May 2021 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for May 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 May 2021

Fatal Drug Overdoses in Maine January – May 2021

The May 2021 total of 48 fatal drug overdoses consists of 7 confirmed drug deaths and 41 suspected drug deaths. The graph below shows the considerable monthly fluctuation since January 2020. Although the 2020 average is 42, the range extends from 34 to 53. The average so far for 2021 is 49, and the range is 42 to 57. For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.

Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021.

Comprehensive total of fatal and nonfatal overdoses

During May 2021, there were an estimated 623 fatal and nonfatal drug overdoses statewide, of which 48 (8%) were suspected and confirmed fatal overdoses. The remaining 575 (92%) were nonfatal overdoses: 313 (50%) emergency department; 157 (25%) EMS not transported, 101 (16%) community reversals, and an estimated 4 (1%) law enforcement reversals without EMS. 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 OverdosesEmergency Department
EMS Not Transported
Reported Community Reversals
Law Enforcement Without EMS 
Nonfatal (estimated)
Total Overdoses
Total %8%48%25%19%<1%100%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021.
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses.

Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The May 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 2019, 2020, and January-May 2021. 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 – May fall within 0%-1% of the 2019 census distribution in many counties including those of Franklin, Hancock, Kennebec, Lincoln, Piscataquis, Sagadahoc, and Waldo. Counties that are 2% or higher than the census include Androscoggin (5%), Oxford (2%), Penobscot (6%), and Washington (3%). Counties that are 2% or lower than the census include Aroostook (-2%), Cumberland (-5%), Knox (-3%), Somerset (-3%) and York (-4%).

CountyPercent of 2019
Census Population
Jan-Dec 2020
May 2021
Est. N=48
Cumulative Jan-May 2021
Est. N=247
Androscoggin8%33…….(9%)52.(10%) 7.(15%)32….(13%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021.

Race, ethnicity, and other demographic indicators of decedents

During the first five months of 2021, out of 247 confirmed and suspected fatal overdoses, 232 (94%) of the victims were identified as White, 9 (4%) as Black or African American, and 6 (2%) as American Indian/Alaska Native. Out of the 242 fatal overdoses where ethnicity was reported, 240 (99%) were reported as not Hispanic, and 2 (1%) were identified as Hispanic. Out of the 247 cases, 18 (7%) were identified as having a military background. Prior overdose history was reported for 82 (33%) of the victims. Transient housing status was reported for 21 (9%) of the victims.

Demographic IndicatorNumber of decedentsPercent of decedents
Race and Ethnicity
Black or African American94%
American Indian/Alaska Native62%
Not Hispanic24099%
Military Background187%
Prior Overdose History8233%
Person Experiencing Homelessness219%
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021.

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 increased since 2019. In the first five months of 2021, it was 70%, which is slightly lower than the 71% level in 2020 and slightly higher than the 68% level in 2019. The cumulative age distribution in January – May 2021 compared to 2019 shows the percentage of those 18-39 decreased by 4%. The percentage of those 40-59 rose by 2%, and the percentage of those over 60 also rose 2%. There was one decedent under 18 in 2021.

Jan-Dec 2020
Jan-May 2021
Est. N=199
Est. N-45
Percent Males258..(68%)357(71%)173.(70%)36(75%)
Percent under 180….(0%)2(<1%)1..(<1%)1…..(2%)
Percent 18-39171..(45%)213..(42%)102.(41%)19(40%)
Percent 40-59175..(46%)235..(47%)118.(48%)21..(44%)
Percent 60+33….(9%)54(11%)26..(11%)7(15%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021.
*Systematic gender data are not reported on the death certificate.

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 five months 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 (5%). The overwhelming majority (88%) of drug overdoses were ruled as accidental manner of death.

Based on the death investigation records, during May, naloxone was administered to 40% of the victims at the scene or in the ambulance, whether by EMS, bystanders, or law enforcement, slightly less than the first five months of 2021 combined (47%) but greater than 2020 (33%). This may be due to the greater availability of police trained to administer it through programs like the Attorney General’s Naloxone Distribution Initiative or ODMAP. It may also be due to the greater availability in the community due to the Maine Naloxone Distribution Initiative. None of the May decedents had naloxone prescriptions, but 7 did in 2020 and 4 in the first four months of 2021.

Based on 203 suspected and confirmed drug death cases with EMS records during the first five months of 2021, 94 (46%) of victims were already deceased when EMS arrived. Of the remaining 109 (54%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of the 109 cases who were still alive when EMS arrived, 34 were transported, and 75 did not survive to be transported. Thus, out of 203 cases with EMS records, only 34 (17%) remained alive long enough to be transported, but died during transport or at the emergency room.

Jan-Dec 2020
Jan-May 2021
Est. N=247
Est. N=48
Public safety response
……EMS alone28(6%)12….(5%)4……(8%)
……Law enforcement alone107.(21%)44..(18%)6….(13%)
……EMS and law enforcement365.(72%)191..(77%)38(79%)
Manner of death (suspected or confirmed)
Naloxone administration
Naloxone administration at the scene and/or
(presumably) in ambulance during transport to
emergency room
Naloxone administration reported at the scene83.(22%)83.(34%)15..(31%)
……Bystander only11(2%)13….(5%)3….(6%)
……Law enforcement only8(2%)12….(5%)2….(4%)
……EMS only55..(11%)37..(15%)5..(10%)
……EMS and law enforcement4(1%)12….(5%)2….(4%)
……EMS and bystander8..(2%)7….(3%)2….(4%)
……Law enforcement and bystander0..(0%)1..(<1%)0….(0%)
……EMS, bystander, and law enforcement…….1..(<1%)1….(2%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021.

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 62%, slightly lower than in 2020. Fentanyl is nearly always found in combination with multiple other drugs. Heroin involvement has been declining during the last several years; it represents only 5% of 2021 deaths, compared to 11% last year. Illicit stimulants have been increasing in recent years, and in the first five months of 2021, methamphetamine caused 20% of the overdoses, which is equal to 2020. Cocaine-involved fatalities constituted 18% of cases, slightly lower than 23% in 2020. Fentanyl is found in combination with cocaine in 15% of cases, and fentanyl and methamphetamine as a combination in 16% of cases. Pharmaceutical opioids were identified as a cause of death in 21%, all in combination with other drugs, just 2% lower than in 2020.

Cause of death (alone or in
combination with other drugs)
Jan-Dec 2020
Jan-May 2021
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)153..(62%)5..(10%)
Nonpharmaceutical Stimulants
Pharmaceutical opioids**118.(23%)43.(25%)1(2%)
Key combinations
……Fentanyl and cocaine97.(19%)38..(15%)1(2%)
……Fentanyl and methamphetamine/amphetamine70.(14%)39..(16%)1(2%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for May 2021.
**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.

Highlight of the month regarding substance use disorder public policy response

Overdose Spike Alerts via text message

The Department of Human Services and Partnership to End Addiction launched on June 25 a free texting service that alerts Maine residents to any sudden increase in overdoses, both fatal and nonfatal, in their county.  Any resident interested in receiving such alerts can simply text SPIKE to 1-888-963-5669 and follow the prompts. The program will link the individual to resources through Maine’s OPTIONS initiative.  They will be directed to the Know Your Options website ( where they can learn how to get a naloxone kit or contact the OPTIONS liaison in their county.

Those individuals who sign up will receive free notifications on their mobile devices if three or more fatal or nonfatal overdoses occur in their county within a 24 hour period.

Maine is the first state to launch the program with the Partnership on a statewide basis .

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.