Download the entire PDF report here: Maine Monthly Overdose Report for March 2021
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.
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine March 2021
Fatal Drug Overdoses in Maine 2021
The March 2021 total of 53 fatal drug overdoses consists of 30 confirmed drug deaths and 23 suspected drug deaths. The graph below shows the considerable monthly fluctuation over the past year. Although the 2020 average is 42, the range extends from 34 to 53. The final January 2021 number of fatal drug overdoses is 55. The February total is 41 confirmed and one suspected fatal overdose. For more information regarding definitions of fatal overdoses, including data collected and case completion timelines 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 March 2021 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 2020 also on the left. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. In general, the cumulative percentages for January – March fall within 2-3% of the 2019 census distribution.most counties accord with both the 2020 patterns and the census distribution.
| County | Percent of 2019 Census Population | Jan-Dec 2020 N=504 | January 2021 N=55 | February 2021 Est. N=42 | March 2021 Est. N=53 | Cumulative Jan-Mar 2021 Est. N=150 |
|---|---|---|---|---|---|---|
| Androscoggin | 8% | 52.(10%) | 8 .(14%) | 4 .(10%) | 8.(15%) | 12….(8%) |
| Aroostook | 5% | 17…(3%) | 1 …(2%) | 2 ..(5%) | 2…(4%) | 5….(3%) |
| Cumberland | 22% | 97.(19%) | 10 .(18%) | 10 (24%) | 8.(15%) | 28..(19%) |
| Franklin | 2% | 8…(2%) | 0 …(0%) | 1.. (2%) | 2..(4%) | 3…(2%) |
| Hancock | 4% | 13…(3%) | 2 …(4%) | 3.. (7%) | 1…(2%) | 6…(4%) |
| Kennebec | 9% | 49.(10%) | 6 ..(11%) | 6 (14%) | 2..(4%) | 14..(9%) |
| Knox | 3% | 16…(3%) | 0 …(0%) | 0.. (0%) | 1…(2%) | 1…(1%) |
| Lincoln | 3% | 9…(2%) | 3 …(5%) | 1. .(2%) | 2..(4%) | 6…(4%) |
| Oxford | 4% | 15…(3%) | 3… (5%) | 3.. (7%) | 2..(4%) | 8…(5%) |
| Penobscot | 11% | 94.(19%) | 7 .(13%) | 5.(12%) | 15(36%) | 27.(12%) |
| Piscataquis | 1% | 10…(2%) | 1… (2%) | 0. (0%) | 0..(0%) | 3….(2%) |
| Sagadahoc | 3% | 8….(1%) | 1 …(2%) | 1.. (2%) | 0..(0%) | 2….(1%) |
| Somerset | 4% | 13…(3%) | 1 …(2%) | 1.. (2%) | 0..(0%) | 2….(1%) |
| Waldo | 3% | 9…(2%) | 2 ..(4%) | 0. (0%) | 0..(0%) | 2….(1%) |
| Washington | 2% | 20..(4%) | 2 ..(4%) | 1… (2%) | 3..(3%) | 6…(4%) |
| York | 15% | 74.(15%) | 8 (15%) | 3.. (7%) | 7.(17%) | 18..(12%) |
Age and gender composition of decedents
The following table displays the age and gender composition of the monthly fatal overdose population. The cumulative proportion of males in the first quarter of 2021 was 66%, which is lower than the 71% level in 2020. The cumulative age distribution in 2021, however, was nearly identical to 2020, and is clustered in the two middle categories, from 18-39 (42%) and 40-59 (48%). There are no decedents that were under 18 in 2021, and only 10% over 60.
| Jan-Dec 2020 N=504 | January 2021 N=55 | February 2021 Est. N=42 | March 2021 Est. N=53 | Cumulative Jan-Mar 2021 Est. N=150 | |
|---|---|---|---|---|---|
| Percent Males | 357(71%) | 35(64%) | 29.(69%) | 35(66%) | 99.(66%) |
| Percent under 18 | 2(<1%) | 0..(0%) | 0…(0%) | 0..(0%) | 0…(0%) |
| Percent 18-39 | 213(42%) | 20(36%) | 22.(52%) | 22(42%) | 42.(42%) |
| Percent 40-59 | 235(47%) | 30(55%) | 18.(38%) | 26(49%) | 48.(48%) |
| Percent 60+ | 54.(11%) | 5..(9%) | 4..(10%) | 3..(6%) | 10..(10%) |
Basic incident patterns in fatal overdoses
The following table highlights some event characteristics among suspected and confirmed overdoses. Roughly similar to 2020, during the first quarter of 2021, Both EMS and police responded to most fatal overdoses, 77%. Law enforcement was more likely to respond to a scene alone (18%) than EMS (4%). The overwhelming majority (95%) of drug overdoses were ruled as accidental manner of death.
Based on the death investigation records, naloxone was administered to 28% of the victims at the scene in 2021, mostly by EMS. This is nearly double the 2020 proportion, which was 16%. During the first quarter of 2021, 45% of overdose victims either received naloxone at the scene or were transported to the emergency room by EMS, or both. The other 55% were found already deceased, or were found by someone who did not have the means to resuscitate them.
Compared to 2020, during the first quarter of 2021, naloxone was more likely to be administered at the scene, whether by EMS, bystanders, or law enforcement. This may be due to the greater availability of police trained to administer it through programs like the Attorney General’s Naloxone Distribution Initiative and ODMAP. It may also be due to the great availability in the community due to the Maine Naloxone Distribution Initiative. Although most cases had bystanders present at the scene when first responders arrive, the details about who may have been present at the time of the overdose was usually unclear.
| Jan-Dec 2020 N=504 | January 2021 N=55 | February 2021 Est. N=42 | March 2021 Est. N=53 | Cumulative Jan-Mar 2021 Est. N=150 | |
|---|---|---|---|---|---|
| EMS and/or law enforcement response | 500 (99%) | 54 (98%) | 42 (100%) | 53 (100%) | 149 (99%) |
| ……EMS alone | 28…(6%) | 2…(4%) | 2…..(5%) | 3…(6%) | 7….(4%) |
| ……Law enforcement alone | 107.(21%) | 10.(18%) | 7….(17%) | 10.(19%) | 27..(18%) |
| ……EMS and law enforcement | 365.(72%) | 42(76%) | 33…(79%) | 40(75%) | 115..(77%) |
| ……Naloxone administration at the scene and/or transport to emergency room | 121.(24%) | 20(36%) | 20…(48%) | 27.(51%) | 67..(45%) |
| Manner of death (suspected or confirmed) | |||||
| ……Accident | 457.(91%) | 53(96%) | 39..(93%) | 51(96%) | 143..(95%) |
| ……Suicide | 33…(7%) | 1..(2%) | 1….(2%) | 2..(4%) | 4….(3%) |
| ……Undetermined | 14…(2%) | 1..(2%) | 2….(5%) | 0..(0%) | 3…..(2%) |
| Naloxone administration | 79.(16%) | 15(27%) | 14…(33%) | 21(38%) | 50..(33%) |
| ……Bystander only | 11…(2%) | 1…(2%) | 2…..(5%) | 5..(9%) | 8….(5%) |
| ……Law enforcement only | 8…(2%) | 3…(5%) | 1…..(2%) | 2..(4%) | 6….(4%) |
| ……EMS only | 55..(11%) | 7..(13%) | 10…(24%) | 7.(13%) | 24..(16%) |
| ……EMS and law enforcement | 4…(1%) | 2…(4%) | 1…..(2%) | 4..(7%) | 7….(5%) |
| ……EMS and bystander | 8..(2%) | 1…(2%) | 0…..(0%) | 1..(2%) | 2….(1%) |
| ……Law enforcement and bystander | 0..(0%) | 0..(0%) | 0…..(0%) | 1..(2%) | 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, nonpharmaceutical fentanyl is the most frequent cause of death to date in 2021, at 81%, 14% higher than in 2020. Heroin involvement has been declining during the last several years; it represents only 10% of 2021 deaths, compared to 11% last year. Illicit stimulants have been increasing in recent years, and in the first quarter of 2021, methamphetamine caused 30% of the overdoses, compared to 20% in 2020. Cocaine-involved fatalities constituted 20% of cases, slightly lower than 23% in 2020. Fentanyl is found in combination with cocaine in 17% of cases, and fentanyl and methamphetamine as a combination in 26% of cases. Pharmaceutical opioids were identified as a cause of death in 25%, all in combination with other drugs, just 2% higher than in 2020.
| Cause of death (alone or in combination with other drugs) | Jan-Dec 2020 N=504 | January 2021 N=55 | February 2021 N=41 | March 2021 N=30 | Cumulative Jan-Mar 2021 N=81 |
|---|---|---|---|---|---|
| Nonpharmaceutical opioids | |||||
| ……Fentanyl or fentanyl analogs | 336.(67%) | 41..(75%) | 35..(85%) | 26….(87%) | 102..(81%) |
| ……Heroin | 57..(11%) | 5….(9%) | 5…(12%) | 3….(10%) | 13..(10%) |
| Nonpharmaceutical Stimulants | |||||
| ……Cocaine | 118.(23%) | 10…(18%) | 7..(17%) | 8…(27%) | 25.(20%) |
| ……Methamphetamine/amphetamine | 99.(20%) | 18..(33%) | 7..(17%) | 13…(43%) | 38.(30%) |
| Pharmaceutical opioids | 118.(23%) | 16..(29%) | 7..(17%) | 8…(27%) | 31.(25%) |
| Key combinations | |||||
| ……Fentanyl and cocaine | 97.(19%) | 8…(15%) | 6..(15%) | 7…(23%) | 21.(17%) |
| ……Fentanyl and methamphetamine/amphetamine | 70.(14%) | 14..(25%) | 7..(23%) | 12..(40%) | 33.(26%) |
Five partially overlapping metrics that estimate the number of nonfatal overdoses in a given month
There is not a precise way to calculate nonfatal overdoses. Several metrics can be used to estimate numbers of nonfatal overdoses from different perspectives (see the chart below). This includes, for example, counting the number of responses by EMS in which the EMT or paramedic suspects an overdose and administers naloxone. However, many persons involved with an overdose event do not call 911. One syringe access program in Maine estimates that as many as 74% of overdose events do not include a 911 call. Put another way, the 911 calls may represent only 26% of the overdoses, whereas 74% constitute “private overdoses.” Some of these persons will unfortunately die. In about 15% of EMS overdose cases, the patient is revived, but refuses to be transported to the emergency room. Some may receive naloxone, but are found later not to have had an overdose, but were unconscious or had stopped breathing for another reason.
| Metrics frequently used to estimate overdose numbers | Unduplicated monthly estimate based on 4th quarter 2020 | Unduplicated monthly estimate based on Jan-Mar 2021 |
|---|---|---|
| Number of EMS runs in which naloxone was administered1 | 105 | 105 |
| Number of emergency department visits likely involving a drug overdose2 | 277 | 282 |
| Number of overdose reversals reported by community naloxone distributors and users of the OD-ME app, minus the number of fatal overdoses in which bystanders administered naloxone (163-2=161)3 | 161 | 121 |
| Number of incidents in which law enforcement administered naloxone and victim survived.4 | 52 | 45 |
Highlight of the month regarding substance use disorder public policy response
The MaineMOM Initiative
In 2020, MaineCare was awarded a five-year, $5 million grant, Maine Maternal Opioid Misuse (MaineMOM), to improve care for pregnant and postpartum women with Opioid Use Disorder (OUD) and their infants by developing a MaineCare service to integrate maternal and substance use disorder treatment services. The MaineMOM team has onboarded key grant staff, including a leading state and national expert in perinatal substance use care as the MaineMOM clinical advisor.
Beginning this summer, MaineCare will pilot these integrated services at 16 health care sites at MaineHealth, Northern Light, MaineGeneral, MidCoast Hospital, Pines Health Services and Penobscot Community Health Center, with an aim to reach nearly 300 women by July 2022. This summer, MaineCare will also begin a public awareness campaign aimed at increasing awareness to pregnant women’s treatment options and available services. This campaign and MaineMOM will utilize the current Maine CDC Public Health Nursing CradleME referral system as one of many ways to connect individuals to MaineMOM treatment sites and other social and health-related resources.
To expand access to this robust care model, MaineCare will propose amendments to Maine’s Medicaid State Plan to include these services as a covered MaineCare service in early 2022. The MaineMOM effort is highly collaborative and is focused on developing a sustainable and accessible family-centered treatment model. The team has worked across Departments within the State of Maine, with recovery centers statewide, with community members and with health and social service providers to achieve this aim.
The MaineMOM initiative is consistent with Strategy 21 in the updated Opioid Response Strategic Action Plan (SAP): Dedicate staff and funding to support the screening, support and recovery of pregnant women with substance use disorder and support substance-exposed infants. Within that strategy, current activity b. specifically references this program.
For more information regarding the State of Maine’s response to the drug crisis in Maine see the Leadership section of the Maine Drug Data Hub.