Download the entire PDF report here: Maine Monthly Overdose Report for June 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 June, the proportion of fatal overdoses averaged 6.0% 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 June 2023, there were an estimated 872 fatal and nonfatal drug overdoses statewide, of which 52 (6.0%) were suspected and confirmed fatal overdoses. The remaining 820 (94.0%) were nonfatal overdoses: 347 (39.8%) emergency department visits; 228 (26.1%) EMS patents who were not transported to the emergency room, 219 (25.1%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 26 (3.0%) 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 | 217 | 202 | 27 | 779 |
| May ’23 | 49 | 294 | 221 | 165 | 30 | 759 |
| Jun ’23 | 52 | 347 | 228 | 219 | 26 | 872 |
| 2023 Total | 307 | 1,936 | 1,367 | 1,199 | 208 | 5,017 |
| 2023 Total % | 6.1% | 38.6% | 27.2% | 23.9% | 4.1% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine June 2023
Fatal Drug Overdoses in Maine Jan – Jun 2023
During 2023, the proportion of fatal overdoses averaged 6.1% of total overdoses. From January to June 2023 there was a total 307 fatal drug overdoses consisting of 268 confirmed and 39 suspected drug deaths. In June 2023 there were 52 fatal drug overdoses consisting of 15 confirmed and 37 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 six months of 2023, fatal overdoses comprised 6.1% of all overdoses; this proportion slightly lower than the 6.9% for 2022. There were 307 confirmed and suspected fatal overdoses in the first five months of 2023; this is 7.5% lower than the 331 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 – June 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 – Jun 2023 | 243 | 289 |
| Nonfatal Overdose Response Jan – Jun 2023 | 4,374 | 601 |
| Total Overdose Response Jan- Jun 2023 | 4,617 | 890 |
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 June 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 – June percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Androscoggin and Penobscot County are 3 percentage points higher than the 2020 census proportion. York County is 4 percentage points lower, and Sagadahoc County is 2 percentage points lower than the 2020 census proportion.
Nonfatal Drug Overdoses in Maine, June 2023
Nonfatal Drug Overdoses in Maine, Jan 2023 – Jun 2023
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=9377 | Jan-Jun 2023 Est. N=4374 | Jun 2023 Est. N=707 |
|---|---|---|---|---|
| Androscoggin | 8% | 1055 (11%) | 460 (11%) | 76 (11%) |
| Aroostook | 5% | 490 (5%) | 189 (4%) | 34 (5%) |
| Cumberland | 22% | 2194 (23%) | 1007 (23%) | 148 (21%) |
| Franklin | 2% | 140 (1%) | 65 (1%) | 7 (1%) |
| Hancock | 4% | 287 (3%) | 138 (3%) | 23 (3%) |
| Kennebec | 9% | 922 (10%) | 446 (10%) | 79 (11%) |
| Knox | 3% | 245 (3%) | 151 (3%) | 17 (2%) |
| Lincoln | 3% | 162 (2%) | 81 (2%) | 22 (3%) |
| Oxford | 4% | 410 (4%) | 166 (4%) | 29 (4%) |
| Penobscot | 11% | 1293 (14%) | 626 (14%) | 97 (14%) |
| Piscataquis | 1% | 90 (1%) | 53 (1%) | 8 (1%) |
| Sagadahoc | 3% | 130 (1%) | 65 (1%) | 13 (2%) |
| Somerset | 4% | 392 (4%) | 229 (5%) | 41 (6%) |
| Waldo | 3% | 199 (2%) | 97 (2%) | 13 (2%) |
| Washington | 2% | 221 (2%) | 82 (2%) | 17 (2%) |
| York | 16% | 1147 (12%) | 519 (12%) | 83 (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-June 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 5 percentage points lower than the 2020 census proportion.
| County | % of 2020 Census Population | Jan-Dec 2022 Est. N=723 | Jan-Jun 2023 Est. N=307 | Jun 2023 Est. N=52 |
|---|---|---|---|---|
| Androscoggin | 8% | 69 (10%) | 41 (13%) | 7 (13%) |
| Aroostook | 5% | 47 (7%) | 16 (5%) | 3 (6%) |
| Cumberland | 22% | 134 (19%) | 66 (21%) | 12 (23%) |
| Franklin | 2% | 13 (2%) | 3 (1%) | 1 (2%) |
| Hancock | 4% | 24 (3%) | 8 (3%) | 2 (4%) |
| Kennebec | 9% | 54 (7%) | 33 (11%) | 4 (8%) |
| Knox | 3% | 20 (3%) | 5 (2%) | 2 (4%) |
| Lincoln | 3% | 14 (2%) | 5 (2%) | 1 (2%) |
| Oxford | 4% | 36 (5%) | 8 (3%) | 0 (0%) |
| Penobscot | 11% | 109 (15%) | 47 (15%) | 8 (15%) |
| Piscataquis | 1% | 9 (1%) | 10 (3%) | 2 (4%) |
| Sagadahoc | 3% | 11 (2%) | 1 (1%) | 0 (0%) |
| Somerset | 4% | 35 (5%) | 12 (4%) | 1 (2%) |
| Waldo | 3% | 21 (3%) | 4 (1%) | 0 (0%) |
| Washington | 2% | 24 (3%) | 13 (4%) | 1 (2%) |
| York | 16% | 103 (14%) | 35 (11%) | 8 (15%) |
Race, ethnicity, and other demographic indicators of decedents
During the six months of 2023, out of 301 confirmed and suspected fatal overdoses for which race was reported, 268 (89%) of the victims were identified as White, 12 (4%) as Black or African American, and 6 (2%) as American Indian/Alaska Native. Out of the 295 fatal overdoses for whom ethnicity was reported, 292 (99%) were reported as not Hispanic, and 3 (1%) were identified as Hispanic.
Out of the 302 cases for which military background was reported in January – June 2023, 17 (6%) were identified as having a military background. Out of the 48 cases in June 2023 where military background was reported, 3 (6%) were identified as having a military background.
Prior overdose history was reported for 112 (36%) of the victims during January-June 2023.
Of 307 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 34 (11%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (13, 38%), Penobscot County (7, 21%) and Androscoggin County (6, 18%). In June 2023, 8 decedents (15%) were identified as undomiciled.
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2022 Est. Race N=720 Ethnicity N=706 | Jan-Jun 2023 Est. Race N=301 Ethnicity N=295 | Jun 2023 Est. Race N=48 Ethnicity N=47 |
|---|---|---|---|---|
| Race and Ethnicity | ||||
| White | 91% | 657 (91%) | 268 (89%) | 42 (88%) |
| Black or African American | 2% | 17 (2%) | 12 (4%) | 1 (2%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 6 (2%) | 3 (6%) |
| Other race, 2+ races combined, non-hispanic | 7% | 12 (2%) | 6 (2%) | 0 (0%) |
| Not Hispanic | 98% | 699 (99%) | 292 (99%) | 46 (98%) |
| Hispanic | 2% | 7 (1%) | 3 (1%) | 1 (2%) |
| Military Background | 81 (11%) | 17 (6%) | 3 (6%) | |
| Prior Overdose History | 269 (37%) | 112 (36%) | 18 (35%) | |
| Undomiciled/Transient Housing Status | 81 (11%) | 34 (11%) | 8 (15%) |
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. During the first six months of 2023 it has continued to rise to 75%. The cumulative age distribution in January – June 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 1 deaths in 2023, a 2 percentage point decrease in the proportion of those aged 18-39, a 1 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-Jun 2023 Est. N=307 | Jun 2023 Est. N=52 | |
|---|---|---|---|---|
| Percent Males | 49% | 527…(73%) | 230 (75%) | 40 (77%) |
| Percent under 18 | 19% | 3…(<1%) | 1 (<1%) | 0 (0%) |
| Percent 18-39 | 26% | 295…(41%) | 119 (39%) | 25 (48%) |
| Percent 40-59 | 27% | 333..(46%) | 143 (47%) | 20 (38%) |
| Percent 60+ | 29% | 92…(13%) | 44 (14%) | 7 (13%) |
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 (74%) in 2023. In 2023, law enforcement was more likely to respond to a scene alone (20%) than EMS (5%). The overwhelming majority (91%) 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 14% (44) 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 243 suspected and confirmed drug death cases with EMS involvement during the first six months of 2023, 140 (58%) of victims were already deceased when EMS arrived. In the remaining 103 (42%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 103 who were still alive when EMS arrived, only 27 (26%) remained alive long enough to be transported but died during transport or at the emergency room and 75 (73%) 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 – Jun 2023 Est. N=307 | Jun 2023 Est. N=52 | |
|---|---|---|---|
| Public safety response | |||
| ……EMS alone | 38….(5%) | 16 (5%) | 4 (8%) |
| ……Law enforcement alone | 131…(18%) | 62 (20%) | 8 (15%) |
| ……EMS and law enforcement | 541…(75%) | 227 (74%) | 40 (74%) |
| ……Private transport to the Emergency. Dept. | 13…..(2%) | 1 (<1%) | 0 (0%) |
| Naloxone administration | |||
| Naloxone administration reported at the scene | 182..(25%) | 76 (25%) | 9 (17%) |
| ……Bystander only | 44…(6%) | 20 (7%) | 2 (4%) |
| ……Law enforcement only | 31….(4%) | 6 (2%) | 2 (4%) |
| ……EMS only | 49….(7%) | 24 (8%) | 3 (6%) |
| ……EMS and law enforcement | 11….(2%) | 3 (1%) | 0 (0%) |
| ……EMS and bystander | 26….(4%) | 17 (6%) | 2 (4%) |
| ……Law enforcement and bystander | 5….(1%) | 6 (2%) | 0 (0%) |
| ……EMS, bystander, and law enforcement | 6….(1%) | 1 (<1%) | 0 (0%) |
| ……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 268 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 215 (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 4% (10) of 2023 deaths and 3% (19) of 2022 deaths, compared to 11% (57) in 2020. Methamphetamine was cited as a cause of death in 31% (84) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – June constituted 32% (86) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 87% (75) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 82% (69) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 268 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 25 (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-Jun 2023 N=268 | *Jun 2023 N=15 |
|---|---|---|---|
| Nonpharmaceutical opioids | |||
| ……Fentanyl or fentanyl analogs | 560..(77%) | 215 (80%) | 12 (80%) |
| ……Heroin | 19….(3%) | 10 (4%) | 0 (0%) |
| Nonpharmaceutical Stimulants | |||
| ……Cocaine | 213.(29%) | 86 (32%) | 6 (40%) |
| ……Methamphetamine | 234.(32%) | 84 (31%) | 5 (33%) |
| Pharmaceutical opioids** | 156..(22%) | 45 (17%) | 0 (0%) |
| Key combinations | |||
| ……Fentanyl and heroin | 18….(2%) | 10 (4%) | 0 (0%) |
| ……Fentanyl and cocaine | 171..(24%) | 75 (28%) | 4 (27%) |
| ……Fentanyl and methamphetamine | 189..(26%) | 69 (26%) | 5 (33%) |
| ……Fentanyl and xylazine | 46….(6%) | 25 (9%) | 0 (0%) |
| ……Fentanyl and tramadol | 10….(1%) | 1 (<1%) | 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
annual opioid response summit
Governor Janet T. Mills welcomed over 1400 registrants to the 5th Annual Opioid Response Summit on July 20 at the Cross Insurance Arena in Portland. With a theme of The Power of Prevention, Focusing on Families, the Summit offered participants four keynote talks during the plenary sessions and twenty breakout sessions including presentations on housing, employment, treatment expansion, faith-based treatment programs, addiction research and the use of opioid litigation settlement funds (and many others). Keynote speakers included national prevention expert Carleton Hall, Center for Substance Abuse Treatment Director Yngvild Olsen, M.D., MPH, author Alison Webb Jones (Recovery Allies), Maine Medical Association President Erik Steele, D.O. and Elizabeth Connolly, Public Health Director at the White House Office of National Drug Control Policy. Governor Mills addressed attendees as did U.S. Attorney Darcie McElwee, Attorney General Aaron Frey, Office of Behavioral Health Director Sarah Squirrell and Maine Health CEO Andrew Mueller.
During his keynote presentation, Dr. Steele announced plans for the Maine Medical Association to lead the 1000 Lives campaign, intended to save 1000 Mainers from potentially fatal overdoses over a five-year period from Jan. 1, 2024 through Dec. 31, 2028. This campaign borrows from the 100,000 Lives campaign introduced by Dr. Donald Berwick and the Institute for Health Care Improvement (IHI) some twenty years ago. All health care associations in the State will be invited to participate in the campaign and help identify interventions that can help save lives, including certainly the offering of more treatment.
During her presentation, Governor Mills noted the changes to the updated Opioid Response Plan (distributed at the conference) and also announced two initiatives intended to further the goals of the Mills administration in reducing the harms associated with drug use. The first initiative provides $1 million to purchase and distribute xylazine test strips across the state. Xylazine has been detected in nine percent of overdose deaths in Maine so far in 2023. The second initiative involves contracting with well-established harm-reduction organizations to hire nine peer outreach workers to provide services to people using drugs to improve their safety and offer pathways to recovery.
The updated Opioid Response Plan expands the previous Plan to six focused areas, adding a new section on Public Safety and on Infrastructure. The updated Plan has nine priorities, thirty-four strategies and dozens of activities implementing the strategies. New language highlights the need to work closely with immigrants to our state, veterans’ groups and faith-based treatment programs. In revising the previous Plan, a collaborative and transparent process reached out to all Mainers resulting in over one thousand comments being offered and considered in the development of the updated Plan. This process included a well-attended webinar during the Fall of 2022.
During the Governor’s remarks, she presented two Opioid Response Awards, recognizing two individuals who have provided extraordinary support to persons in recovery. Scott Pardy of Bangor was recognized for his establishing 14 certified recovery residences in the Bangor area. Michael Botticelli, a part-time resident of Maine, was honored for his lifetime of service in the SUD field including his time in the Obama Administration as Director of the White House Office of National Drug Control Policy. Mr. Botticelli was the first Director of the office to be in long-term recovery and has been an important supporter of the Mills’ administration opioid response strategy, including participating in all five of the Governor’s Summits.
As has been the case in all the previous Summits, each presentation was preceded by a Voice of Recovery, with over twenty individuals sharing their stories of recovery with attendees.
Links to the plenary sessions and two of the breakout sessions can be found on the AdCare website and at www.mainedrugdata.org. The updated Opioid Response Strategic Action Plan is also available at www.mainedrugdata.org.