Download the entire PDF report: Maine Monthly Overdose Report for March 2024
Overview: Composite total of fatal and nonfatal overdoses
This report documents suspected and confirmed fatal and nonfatal drug overdoses in Maine during March 2024 as well as for the period January 2023–March 2024 (Table 1). During March 2024, the proportion of fatal overdoses averaged 6.7% of total overdoses. Monthly proportions of 2024 fatalities fluctuated from a low of 6.1% in February to a high of 6.7% in both January and March. During the first three months of 2024, fatal overdoses constituted 6.5% of all overdoses, slightly higher than the 5.6% for the same time period in 2023. The total number of confirmed and suspected fatal overdoses January–March 2024 is 143, 0.7% lower than the total confirmed fatal overdoses for the same period in 2023, 144. The total number of nonfatal overdoses January–March 2024 is 2,057, 15.1% lower than the total confirmed nonfatal overdoses for the same period in 2023, 2,423.
Data derived from multiple statewide sources were compiled and deduplicated to calculate fatal and nonfatal overdose totals (Table 1). These include nonfatal overdose incidents reported by hospital emergency departments (ED), nonfatal emergency medical service (EMS) responses without transport to the ED, overdose reversals reported by law enforcement in the absence of EMS, and overdose reversals reported by community members or agencies receiving state-supplied naloxone through the Maine Naloxone Distribution Initiative. There are also an unknown number of private overdose reversals that were not reported and an unknown number of community-reported reversals that may have overlapped with emergency response by EMS or law enforcement. The total number of fatal overdoses in this report includes those that have been confirmed, as well as those that are suspected but not yet confirmed for January, February, and March 2024 (see Figure 1).
The total number of suspected and confirmed fatal overdoses and reported nonfatal overdoses for March 2024, 776, is displayed in Table 1 near the bottom row. Of those 776, there were 52 (6.7%) confirmed and suspected fatal overdoses, 372 (47.9%) nonfatal emergency department visits, 221 (28.5%) nonfatal EMS responses not transported to the emergency department, 119 (15.3%) reported community overdose reversals, and 12 (1.5%) law enforcement reversals in incidents that did not include EMS.
Table 1: Composite reported overdose totals, all drugs, January 2023-march 2024
| 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 ’23 | 54 | 296 | 221 | 184 | 48 | 803 |
| Feb ’23 | 49 | 348 | 185 | 192 | 30 | 804 |
| Mar ’23 | 41 | 382 | 246 | 237 | 54 | 960 |
| Apr ’23 | 63 | 270 | 217 | 202 | 29 | 781 |
| May ’23 | 49 | 295 | 223 | 165 | 47 | 779 |
| Jun ’23 | 58 | 378 | 209 | 219 | 35 | 899 |
| Jul ’23 | 50 | 340 | 291 | 173 | 34 | 887 |
| Aug ’23 | 40 | 330 | 247 | 152 | 22 | 791 |
| Sep ’23 | 53 | 390 | 235 | 141 | 26 | 845 |
| Oct ’23 | 54 | 317 | 254 | 147 | 17 | 789 |
| Nov ’23 | 48 | 254 | 190 | 101 | 20 | 613 |
| Dec ’23 | 46 | 325 | 183 | 129 | 23 | 706 |
| 2023 Total | 605 | 3,925 | 2,701 | 2,042 | 385 | 9,658 |
| 2023 Total % | 6.3% | 40.6% | 28.0% | 21.1% | 4.0% | 100% |
| Jan ’24 | 46 | 269 | 209 | 139 | 27 | 690 |
| Feb ’24 | 45 | 306 | 221 | 136 | 26 | 734 |
| Mar ’24 | 52 | 372 | 221 | 119 | 12 | 776 |
| 2024 Total | 143 | 947 | 651 | 394 | 65 | 2200 |
| 2024 Total % | 6.5% | 43.0% | 29.3% | 17.9% | 3.0% | 100% |
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 total activity of both law enforcement officials and EMS agencies is underrepresented in the above table. The process used to deduplicate overdoses begins by removing fatal overdoses from the emergency department and EMS overdose incidents. Then the number of patients transported to emergency departments by Maine EMS are removed from the EMS overdose incidents. Finally, EMS involvement and fatal overdose incidents are removed from law enforcement responses.
Table 2 shows the public safety response to fatal and nonfatal overdose events in January–March 2024 as well as January–December 2023. During January–March 2024, law enforcement officers responded to a reported 372 overdose incidents (135 fatal; 237 nonfatal), and Maine EMS responded to a reported 2,153 incidents (108 fatal; 2,045 nonfatal). During 2023 as a whole, law enforcement officers responded to a reported 1,615 incidents (562 fatal; 1,053 nonfatal), and Maine EMS responded to a reported 9,330 incidents (479 fatal; 8,841 nonfatal).
Table 2. Fatal and nonfatal overdose emergency response count from law enforcement and Maine EMergency Medical Services, including overlapping cases
| Maine EMS | Law Enforcement | |
| Fatal Overdose Response 2023 | 479 | 562 |
| Nonfatal Overdose Response 2023 | 8,841 | 1,053 |
| Total Overdose Response 2023 | 9,330 | 1,615 |
| Fatal Overdose Response Jan – Mar 2024 | 108 | 135 |
| Nonfatal Overdose Response Jan – Mar 2024 | 2045 | 237 |
| Total Overdose Response Jan – Mar 2024 | 2153 | 372 |
County Distribution of Suspected Nonfatal Overdoses
Table 3 shows the frequency distribution of nonfatal overdoses to which EMS responded at the county level. Overdose reversal totals reported by community partners and emergency departments are not reported by county; only EMS case data include county frequencies. The March 2024 monthly totals in the far right column can be compared to the percentage of the census population on the far left, the percentage of nonfatal overdoses for the year in 2023, or the January–March 2024 year-to-date total. Caution must be exercised viewing single counties, especially for a single month, due to small numbers. These may fluctuate randomly, without reflecting any statistically significant trend.
January–March 2024 percentage totals for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Cumberland is 3 percentage points higher than the 2020 census proportion. Androscoggin County, Aroostook County, Kennebec County and Penobscot County are 2 percentage points higher than the 2020 census proportion. York County is 6 percentage points lower and Sagadahoc County is 2 percentage points lower than the 2020 census proportion.
Nonfatal Drug Overdoses in Maine, March 2024
Nonfatal Drug Overdoses in Maine, Jan 2024 – Mar 2024
Table 3. County of EMS Incident among suspected and confirmed nonfatal overdoses
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 8841 | Jan–Mar 2024 Est. N = 2045 | Mar 2024 Est. N = 669 | ||||
| Androscoggin | 8% | 912 | 10% | 210 | 10% | 75 | 11% |
| Aroostook | 5% | 447 | 5% | 135 | 7% | 42 | 6% |
| Cumberland | 22% | 2038 | 23% | 513 | 25% | 166 | 25% |
| Franklin | 2% | 138 | 2% | 35 | 2% | 8 | 1% |
| Hancock | 4% | 255 | 3% | 59 | 3% | 16 | 2% |
| Kennebec | 9% | 871 | 10% | 215 | 11% | 70 | 10% |
| Knox | 3% | 300 | 3% | 61 | 3% | 23 | 3% |
| Lincoln | 3% | 185 | 2% | 37 | 2% | 12 | 2% |
| Oxford | 4% | 355 | 4% | 79 | 4% | 28 | 4% |
| Penobscot | 11% | 1253 | 14% | 276 | 13% | 89 | 13% |
| Piscataquis | 1% | 109 | 1% | 24 | 1% | 10 | 1% |
| Sagadahoc | 3% | 130 | 1% | 23 | 1% | 11 | 2% |
| Somerset | 4% | 431 | 5% | 102 | 5% | 35 | 5% |
| Waldo | 3% | 193 | 2% | 37 | 2% | 11 | 2% |
| Washington | 2% | 193 | 2% | 43 | 2% | 16 | 2% |
| York | 16% | 1031 | 12% | 196 | 10% | 57 | 9% |
Age and Gender Distribution of Suspected Nonfatal Overdoses with EMS Response
Table 4 displays the age composition of individuals suspected of experiencing nonfatal overdoses involving EMS response in March 2024, Janaury–March 2024 as well as January–December 2023. Overdose reversal totals reported by community partners and emergency departments are not categorized and reported by age; only EMS case data include age frequencies at a monthly cadence. Age group totals can be compared to the 2020 census proportion by age group in the far left column, or the January – December 2023 totals. When comparing the March 2024 data with the 2024 year-to-date column, the 2023 data or the census population proportion, caution must be exercised as the small number of cases in each month is vulnerable to random fluctuation that may not reflect a significant statistical trend. The age distribution for January–March 2024 compared to the 2020 census poportion shows a disproportionately large impact of suspected nonfatal overdose victims with EMS involvement in those aged 25-54. There are 12 percentage points fewer of those under the age of 18 compared to the census population, 4 percentage points fewer of those aged 55-64, and14 percentage points fewer of those 65 and older compared to the census proportion of the population.
Table 4. Reported age group among suspected nonfatal overdose victims involving EMS response
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 8786 | Jan-Mar 2024 Est. N = 2045 | Mar 2024 Est. N = 672 | ||||
| < 18 | 18% | 409 | 5% | 113 | 6% | 41 | 6% |
| 18-24 | 7% | 877 | 10% | 209 | 10% | 68 | 10% |
| 25-34 | 12% | 1945 | 22% | 424 | 21% | 135 | 20% |
| 35-44 | 12% | 2375 | 27% | 542 | 27% | 175 | 26% |
| 45-54 | 12% | 1343 | 15% | 321 | 16% | 113 | 17% |
| 55-64 | 16% | 1074 | 12% | 246 | 12% | 88 | 13% |
| > 64 | 23% | 763 | 9% | 190 | 9% | 52 | 8% |
Table 5 displays the reported gender of individuals experiencing nonfatal overdoses involving EMS response in January–March 2024 as well as January–December 2023. Overdose reversal totals reported by community partners and emergency departments, as well as fatal overdoses are not categorized by gender; only EMS case data include gender categories at a monthly cadence. Gender group totals can be compared to the 2020 census proportion by age group in the far left column or the January–December 2023 totals in the center column. When comparing the January–March 2024 with 2023, as well as the census population proportion, caution must be exercised as the small number of cases in each month is vulnerable to random fluctuation that may not reflect a significant statistical trend. Males represent 49% of the 2020 estimated census population and 60% of the nonfatal overdose victims with EMS involvement during January–March 2024.
abel 5. Reported Gender among suspected nonfatal overdose victims involving ems response
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 8798 | Jan–Mar 2024 Est. N = 1976 | Mar 2024 Est. N = 639 | ||||
| Male | 49% | 5297 | 60% | 1189 | 60% | 392 | 61% |
| Female | 51% | 3476 | 40% | 786 | 40% | 247 | 39% |
| Transgender | Not collected | 25 | 0.3% | 1 | 0% | 0 | 0% |
County Distribution of Suspected and Confirmed Fatal Overdoses
Table 6 shows the frequency distribution of fatal overdoses at the county level. The March 2024 monthly totals in the far right column can be compared either to the percentage of the census population in the far-left column, the percentage of county fatal overdoses for 2023, or the January–March 2024 year-to-date percentages. Caution must be exercised when viewing single counties with small numbers for a single month. These may fluctuate randomly, without reflecting any significant statistical trend. The January–March 2024 percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Knox County is 5 percentage points higher than the 2020 census proportions. Aroostook County is 4 percentage points higher and Kennebec is 2 percentage points higher than the 2020 census proportion. Cumberland County is 7 percentage points lower than the 2020 census proportion, York County is 5 percentage points lower and Sagadahoc County is 2 percentage points lower than the 2020 census proportion.
Table 6. County of death among suspected and confirmed fatal overdoses
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 604 | Jan–Mar 2024 Est. N = 143 | Mar 2024 Est. N = 52 | ||||
| Androscoggin | 8% | 69 | 11% | 13 | 9% | 4 | 8% |
| Aroostook | 5% | 39 | 6% | 13 | 9% | 6 | 12% |
| Cumberland | 22% | 116 | 19% | 22 | 15% | 6 | 12% |
| Franklin | 2% | 6 | 1% | 1 | 1% | 0 | 0% |
| Hancock | 4% | 22 | 4% | 4 | 3% | 2 | 4% |
| Kennebec | 9% | 60 | 10% | 16 | 11% | 7 | 13% |
| Knox | 3% | 16 | 3% | 11 | 8% | 5 | 10% |
| Lincoln | 3% | 7 | 1% | 5 | 3% | 2 | 4% |
| Oxford | 4% | 25 | 4% | 6 | 4% | 1 | 2% |
| Penobscot | 11% | 91 | 15% | 14 | 10% | 5 | 10% |
| Piscataquis | 1% | 17 | 3% | 2 | 1% | 1 | 2% |
| Sagadahoc | 3% | 7 | 1% | 2 | 1% | 2 | 4% |
| Somerset | 4% | 29 | 5% | 7 | 5% | 3 | 6% |
| Waldo | 3% | 10 | 2% | 6 | 4% | 1 | 2% |
| Washington | 2% | 26 | 4% | 5 | 3% | 1 | 2% |
| York | 16% | 64 | 11% | 16 | 11% | 6 | 12% |
Fatal Drug Overdoses in Maine March 2024
Fatal Drug Overdoses in Maine Jan – Mar 2024
Age and Sex Distribution of Fatal Overdose Victims
Table 7 displays the age and sex composition of the March 2024 fatal overdose population, the January-March 2024 year-to-date fatal overdose population, the 2023 year-to-date fatal overdose population, and the 2020 estimated census population. When comparing the March 2024 data with 2023 as well as the census population proportion, caution must be exercised as the small number of cases in each month is vulnerable to random fluctuation that may not reflect a significant statistical trend. The cumulative proportion of males is lower in January–March 2024 (68%) compared to 2023 (73%). The age distribution for 2024 compared to the 2020 census proportion shows a disproportionately large impact of fatal overdoses in those aged 35–64, as was true in 2023, 3 percentage points lower for those aged 18-24, and 17 percentage points lower for those 65 and older.
Table 7. Decedent Reported Age Group and Sex among suspected and confirmed fatal overdoses
| % 2020 estimated Census population | Jan–Dec 2023 Est. N = 606 | Jan–Mar 2024 Est. N = 143 | Mar 2024 Est. N = 52 | ||||
| Male | 49% | 441 | 73% | 97 | 68% | 36 | 69% |
| < 18 | 18% | 3 | 0% | 3 | 2% | 2 | 4% |
| 18-24 | 7% | 28 | 5% | 6 | 4% | 5 | 10% |
| 25-34 | 12% | 85 | 14% | 17 | 12% | 6 | 12% |
| 35-44 | 12% | 198 | 33% | 45 | 31% | 17 | 33% |
| 45-54 | 12% | 135 | 22% | 36 | 25% | 9 | 17% |
| 55-64 | 16% | 119 | 20% | 27 | 19% | 10 | 19% |
| > 64 | 23% | 38 | 6% | 9 | 6% | 3 | 6% |
Race, ethnicity, and other demographic indicators of decedents
Table 8 displays the reported race and ethnicity of confirmed and suspected fatal overdoses in March 2024, January–March 2024, and January–December 2023 compared to the 2020 census population. Note that race and ethnicity are not finalized until the full death certificate is entered into Vital Records, and a small number of decedents’ records currently lack information about these variables. Out of 140 decedents for whom race was reported January-March 2024, 89% of the victims were identified as White, 0% as Black/African American, and 4% as American Indian/Alaska Native. Out of 138 decedents for whom Hispanic ethnicity status was reported, 4% were identified as Hispanic.
Table 8. Decedent race and ethnicity among suspected and confirmed fatal overdoses
| % 2020 Estimated Census Population: Race & Hispanic/Latinx Ethnicity | Jan–Dec 2023 Race N = 605 Ethnicity N = 589 | Jan–Mar 2024 Race N = 140 Ethnicity N = 138 | Mar 2024 Race Est. N = 50 Ethnicity Est. N = 50 | ||||
| White alone, non-Hispanic | 91% | 551 | 91% | 125 | 89% | 43 | 86% |
| Black/African American alone, non-Hispanic | 2% | 24 | 4% | 0 | 0% | 0 | 0% |
| American Indian/Alaska Native, non-Hispanic | 1% | 12 | 2% | 5 | 4% | 2 | 4% |
| Other race and 2+ races combined, non-Hispanic | 7% | 11 | 2% | 4 | 3% | 2 | 4% |
| Hispanic/Latinx alone or in combination | 2% | 7 | 1% | 6 | 4% | 3 | 6% |
military status and housing stability of fatal overdose victims
Out of the 141 cases for which military background was reported January–March 2024, 5 (4%) were identified as having a military background. Out of the 52 cases in March 2024 where military background was reported, 0 (0%) were identified as having a military background.
Of the 143 total suspected and confirmed fatal overdose cases year-to-date in 2024, undomiciled or transient housing status was reported for 17 (12%) victims. Among those 17, the largest proportions of undomiciled persons were found in Androscoggin County (5, 29%) and Cumberland County (3, 18%). In March 2024, 9 fatal overdose victims (17%) were identified as undomiciled.
Basic incident patterns in fatal overdoses
Table 9 reports some of the basic incident patterns for fatal overdoses. March 2024 can be compared to 2023 as a whole or to January-March year-to-date totals. Caution must be exercised interpreting a single month of data as numbers may fluctuate randomly and not reflect a statistically significant trend. In addition, data totals may change slightly as suspected cases are confirmed or eliminated. Both EMS and police responded together to most fatal overdoses (70%) in 2024 year to date. Law enforcement was more likely to respond to a scene alone (24%) than EMS (5%). The overwhelming majority (89%) of confirmed fatal drug overdoses were ruled as, or suspected of being, accidental manner of death. Of the 143 confirmed or suspected fatal overdoses in 2024, 51 (36%) had a history of prior overdose. Although most cases had bystanders or witnesses present at the scene by the time first responders arrived, the details about who was present at the time of the overdose were frequently unclear. However, responding family and friends or bystanders administered naloxone for 13 (9%) of the 2024 fatal overdoses, lower than 2023 (13%). Often, bystanders or witnesses administered naloxone in addition to EMS and/or law enforcement. During 2024, 22% of suspected and confirmed fatal overdose cases had naloxone administered at the scene by EMS, bystanders, and/or law enforcement. This rate lower than in 2023 (26%).
Of the 108 suspected or confirmed drug death cases with EMS involvement during 2024, 56 (52%) victims were already deceased when EMS arrived. In the remaining 51 (47%) cases, resuscitation was attempted either at the scene or presumably in the ambulance during transport to the emergency room. 1 case (1%) had an unreported response once EMS arrive. Of those 51 who were still alive when EMS arrived, 17 (33%) were transported, and 34 (67%) did not survive to be transported. Thus, out of 108 ultimately fatal cases with EMS response, only 17 (16%) remained alive long enough to be transported but died during transport or at the emergency room. This outcome is likely due to a combination of 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 bystanders to find an overdose victim alive, administer naloxone, and call 911.
Table 9. Incident CHARACTERISTICS among suspected and confirmed fatal overdoses
| Jan–Dec 2023 Est. N = 606 | Jan–Mar 2024 Est. N = 143 | Mar 2024 Est. N = 52 | ||||
| EMS response alone | 37 | 6% | 7 | 5% | 3 | 6% |
| Law enforcement alone | 120 | 20% | 35 | 24% | 14 | 27% |
| EMS and law enforcement | 441 | 73% | 100 | 70% | 35 | 67% |
| Private transport to Emergency Dept. | 5 | 1% | 0 | 0% | 0 | 0% |
| Naloxone administration reported at the scene | 156 | 26% | 32 | 22% | 14 | 27% |
| Bystander only administered | 39 | 6% | 8 | 6% | 5 | 10% |
| Law enforcement only administered | 15 | 2% | 2 | 1% | 0 | 0% |
| EMS only administered | 43 | 7% | 15 | 10% | 5 | 10% |
| EMS and law enforcement administered | 10 | 2% | 0 | 0% | 0 | 0% |
| EMS and bystander administered | 30 | 5% | 4 | 3% | 3 | 6% |
| Law enforcement and bystander administered | 8 | 1% | 1 | 1% | 1 | 2% |
| EMS, bystander, and law enforcement administered | 4 | 1% | 0 | 0% | 0 | 0% |
| Naloxone administered by unspecified person | 4 | 1% | 0 | 0% | 0 | 0% |
| History of prior overdose | 205 | 34% | 51 | 36% | 14 | 27% |
Key drug categories and combinations causing overdose deaths
Table 10 displays the frequencies of the most prominent drug categories causing death among confirmed drug deaths. As expected, within the 96 confirmed drug death cases so far in 2024, nonpharmaceutical fentanyl was the most frequent cause of death, mentioned on the death certificate of 75 (78%) victims.
Fentanyl is nearly always found in combination with multiple other drugs. Heroin involvement, declining rapidly in recent years, was reported as a cause of death in 3 (3%) of 2024 deaths and 12 (2%) of 2023 deaths. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 96 confirmed deaths in 2024, there were 20 cases (21%) with xylazine listed in addition to fentanyl as a cause of, and 0 cases (0%) with tramadol listed along with fentanyl.
Stimulants continue to increase as a cause of death, usually in combination with other drugs, particularly fentanyl. Cocaine-involved fatalities constituted 41 (43%) of confirmed cases in 2024, higher than 2023 (37%) and an increase from 29% in 2022. Fentanyl is mentioned as a cause in combination with cocaine in 32 cases, 78% of 2024 cocaine cases. Methamphetamine was cited as a cause of death in 44 (46%) of the confirmed fatal overdoses in 2024, higher than in 2023 (33%); 36 (82%) of the methamphetamine deaths also involved fentanyl as a co-intoxicant cause of death. Cocaine and methamphetamine are named together on 13 (14%) death certificates in 2024, in most of those cases (11, 85%) as co-intoxicants of fentanyl.
table 10. Key drug categories and combinations causing death among confirmed overdoses
| Cause of death (alone or in combination with other drugs) Sample size for confirmed cases only | Jan–Dec 2023 Est. N = 606 | Jan–Mar 2024 Est. N = 96 | Mar 2024 Est. N = 17 | |||
| Fentanyl or fentanyl analogs | 472 | 78% | 75 | 78% | 11 | 65% |
| Heroin | 12 | 2% | 3 | 3% | 0 | 0% |
| Cocaine | 226 | 37% | 41 | 43% | 9 | 53% |
| Methamphetamine | 198 | 33% | 44 | 46% | 7 | 41% |
| Pharmaceutical opioids** | 109 | 18% | 7 | 7% | 1 | 6% |
| Fentanyl and heroin | 12 | 2% | 3 | 3% | 0 | 0% |
| Fentanyl and cocaine | 192 | 32% | 32 | 33% | 6 | 35% |
| Fentanyl and methamphetamine | 163 | 27% | 36 | 38% | 6 | 35% |
| Fentanyl and xylazine | 60 | 10% | 20 | 21% | 1 | 6% |
| Fentanyl and tramadol | 3 | 0% | 0 | 0% | 0 | 0% |