelming majority (95%) of drug overdoses were ruled, or suspected of being, accidental manner of death.

During 2022, 29% 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 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 329 suspected and confirmed drug death cases with EMS records during January – June of 2022, 138 (51%) of victims were already deceased when EMS arrived. Of the remaining 130 (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 41 (15%) remained alive long enough to be transported but died during transport or at the emergency room and 89 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

Jan-Dec 2021
Est. N=631
Jan-Jun 2022
Est. N=329
June 2022
Est. N=69
Public safety response
……EMS alone28(6%)30….(5%)16….(5%)3 (4%)
……Law enforcement alone107.(21%)104..(16%)59(18%)16 (23%)
……EMS and law enforcement365.(72%)485..(77%)252(77%)50 (72%)
……Private transport to the Emergency. Dept.7….(1%)2…..(<1)0 (0%)
Naloxone administration
Naloxone administration reported at the scene83.(22%)187..(30%)95..(29%)17 (25%)
……Bystander only11(2%)36….(6%)20(6%)3 (4%)
……Law enforcement only8(2%)22….(3%)14….(4%)5 (7%)
……EMS only55..(11%)84..(13%)29(9%)6 (9%)
……EMS and law enforcement4(1%)20….(3%)6….(2%)1 (1%)
……EMS and bystander8..(2%)15….(2%)16….(5%)1 (1%)
……Law enforcement and bystander0..(0%)5…..(1%)4….(1%)0 (0%)
……EMS, bystander, and law enforcement…….2..(<1%)4….(1%)1 (1%)

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 271 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 208 (77%), the same rate as in 2021 (77%) but 10% 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, which is 8% more than 2021 (27%). Cocaine-involved fatalities January – June constituted 28% of cases, an increase from 25% in 2021 and 23% in 2020. Fentanyl is found in combination with cocaine in 22% 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 271 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 17 (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

Jan-Dec 2021
Jan-Jun 2022
June 2022
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)489..(77%)208..(77%)13 (87%)
……Heroin57..(11%)22….(3%)5….(2%)0 (0%)
Nonpharmaceutical Stimulants
……Cocaine118.(23%)156..(25%)75.(28%)1 (7%)
……Methamphetamine/amphetamine99.(20%)172..(27%)96.(35%)5 (33%)
Pharmaceutical opioids**118.(23%)130..(21%)57..(21%)1 (7%)
Key combinations
……Fentanyl and heroin47(9%)20….(3%)5….(2%)0 (0%)
……Fentanyl and cocaine97.(19%)127..(20%)59..(22%)0 (0%)
……Fentanyl and methamphetamine/amphetamine70.(14%)133..(21%)78..(29%)5 (33%)
……Fentanyl and xylazine0(0%)53….(8%)17….(6%)1 (7%)
……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

Maine Substance Use Disorders Learning Community

The Co-Occurring Collaborative Serving Maine in partnership with and with funding from the Maine Department of Health and Human Services supports Prescribing Clinicians and their Teams to provide more evidence-based treatment to individuals and their families affected by Substance Use Disorders and Opioid Use Disorder (SUD/OUD) to promote recovery and reduce drug overdose deaths. The aim is to increase the number of prescribing clinicians offering evidence-based treatments and the number of patients that they serve. The Statewide SUD Learning Community offers an array of education and support modalities for Prescribers (physicians, nurse practitioners, and physician assistants) and their entire Practice Team through an array of highly accomplished faculty consultants and with support from Muskie School of Public Policy e-learning team and AdCare Educational Institute Maine.

More information and all the available course offerings can be viewed on the project’s website at http://mesudlearningcommunity.org