Download the entire PDF report here: Maine Cumulative Monthly Overdose Report for January through May 2022
*Note: This cumulative dashboard is provided in lieu of monthly dashboards for January through May of 2022, which were unable to be completed and released due to pandemic-related delays in toxicology and substance testing. Emergent substances requiring out-of-scope toxicology testing have also caused additional delays. Going forward, we expect to resume monthly reporting with the June report, which will be released at the end of July. For more information see the full report.
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
The proportion of fatal overdoses averaged 7% of total overdoses over the course of 2021, and has stayed at that level during the first five months of 2022 as a whole. During 2021 the average number of overdoses per month was 658 (49 fatal and 609 nonfatal cases). During the first five months of 2022 the average number of overdoses per month was 792 (53 fatal and 739 nonfatal cases).
From January 2022 to May 2022, there were an estimated 3,962 fatal and nonfatal drug overdoses statewide, of which 266 (7%) were suspected and confirmed fatal overdoses. The remaining 3,814 (93%) were nonfatal overdoses: 1,778 (45%) emergency department visits; 1,017 (26%) EMS patents who were not transported to the emergency room, 896 (23%) 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 Overdoses | Emergency Department Nonfatal | EMS Not Transported to the ED Nonfatal | Reported Community Reversals Nonfatal | Law Enforcement Without EMS Nonfatal (estimated) | Total Overdoses | |
| January ’21 | 54 | 270 | 164 | 127 | 0 | 615 |
| February ’21 | 41 | 277 | 118 | 100 | 0 | 536 |
| March ’21 | 58 | 329 | 172 | 156 | 2 | 717 |
| April ’21 | 45 | 334 | 190 | 136 | 0 | 705 |
| May ’21 | 46 | 409 | 163 | 100 | 1 | 719 |
| June ’21 | 54 | 411 | 223 | 189 | 0 | 877 |
| July ’21 | 44 | 482 | 225 | 167 | 0 | 918 |
| August ’21 | 50 | 428 | 232 | 222 | 3 | 935 |
| September ’21 | 58 | 473 | 234 | 276 | 2 | 1,043 |
| October ’21 | 65 | 383 | 246 | 208 | 2 | 904 |
| November ’21 | 60 | 308 | 219 | 195 | 2 | 784 |
| December ’21 | 52 | 344 | 198 | 176 | 11 | 781 |
| 2021 Total | 627 | 4,448 | 2,384 | 2,052 | 23 | 9,534 |
| 2021 Total % | 6.6% | 46.7% | 25.1% | 21.5% | <1% | 100% |
| January ’22 | 44 | 296 | 206 | 177 | 1 | 724 |
| February ’22 | 49 | 333 | 185 | 152 | 1 | 720 |
| March ’22 | 65 | 458 | 201 | 202 | 0 | 926 |
| April ’22 | 59 | 290 | 177 | 186 | 3 | 715 |
| May ’22 | 49 | 401 | 248 | 179 | 0 | 877 |
| 2022 Total | 266 | 1,778 | 1,017 | 896 | 5 | 3,962 |
| 2022 Total % | 6.5% | 44.8% | 25.6% | 22.6% | <1% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine May 2022
Fatal Drug Overdoses in Maine January – May 2022
During the first 5 months of 2022, the proportion of fatal overdoses averaged 6.5% of total overdoses. From January to May 2022 there was a total 266 fatal fatal drug overdoses consisting of 230 confirmed and 36 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 65 (October 2021; March 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 – May 2022 (266) is 9.0% higher than the first five months of 2021 (244) 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-May 2022. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.
The cumulative January-May 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, Somerset, and Waldo. The only county that is 2% or more higher than the 2020 census proportions in 2022 is Penobscot (+7%). Counties that are 2% or more lower than the 2020 census proportion in 2022 are Cumberland (-3%), Hancock (-2%), and Kennebec (-3%).
| County | Percent of 2020 Census Population | Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=627 | Jan-May 2022 Est. N=266 | Jan 2022 Est. N=44 | Feb 2022 Est. N=49 | Mar 2022 Est. N=65 | Apr 2022 Est. N=59 | May 2022 Est. N=49 |
|---|---|---|---|---|---|---|---|---|---|---|
| Androscoggin | 8% | 33…….(9%) | 52.(10%) | 71…..(11%) | 23 (9%) | 3 (7%) | 4 (8%) | 6 (9%) | 7 (12%) | 3 (6%) |
| Aroostook | 5% | 14…….(4%) | 17…(3%) | 38……(6%) | 16 (6%) | 3 (7%) | 1 (2%) | 5 (8%) | 3 (5%) | 4 (8%) |
| Cumberland | 22% | 100…..(26%) | 97.(19%) | 130….(21%) | 51 (19%) | 10 (23%) | 12 (24%) | 8 (12%) | 12 (20%) | 9 (18%) |
| Franklin | 2% | 5……..(1%) | 8…(2%) | 7…….(1%) | 8 (3%) | 1 (2%) | 2 (4%) | 3 (5%) | 0 (0%) | 2 (4%) |
| Hancock | 4% | 9…….(2%) | 13…(3%) | 17……(3%) | 5 (2%) | 1 (2%) | 1 (2%) | 2 (4%) | 1 (2%) | 0 (0%) |
| Kennebec | 9% | 42……(11%) | 49.(10%) | 54…..(9%) | 16 (6%) | 3 (7%) | 5(10%) | 2 (4%) | 3 (5%) | 3 (6%) |
| Knox | 3% | 7…….(2%) | 16…(3%) | 9……(1%) | 6 (2%) | 0(0%) | 1 (2%) | 2 (4%) | 3 (5%) | 0 (0%) |
| Lincoln | 3% | 11…….(3%) | 9…(2%) | 15……(2%) | 5 (2%) | 1 (2%) | 0 (0%) | 1 (2%) | 1 (2%) | 2 (4%) |
| Oxford | 4% | 9…….(2%) | 15…(3%) | 26……(4%) | 12 (5%) | 3 (7%) | 0 (0%) | 2 (4%) | 4 (7%) | 3 (6%) |
| Penobscot | 11% | 53…..(14%) | 94.(19%) | 115…..(18%) | 48 (18%) | 8 (18%) | 8 (16%) | 11 (17%) | 10 (17%) | 11 (22%) |
| Piscataquis | 1% | 3…….(1%) | 10…(2%) | 11……(2%) | 4 (2%) | 0 (0%) | 1 (2%) | 2 (4%) | 1 (2%) | 0 (0%) |
| Sagadahoc | 3% | 8……(2%) | 8….(1%) | 5……(1%) | 5 (2%) | 0 (0%) | 2 (4%) | 0 (0%) | 2 (3%) | 1 (2%) |
| Somerset | 4% | 16……(4%) | 13…(3%) | 24…..(4%) | 12 (5%) | 3 (7%) | 3 (6%) | 2 (4%) | 2 (3%) | 2 (4%) |
| Waldo | 3% | 3…….(1%) | 9…(2%) | 14…..(2%) | 10 (4%) | 1 (2%) | 1 (2%) | 4 (6%) | 3 (5%) | 1 (2%) |
| Washington | 2% | 10……(3%) | 20..(4%) | 24…..(4%) | 6 (2%) | 2 (5%) | 1 (2%) | 0 (0%) | 0 (0%) | 3 (6%) |
| York | 16% | 57….(15%) | 74.(15%) | 67….(11%) | 39 (15%) | 5 (11%) | 7 (14%) | 15 (23%) | 7 (12%) | 5 (10%) |
Race, ethnicity, and other demographic indicators of decedents
During January – May of 2022, out of 265 confirmed and suspected fatal overdoses for which race was reported, 253 (95%) of the victims were identified as White, 5 (2%) as Black or African American, 1 (<1%) as Black or African American – White, 2 (1%) as American Indian/Alaska Native, 2 (1%) as American Indian/Alaska Native – White, and 1 (<1%) as Hawaiian/Pacific Islander. Out of the 257 fatal overdoses for whom ethnicity was reported, 254 (99%) were reported as not Hispanic, and 3 (1%) were identified as Hispanic. Out of the 266 cases, 25 (9%) were identified as having a military background. Prior overdose history was reported for 102 (38%) of the victims. Transient housing status was reported for 41 (15%) of the victims.
| Demographic Indicator | Number of decedents N=265 | Percent of decedents |
|---|---|---|
| Race and Ethnicity | ||
| White | 253 | 95% |
| Black or African American | 5 | 2% |
| Black or African American—White | 1 | <1% |
| American Indian/Alaska Native | 2 | 1% |
| American Indian/Alaska Native—White | 2 | 1% |
| Hawaiian/Pacific Islander | 1 | <1% |
| Not Hispanic | 254 | 99% |
| Hispanic | 3 | 1% |
| Military Background | 25 | 9% |
| Prior Overdose History | 102 | 38% |
| Undomiciled/Transient Housing Status | 41 | 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 from 68% in 2019 to 71% in 2020 and 2021, and to 73% in 2022. The cumulative age distribution in January – May 2022 compared to 2021 shows 1 decedent under age 18, no change in the proportion of those aged 18-39, a 2% decrease in those aged 40-59, and a 2% increase in the proportion 60 and above.
| Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=627 | Jan-May 2022 Est. N=266 | Jan 2022 Est. N=44 | Feb 2022 Est. N=49 | Mar 2022 Est. N=65 | Apr 2022 Est. N=59 | May 2022 Est. N=49 | |
|---|---|---|---|---|---|---|---|---|---|
| Percent Males | 258..(68%) | 357…(71%) | 447.(71%) | 195…(73%) | 34 (77%) | 38 (78%) | 45 (69%) | 45 (76%) | 33 (67%) |
| Percent under 18 | 0….(0%) | 2…(<1%) | 1..(<1%) | 0…..(0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Percent 18-39 | 171..(45%) | 213..(42%) | 247.(39%) | 104…(39%) | 21 (48%) | 13 (27%) | 29 (48%) | 28 (47%) | 21 (43%) |
| Percent 40-59 | 175..(46%) | 235..(47%) | 313.(50%) | 128..(48%) | 19 (43%) | 27 (55%) | 24 (40%) | 24 (41%) | 22 (45%) |
| Percent 60+ | 33….(9%) | 54…(11%) | 66..(11%) | 34…..(13%) | 4 (9%) | 9 (18%) | 7 (12%) | 7 (12%) | 6 (12%) |
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 five months of 2022. Law enforcement was more likely to respond to a scene alone (17%) than EMS (5%) in both 2021 and 2022. The overwhelming majority (95%) of drug overdoses were ruled, or suspected of being, accidental manner of death.
During 2022, 35% of fatal overdose cases had naloxone administered at the scene or in the ambulance, by EMS, bystanders, or law enforcement. This rate is higher than the 33% of fatal overdose cases in which naloxone was reportedly administered at the scene in 2020, but lower than the 45% 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 15% 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 only 11% of victims in 2021.
Based on 218 suspected and confirmed drug death cases with EMS records during January – May of 2022, 92 (42%) of victims were already deceased when EMS arrived. Of the remaining 127 (58%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of the 218 cases with EMS response, only 28 (13%) remained alive long enough to be transported but died during transport or at the emergency room. 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=627 | Jan-May 2022 Est. N=266 | Jan 2022 Est. N=44 | Feb 2022 Est. N=49 | Mar 2022 Est. N=65 | Apr 2022 Est. N=59 | May 2022 Est. N=49 | |
|---|---|---|---|---|---|---|---|---|
| Public safety response | ||||||||
| ……EMS alone | 28…(6%) | 34….(5%) | 13….(5%) | 2 (5%) | 4 (8%) | 3 (5%) | 2 (3%) | 2 (4%) |
| ……Law enforcement alone | 107.(21%) | 108..(17%) | 46…(17%) | 9 (20%) | 10 (20%) | 12 (18%) | 4 (7%) | 11 (22%) |
| ……EMS and law enforcement | 365.(72%) | 480..(77%) | 205…(77%) | 32 (73%) | 35 (71%) | 50 (77%) | 52 (88%) | 36 (73) |
| ……Private transport to the Emergency. Dept. | — | 5….(1%) | 2…..(<1) | 1 (2%) | 0 (0%) | 0 (0%) | 1 (2%) | 0 (0%) |
| Naloxone administration | ||||||||
| Naloxone administration at the scene and/or (presumably) in ambulance during transport to emergency room | 127.(33%) | 283..(45%) | 16..(31%) | 20 (45%) | 19 (39%) | 21 (32%) | 20 (34%) | 13 (27%) |
| Naloxone administration reported at the scene | 83.(22%) | 189..(30%) | 12..(24%) | 17 (39%) | 16 (33%) | 18 (28%) | 18 (31%) | 10 (20%) |
| ……Bystander only | 11…(2%) | 42….(7%) | 5…(10%) | 2 (5%) | 6 (12%) | 3 (5%) | 2 (3%) | 4 (8%) |
| ……Law enforcement only | 8…(2%) | 19….(3%) | 0….(0%) | 5 (11%) | 1 (2%) | 2 (3%) | 2 (3%) | 0 (0%) |
| ……EMS only | 55..(11%) | 83..(13%) | 6..(12%) | 4 (9%) | 5 (10%) | 7 (11%) | 5 (8%) | 4 (8%) |
| ……EMS and law enforcement | 4…(1%) | 22….(4%) | 0….(0%) | 1 (2%) | 1 (2%) | 1 (2%) | 2 (3%) | 0 (0%) |
| ……EMS and bystander | 8..(2%) | 21….(3%) | 0….(0%) | 3 (7%) | 2 (4%) | 4 (6%) | 4 (7%) | 2 (4%) |
| ……Law enforcement and bystander | 0..(0%) | 8…..(1%) | 0….(0%) | 2 (5%) | 1 (2%) | 0 (0%) | 1 (2%) | 0 (0%) |
| ……EMS, bystander, and law enforcement | —……. | 3..(<1%) | 1….(2%) | 0 (0%) | 0 (0%) | 1 (2%) | 2 (3%) | 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 230 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 173 (75%), 2% lower than the rate in 2021 (77%) but 8% 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, 4% 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. Cocaine-involved fatalities January – May constituted 30% of cases, an increase from 25% in 2021 and 23% in 2020. Fentanyl is found in combination with cocaine in 24% of 2022 cases, and in combination with methamphetamine in 28%. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 230 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 15 (7%) of confirmed overdose deaths, and 5 (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-May 2022 N=230 | Jan 2022 N=44 | Feb 2022 N=49 | Mar 2022 N=65 | Apr 2022 N=55 | May 2022 N=17 |
|---|---|---|---|---|---|---|---|---|
| Nonpharmaceutical opioids | ||||||||
| ……Fentanyl or fentanyl analogs | 336.(67%) | 485..(77%) | 173..(75%) | 31 (70%) | 37 (76%) | 50 (77%) | 41 (75%) | 14 (82%) |
| ……Heroin | 57..(11%) | 28….(4%) | 4….(2%) | 1 (2%) | 2 (4%) | 1 (2%) | 0 (0%) | 0 (0%) |
| Nonpharmaceutical Stimulants | ||||||||
| ……Cocaine | 118.(23%) | 156..(25%) | 69.(30%) | 10 (23%) | 17 (35%) | 19 (28%) | 16 (29%) | 8 (47%) |
| ……Methamphetamine/amphetamine | 99.(20%) | 171..(27%) | 81.(35%) | 11 (25%) | 15 (31%) | 26 (40%) | 21 (38%) | 8 (47%) |
| Pharmaceutical opioids** | 118.(23%) | 136..(22%) | 50..(22%) | 10 (23%) | 10 (20%) | 12 (18%) | 17 (31%) | 1 (6%) |
| Key combinations | ||||||||
| ……Fentanyl and heroin | 47…(9%) | 21….(3%) | 4….(2%) | 1 (2%) | 2 (4%) | 1 (2%) | 0 (0%) | 0 (0%) |
| ……Fentanyl and cocaine | 97.(19%) | 126..(20%) | 55..(24%) | 7 (16%) | 12 (24%) | 15 (23%) | 13 (24%) | 8 (47%) |
| ……Fentanyl and methamphetamine/amphetamine | 70.(14%) | 132..(21%) | 65..(28%) | 8 (18%) | 12 (24%) | 22 (34%) | 16 (29%) | 7 (41%) |
| ……Fentanyl and xylazine | 0…(0%) | 53….(8%) | 15….(7%) | 1 (2%) | 4 (8%) | 3 (5%) | 5 (9%) | 2 (12%) |
| ……Fentanyl and tramadol | 0…(0%) | 20….(3%) | 5….(2%) | 0 (0%) | 0 (0%) | 2 (3%) | 3 (5%) | 0 (0%) |