March 2023 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for March 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 March, the proportion of fatal overdoses averaged 4.2% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.2% in March and a high of 6.6% in January. During March 2023, there were an estimated 928 fatal and nonfatal drug overdoses statewide, of which 39 (4.2%) were suspected and confirmed fatal overdoses. The remaining 889 (95.8%) were nonfatal overdoses: 374 (40.3%) emergency department visits; 245 (26.4%) EMS patents who were not transported to the emergency room, 237 (25.5%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 33 (3.6%) 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	44	304	206	178	39	771
Feb ’22	48	341	185	153	37	764
Mar ’22	65	465	201	202	30	963
Apr ’22	58	297	178	189	26	748
May ’22	46	405	248	186	41	926
Jun ’22	66	492	250	177	44	1029
Jul ’22	64	357	287	183	40	931
Aug ’22	62	393	272	255	37	1019
Sep ’22	55	467	256	153	33	964
Oct ’22	65	289	238	177	27	796
Nov ’22	66	295	206	200	20	787
Dec ’22	75	376	212	198	14	875
2022 Total	714	4,481	2,739	2,251	388	10,573
2022 Total %	6.8%	42.4%	25.9%	21.3%	3.7%	100%
Jan ’23	52	296	221	184	31	784
Feb ’23	49	345	186	192	22	794
Mar ’23	39	374	245	237	33	928
2023 Total	140	1,015	652	613	86	2506
2023 Total %	5.6%	40.5%	26.0%	24.5%	3.4%	100%

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Number of suspected and confirmed fatal overdoses

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 – March 2023 as well as 2022.

	Maine EMS	Law Enforcement
Fatal Overdose Response 2022	577	665
Nonfatal Overdose Response 2022	9,374	1,471
Total Overdose Response 2022	9,951	2,136
Fatal Overdose Response Jan – Mar 2023	107	133
Nonfatal Overdose Response Jan – Mar 2023	2,229	313
Total Overdose Response Jan- Mar 2023	2,336	446

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 March 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 2022 percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. York County is 4 percentage points lower; Sagadahoc County is 2 percentage points lower than the 2020 census proportion. Androscoggin County and Penobscot County are 3 percentage points higher than the 2020 census proportion.

County	% of 2020 Census Population	Jan-Dec 2022 Est. N=9374	Jan-Mar 2023 Est. N=2229	Mar 2023 Est. N=779
Androscoggin	8%	1,055 (11%)	243 (11%)	104 (13%)
Aroostook	5%	490 (5%)	93 (4%)	25 (3%)
Cumberland	22%	2,194 (23%)	537 (24%)	187 (24%)
Franklin	2%	139 (1%)	35 (2%)	16 (2%)
Hancock	4%	287 (3%)	63 (3%)	19 (2%)
Kennebec	9%	922 (10%)	224 (10%)	76 (10%)
Knox	3%	245 (3%)	73 (3%)	25 (3%)
Lincoln	3%	161 (2%)	37 (2%)	16 (2%)
Oxford	4%	410 (4%)	84 (4%)	25 (3%)
Penobscot	11%	1,292 (14%)	321 (14%)	112 (14%)
Piscataquis	1%	90 (1%)	31 (1%)	11 (1%)
Sagadahoc	3%	130 (1%)	26 (1%)	8 (1%)
Somerset	4%	392 (4%)	118 (5%)	46 (6%)
Waldo	3%	199 (2%)	59 (3%)	21 (3%)
Washington	2%	221 (2%)	35 (2%)	11 (1%)
York	16%	1,147 (12%)	250 (11%)	77 (10%)

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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-December 2022 percentages of deaths in most counties fall within plus or minus 0 to 1 percentage points of the 2020 census distribution. Cumberland County is 4 percentage points lower, Sagadahoc County and York County are 2 percentage points lower than the 2020 census proportion in 2022. Androscoggin County and Aroostook County are 2 percentage points higher and Penobscot County is 4 percentage points higher than the 2020 census proportion.

County	% of 2020 Census Population	Jan-Dec 2022 Est. N=714	Jan-Mar 2023 Est. N=140	Mar 2023 Est. N=39
Androscoggin	8%	69 (10%)	19 (14%)	6 (15%)
Aroostook	5%	47 (7%)	5 (4%)	1 (3%)
Cumberland	22%	130 (18%)	35 (25%)	8 (21%)
Franklin	2%	14 (2%)	0 (0%)	0 (0%)
Hancock	4%	24 (3%)	4 (3%)	1 (3%)
Kennebec	9%	54 (8%)	19 (14%)	7 (18%)
Knox	3%	20 (3%)	0 (0%)	0 (0%)
Lincoln	3%	14 (2%)	1 (1%)	0 (0%)
Oxford	4%	36 (5%)	3 (2%)	0 (0%)
Penobscot	11%	107 (15%)	25 (18%)	8 (21%)
Piscataquis	1%	9 (1%)	5 (4%)	0 (0%)
Sagadahoc	3%	10 (1%)	0 (0%)	0 (0%)
Somerset	4%	35 (5%)	5 (4%)	0 (0%)
Waldo	3%	21 (3%)	2 (1%)	0 (0%)
Washington	2%	24 (3%)	7 (5%)	4 (10%)
York	16%	100 (14%)	10 (7%)	4 (10%)

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Race, ethnicity, and other demographic indicators of decedents

During the first quarter of 2023, out of 139 confirmed and suspected fatal overdoses for which race was reported, 128 (92%) of the victims were identified as White, 5 (4%) as Black or African American, and 0 (0%) as American Indian/Alaska Native. Out of the 139 fatal overdoses for whom ethnicity was reported, 138 (99%) were reported as not Hispanic, and 1 (1%) were identified as Hispanic.

Out of the 138 cases for which military background was reported in January – March 2023, 11 (8%) were identified as having a military background. Out of 39 cases in March 2023 where military background was reported, 4 (10%) were identified as having a military background.

Prior overdose history was reported for 58 (41%) of the victims during January-March 2023.

Of 140 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 14 (10%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (5, 36%), Penobscot County (3, 21%), and Kennebec County (3, 21%). In March 2023, 4 decedents (13%) were identified as undomiciled.

Demographic Indicator	% of 2020 Census Population	Jan-Dec 2022 Est. Race N=712 Ethnicity N=698	Jan-Mar 2023 Est. Race N=139 Ethnicity N=139	Mar 2023 Est. Race N=39 Ethnicity N=39
Race and Ethnicity
White	91%	662 (93%)	128 (92%)	36 (92%)
Black or African American	2%	16 (2%)	5 (4%)	1 (3%)
American Indian/Alaska Native	1%	14 (2%)	0 (0%)	0 (0%)
Other race, 2+ races combined, non-hispanic	7%	15 (2%)	4 (3%)	1 (3%)
Not Hispanic	98%	691 (99%)	138 (99%)	38 (97%)
Hispanic	2%	7 (1%)	1 (1%)	1 (3%)
Military Background		81 (11%)	11 (8%)	4 (10%)
Prior Overdose History		268 (37%)	58 (41%)	17 (44%)
Undomiciled/Transient Housing Status		81 (11%)	14 (10%)	4 (13%)

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. It has slightly decreased during the first quarter of 2023 to 72%. The cumulative age distribution in January – March 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 0 deaths in 2022, a 7 percentage point decrease in the proportion of those aged 18-39, a 3 percentage point increase in those aged 40-59, and a 4 percentage point increase in the proportion 60 and above.

	% of 2020 Census Population	Jan-Dec 2022 Est. N=714	Jan-Mar 2023 Est. N=140	Mar 2023 Est N=39
Percent Males	49%	521…(73%)	101 (72%)	26 (67%)
Percent under 18	19%	3…(<1%)	0 (0%)	0 (0%)
Percent 18-39	26%	291…(41%)	48 (34%)	15 (39%)
Percent 40-59	27%	331..(46%)	69 (49%)	19 (49%)
Percent 60+	29%	89…(12%)	23 (16%)	5 (13%)

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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 (73%) in 2023. In 2023, law enforcement was more likely to respond to a scene alone (22%) than EMS (4%). The overwhelming majority (91%) of drug overdoses were ruled, or suspected of being, accidental manner of death.

During 2023, 21% of fatal overdose cases had naloxone administered at the scene by EMS, bystanders, or law enforcement. This rate is slightly lower than the 22% of fatal overdose cases in which naloxone was reportedly administered at the scene in 2020, and lower than the 30% recorded in 2021 and the 25% recorded in 2022. 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 10% (14) of the fatal overdoses, often in addition to EMS and/or law enforcement. This is slightly less than 2022 (11%) but greater than 2021 (9%) and 2020 (4%).

Based on 107 suspected and confirmed drug death cases with EMS involvement during the first three months of 2023, 66 (62%) of victims were already deceased when EMS arrived. In the remaining 41 (38%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 41 who were still alive when EMS arrived, only 10 (9%) remained alive long enough to be transported but died during transport or at the emergency room and 31 (76%) did not survive to be transported. 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=714	Jan – Mar 2023 Est. N=140	Mar 2023 Est. N=39
Public safety response
……EMS alone	39….(5%)	5 (4%)	0 (0%)
……Law enforcement alone	127…(18%)	31 (22%)	8 (21%)
……EMS and law enforcement	538…(75%)	102 (73%)	27 (69%)
……Private transport to the Emergency. Dept.	13…..(2%)	2 (1%)	0 (0%)
Naloxone administration
Naloxone administration reported at the scene	181..(25%)	30 (21%)	6 (15%)
……Bystander only	45…(6%)	7 (5%)	2 (5%)
……Law enforcement only	32….(4%)	1 (1%)	0 (0%)
……EMS only	55….(8%)	14 (10%)	2 (5%)
……EMS and law enforcement	11….(2%)	1 (1%)	0 (0%)
……EMS and bystander	26….(4%)	5 (4%)	1 (3%)
……Law enforcement and bystander	5….(1%)	2 (1%)	1 (3%)
……EMS, bystander, and law enforcement	6….(1%)	0 (0%)	0 (0%)
……Naloxone administered by unspecified person	10…(1%)	0 (0%)	0 (0%)

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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 108 cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 86 (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 6% (6) 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% (33) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – March constituted 34% (37) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 86% (32) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 82% (27) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 108 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 10 (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=712	Jan-Mar 2023 N=108	*Mar 2023 N=10
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs	560..(79%)	86 (80%)	8 (80%)
……Heroin	19….(3%)	6 (6%)	1 (10%)
Nonpharmaceutical Stimulants
……Cocaine	211.(30%)	37 (34%)	3 (30%)
……Methamphetamine	233.(33%)	33 (31%)	2 (20%)
Pharmaceutical opioids**	155..(22%)	26 (24%)	4 (40%)
Key combinations
……Fentanyl and heroin	18….(3%)	6 (6%)	1 (10%)
……Fentanyl and cocaine	171..(24%)	32 (30%)	3 (30%)
……Fentanyl and methamphetamine	189..(27%)	27 (25%)	2 (20%)
……Fentanyl and xylazine	46….(6%)	10 (9%)	1 (10%)
……Fentanyl and tramadol	10….(1%)	1 (1%)	0 (0%)

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