Maine Drug Death Report for 2020

Download the entire PDF report here: Maine Drug Death Report for 2020

This report, funded by the Maine Office of Attorney General, provides a summary of statistics regarding drug fatalities in Maine during 2020. Data for the report were collected at the Office of the Chief Medical Examiner. A drug death is identified when one or more drugs are mentioned on the death certificate as a cause or significant contributing factor for the death. All drug deaths that occurred in Maine are included, whether or not they were Maine residents. Death of Maine residents who died out of state are not included.

Fatal overdoses rose 33% in the State of Maine to 504 drug deaths occurring in 2020

Drug deaths totaled 504 in 2020, a 33% increase over 380 in 2019. Of those 504, 83% were caused by opioids, nearly always in combination with other drugs or alcohol. The rise over 2019 was largely driven by a 33% rise in deaths due to nonpharmaceutical drugs, primarily fentanyl, increasingly combined with methamphetamine or cocaine. Because fentanyl is nearly always combined with other drug categories, such as pharmaceutical opioids, benzodiazepines, and alcohol, as well as illicit stimulants, the fentanyl increase is associated with an increase in those categories as well. Deaths due to nonpharmaceutical fentanyl, with or without other co-intoxicants, increased 30% from 250 to 336. The chart below highlights changes in the major categories of opioids deaths. The non pharmaceutical opioid categories includes fentanyl (97%) and its analogs, as well as heroin (11%). Heroin is involved mostly in combination with fentanyl.

Source: Maine Office of the Attorney General, Maine Drug Death Report, 2020.

Nearly all counties, except Cumberland, Lincoln, and Somerset saw substantial increases in drug deaths during 2020.

Almost every county in Maine experienced substantial increases in the number of drug deaths during 2020. Cumberland, Lincoln, and Somerset were exceptions that saw decreases. Most of these increases were proportionate to the county’s share of the drug deaths in 2019, rising or decreasing by 1% in 2020. However, Cumberland saw a larger decreases in its proportion of drug deaths, down by 7%. Penobscot, by contrast, saw a 5% increase. It is important to note that fluctuations up and down within small populations are to be expected statistically. Nevertheless, these deaths have a troubling impact on the communities where they occurred. The 2020 totals can be compared either to the precent of the census population on the left or the percent of drug deaths during 2019 in the center.

CountyPercent of 2019
Census Population
Jan-Dec 2020
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021.

Maine is seeing a dramatic increase in the involvement illicit stimulant drugs.

Illicit stimulant drugs, frequently combined with fentanyl, are an emerging cause of concern due to their increased involvement in drug deaths. These include cocaine, which increased 7% from 110 deaths in 2019 to 188 in 2020, and methamphetamine, which increased 111% from 47 to 99 deaths during the same time period.

Source: Maine Office of the Attorney General, Maine Drug Death Report, 2020.

Drug deaths began increasing during 2019, prior to the start of the COVID-19 pandemic.

The COVID-19 pandemic is associated in time with an increase in drug deaths during 2020. However, as shown in two graphs below, the increase in deaths began in 2019, prior to the start of the pandemic. Further, the increase in drug deaths is not due to infection by COVID-19 itself. Only 22 cases out of 504 had symptoms or circumstances that prompted COVID-19 testing, and only one person out of the 22 tested positive.

Source: Maine Office of the Attorney General, Maine Drug Death Report, 2020.

Other contributing circumstances and population characteristics of fatal drug overdoses.

Despite the isolation of the pandemic, the increase in fatal drug overdoses is also not due to an increase in suicidal overdoses; that number declined from 34 in 2019 to 33 in 2020, while accidental overdoses rose from 341 to 457. It is also not due to an increase in a particular age category or sex. More research is being conducted by the Margaret Chase Smith Policy Center at the University of Maine to explore whether characteristics of the pandemic, such as isolation, access to medical services, or to alterations in opioid availability with associated fluctuations in opioid tolerance may have differentially exposed people more to the lethal effects of illicit fentanyl.

The circumstances and demographic composition of decedents during 2020 can be compared to 2019 which is listed in the following table on the left. Naloxone administrations, race and ethnicity, as well as persons experiencing homelessness were not included in the Annual Maine Drug Death Report for 2019

Jan-Dec 2020
Sex Composition
Percent males258..(68%)357(71%)
Age Composition
Percent under 180….(0%)2(<1%)
Percent 18-39171..(45%)213..(42%)
Percent 40-59175..(46%)235..(47%)
Percent 60+33….(9%)54(11%)
Event Characteristics
Accidental manner of death341..(90%)457..(91%)
Undetermined manner of death5…..(1%)14….(3%)
Naloxone Administration at the Time of the Event
EMS administration————58..(12%)
Law enforcement administration————13(3%)
Bystander administation————21(4%)
Demographic Indicators
Person experiencing homelessness————36(7%)
Race and Ethnicity
Black or African American————16(3%)
American Indian/Alaska Native————10(2%)
Hispanic or Latino————7….(1%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021; Maine Office of the Attorney General, Maine Drug Death Report, 2020.
*Systematic gender data are not reported on the death certificate. Demographic data and circumstances of overdoses such as naloxone administration is now being tracked and reported in the Maine Monthly Overdose Reports as well as quarterly and annual reports moving forward. Naloxone is a medication that can potential reverse an opioid overdose. In some cases, naloxone was administered by more than one entity. Two additional naloxone administrations by first responders are not included in the table as it is unknown if EMS or law enforcement administered the doses.

Of the 504 total drug deaths, 475 (94%) occurred in decedents who were described on the death certificate as white, 16 (3%) were Black or African American, and 10 (2%) were American Indian or Alaska Native. In comparison to the Maine census population, the proportion of white is slightly less (94% versus 97%), Black or African American is slightly greater (3% versus 2%) and American Indian or Alaska Native is similar (2% versus 2%). The proportion of drug deaths for all other race and ethnicity categories is less than or similar to the census population. These proportional comparisons should be interpreted with caution due to the small population numbers.

Key drug categories and combinations causing overdose deaths.

During 2020 the average cause of death involved three drugs. 401 (81%) of deaths were caused by two or more drugs. This is a 26% increase over 2019 (323, 86%) and slightly less percentage. Deaths caused by opioids totaled 417 (83%), a 31% increase in number compared to 2019 (318, 84%), but about the same proportion. In the following table, deaths due to key drug categories and combinations are listed. These figures for 2020 on the right can be compared with figures from 2019 on the left.

Cause of death (alone or in
combination with other drugs)
Jan-Dec 2019
Jan-Dec 2020
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs259(68%)336.(67%)
Nonpharmaceutical Stimulants
Pharmaceutical opioids**96..(25%)118.(23%)
Key combinations
……Fentanyl and cocaine88..(34%)97.(19%)
……Fentanyl and methamphetamine/amphetamine34..(13%)70.(14%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021; Maine Office of the Attorney General, Maine Drug Death Report, 2020.
**The opioid tramadol is now being combined with fentanyl in pills and powders for illicit drug use. When found in combination with fentanyl, tramadol will henceforth be categorized as a nonpharmaceutical opioid.