Maine Quarterly Drug Death Dashboard Jan-Sep 2021

Download the entire PDF report here:

Maine Quarter 3 Drug Death Report July – September 2021

This report, funded by the Maine Office of Attorney General, provides a summary of statistics regarding drug fatalities in Maine during the first three quarters of 2021. 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. Deaths of Maine residents who died out of state are not included.

Fatal overdoses rose 19% in the State of Maine during the first three quarters of 2021 compared to the first three quarters of 2020

Drug deaths totaled 454 during the first three quarters of 2021, a 19% increase over the 380 occurring during the first three quarters of 2020. This pattern, similar to that seen in many other states, is likely due at least in part to the effects of the covid-19 pandemic: isolation, avoidance of medical services, and alterations in the illicit drug supply. The high number of fatal overdoses continues to be driven by illicit, nonpharmaceutical fentanyl and fentanyl analogs, totaling 342 over the first three quarters, 76% of deaths. In contrast, pharmaceutical opioids were mentioned as a cause of death in 98 cases, 22% of deaths. Approximately one-third of opioid deaths (142, 33%) received naloxone at some point near the time of their death. Finally, half (227, 50%) of the drug fatalities in the first three quarters of 2021 involved the illicit stimulants cocaine and/or methamphetamine.

County trends in fatal overdoses

The table below provides totals for Maine counties, comparing the annual 2020 totals with the first three quarters of 2021 and projecting to the end of 2021. It is important to note that because the numbers for individual counties are relatively small, fluctuations between quarters or years are likely due more to random chance than to actual changes in underlying epidemiological trends.

CountyPercent of Estimated
“Vintage” Census
Population 2020
Jan-Dec 2020
Jan-Sep 2021
Projected 2021
(Jan-Sep totals x 1.33)
(453 x 1.33=602)
Androscoggin8%33…….(9%)51.(10%)53 (12%)71
Aroostook5%14…….(4%)17(3%)21 (5%)27
Cumberland22%100…..(26%)97.(19%)95 (21%)126
Franklin2%5……..(1%)8(2%)6 (1%)8
Hancock4%9…….(2%)13(3%)14 (3%)19
Kennebec9%42……(11%)49.(10%)44 (10%)59
Knox3%7…….(2%)16(3%)9 (2%)12
Lincoln3%11…….(3%)9(2%)14 (3%)19
Oxford4%9…….(2%)15(3%)17 (4%)23
Penobscot11%53…..(14%)94.(19%)75 (17%)100
Piscataquis1%3…….(1%)10(2%)9 (2%)12
Sagadahoc3%8……(2%)8….(1%)3 (1%)4
Somerset4%16……(4%)13(3%)13 (3%)17
Waldo3%3…….(1%)9(2%)13 (3%)18
Washington2%10……(3%)20..(4%)19 (4%)25
York16%57….(15%)74.(15%)49 (11%)65
The “vintage” estimated 202 census population totals are estimated from the last decennial census, 2010. The county totals from the 2020 census are not yet available.

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. During the first three quarters of 2021, nearly half (208, 46%) involved the illicit stimulants cocaine and methamphetamine.

Other patterns of note and population characteristics of fatal drug overdoses.

Patterns of note:

  • During the first three quarters of 2021, fatal overdoses made up 7% of total overdoses, the vast majority (93%) being nonfatal.
  • Most (79%) drug deaths were caused by two or more drugs. The average cause of death involved 3 drugs.
  • The vast majority of overdoses (86%) were caused by at least one opioid, including both illicit nonpharmaceutical (77%) and pharmaceutical (22%) opioid drugs.
  • Fentanyl (and/or its analogs) caused 76% of deaths, usually in combination with other drugs, an increase in proportion from 67% in 2020.
  • Xylazine has been identified as a co-intoxicant of fentanyl in an increasing number of deaths in 2021, total 42 (9%).

The circumstances and demographic composition of decedents during the first three quarters of 2021 can be compared to 2020 in the center column or can be compared to 2019 which is listed in the following table on the left. Please note, race and ethnicity were not reported in the 2019 Maine Annual Drug Death Report.

Jan-Dec 2020
Jan-Sep 2021
Sex Composition
Percent males258..(68%)357(71%)316(70%)
Age Composition
Average age434344
Age range18-880-9617-85
Event Characteristics
Accidental manner of death341..(90%)457..(91%)434(96%)
Undetermined manner of death5…..(1%)14….(3%)5…..(1%)
Naloxone Administration at the Time of the Event
Bystander administation————21(4%)43(9%)
Race and Ethnicity
Black or African American————16(3%)16…..(4%)
American Indian/Alaska Native————10(2%)11…..(2%)
Hispanic or Latino————7….(1%)5..(7 unknown)
*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 454 total drug deaths during the first three quarters of 2021, 420 (93%) occurred in decedents who were described on the death certificate as white, 16 (4%) were Black or African American, and 11 (2%) were American Indian or Alaska Native. In comparison to the Maine census population, the proportion of white is slightly less (93% versus 97%), Black or African American is slightly greater (4% 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 the first 3 quarters of 2021 the average cause of death involved three drugs. 360 (79%) deaths were caused by two or more drugs. Deaths caused by opioids totaled 392 (86%). In the following table, deaths due to key drug categories and combinations are listed. These figures for the first 3 quarters of 2021 on the right can be compared with figures from 2020 in the middle column or 2019 on the left.

Cause of death (alone or in
combination with other drugs)
Jan-Dec 2019
Jan-Dec 2020
Jan-Sep 2021
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs259(68%)336.(67%)342..(75%)
Nonpharmaceutical Stimulants
Pharmaceutical opioids**96..(25%)118.(23%)98..(22%)
Key combinations
……Fentanyl and cocaine88..(34%)97.(19%)94..(21%)
……Fentanyl and methamphetamine/amphetamine34..(13%)70.(14%)84..(19%)

**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.