May 2024 Monthly Overdose Report

Download the entire PDF report: Maine Monthly Overdose Report for May 2024

Overview: Composite total of fatal and nonfatal overdoses

This report documents suspected and confirmed fatal and nonfatal drug overdoses in Maine during May 2024 as well asfor the period January 2023–May 2024 (Table 1). The total number of confirmed and suspected fatal overdoses January–May 2024 is 231, 9.8% lower than the total confirmed fatal overdoses for the same period in 2023, 256. The total number of nonfatal overdoses January–May 2024 is 3,486, 11.8% lower than the total confirmed nonfatal overdoses for the same period in 2023, 3,951. During May 2024, the proportion of fatal overdoses averaged 5.1% of total overdoses. Monthly proportions of2024 fatalities fluctuated from a low of 5.1% in May to a high of 7.3% in March. During the first five months of 2024, fataloverdoses constituted 6.2% of all overdoses, slightly higher than the 6.1% for the same time period in 2023.  

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, March, and April 2024 (see Figure 1).

The total number of suspected and confirmed fatal overdoses and reported nonfatal overdoses for May 2024, 777, isdisplayed in Table 1 near the bottom row.  Of those 777, there were 40 (5.1%) confirmed and suspected fatal overdoses, 306 (40.7%) nonfatal emergency department visits, 256 (32.2%) nonfatal EMS responses not transported to the emergencydepartment, 165 (18.1%) reported community overdose reversals, and 10 (2.9%) law enforcement reversals in incidents that did not include EMS.

Table 1: Composite reported overdose totals, all drugs, January 2023-APRIL 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 ’235429623818448820
Feb ’234934820419230823
Mar ’234138226023754974
Apr ’236327023220229796
May ’234929523816547794
Jun ’235837823221935922
Jul ’235034030717334904
Aug ’234033026615222810
Sep ’235339025614126866
Oct ’235431727414717810
Nov ’234725521410120637
Dec ’234632520212923725
2023 Total6053926292120423859879
2023 Total %6.1%40.6%28.0%21.1%4.0%100%
Jan ’244626922613910689
Feb ’244530624213622751
Mar ’245537823311912800
Apr ’24452542051908700
May ’244030625616510777
2024 Total23115131162749623717
2024 Total %6.2%40.7%31.3%20.2%1.7%100%
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses. Fatal overdoses in those categories have been removed.

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– May 2024 as well as January–December 2023. During January–May 2024, law enforcement officers responded to a reported 577 overdose incidents (216 fatal; 361 nonfatal), and Maine EMS responded to a reported 4,064 incidents (181 fatal; 3,883 nonfatal). During 2023, law enforcement officers responded to a reported 1,615 incidents (562 fatal; 1,053 nonfatal), and Maine EMS responded to a reported 10,316 incidents (478 fatal; 9,838 nonfatal).

Table 2. Fatal and nonfatal overdose emergency response count from law enforcement and Maine EMergency Medical Services, including overlapping cases
Fatal overdose response
Jan–Dec 2023
Nonfatal overdose response
Jan–Dec 2023
Total overdose response
Jan–Dec 2023
Fatal overdose response
Jan–May 2024
Nonfatal overdose response
Jan–May 2024
Total Overdose
Response
Jan–May 2024
Maine EMS47898381031618138834064
Law Enforcement56210531615216361577
*Please note numbers will fluctuate from month-to-month as public safety agencies catch up their reporting . Due to methodological convention, alcohol-only cases are excluded from this table.  However, we recognize that alcohol is a large part of substance misuse epidemic. Cases with both drugs and alcohol are included. 

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 May 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–May 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–May 2024 percentage totals for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Compared to the 2020 census proportion, Cumberland County is 3 percentage points higher, Androscoggin County and Penobscot County are 2 percentage points higher, and York County is 5 percentage points lower.

Nonfatal Drug Overdoses in Maine, May 2024

Nonfatal Drug Overdoses in Maine, Jan 2024 – May 2024

Table 3. County of EMS Incident among suspected and confirmed nonfatal overdoses
% 2020 estimated
Census population
Jan–Dec 2023  
Est. N = 9838
Jan–May 2024 
 Est. N = 3883
May 2024  
Est. N = 841
Androscoggin8%100910%38710%789%
Aroostook5%4855%2416%658%
Cumberland22%230923%97825%23328%
Franklin2%1602%682%121%
Hancock4%2763%1013%243%
Kennebec9%96310%38410%718%
Knox3%3273%1083%212%
Lincoln3%2272%702%121%
Oxford4%3974%1494%273%
Penobscot11%135114%49713%10613%
Piscataquis1%1141%431%132%
Sagadahoc3%1512%592%162%
Somerset4%4715%1935%415%
Waldo3%2202%832%152%
Washington2%2152%892%223%
York16%116312%43311%8510%
*EMS nonfatal overdose counts include incidents where a patient may have died after admission to the ED. Please note numbers will fluctuate from month-to-month as public safety agencies catch up their reporting. Due to methodological convention, alcohol-only cases are excluded from this table. However, we recognize thatalcohol is a large part of substance misuse epidemic. Cases with both drugs and alcohol are included.

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 May 2024, January–May 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  in the far left column.  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 both 2023 and 2024 year to date compared to the 2020 census poportion shows a disproportionately large impact of suspected nonfatal overdose victims with EMS involvement for those aged 25–54. This impact is illustrated by looking at the 25–54 year age groups, which comprise 36% in the 2020 census, compared to 64% in the overdose population during 2023 and 61% in during January to May 2024. In 2024 there are 14 percentage points fewer overdose victims among those under the age of f 18 compared to the percentage of the census population in that age group. Similarly, there were 3 percentage points fewer overdose victims among those aged 55–64, and 11 percentage points fewer overdose victims among those 65 and older compared to the percentages of the census population for those age groups.  

Table 4. Reported age group among suspected nonfatal overdose victims involving EMS response
% 2020 estimated
Census population
Jan–Dec 2023 
Est. N = 9775
Jan-May 2024 
Est. N =3902
May 2024 
Est. N = 845
< 1818%4024%1694%243%
18–247%9039%38210%8410%
25–3412%208321%78420%18021%
35–4412%260327%98925%22126%
45–5412%152216%61016%13015%
55–6416%131713%51913%9611%
> 6423%94510%44912%11013%
*EMS nonfatal overdose counts include incidents where a patient may have died after admission to the ED. Please note numbers will fluctuate from month-to-month as public safety agencies catch up their reporting. Due to methodological convention, alcohol-only cases are excluded from this table. However, we recognize thatalcohol is a large part of substance misuse epidemic. Cases with both drugs and alcohol are included.

Table 5 displays the reported gender of individuals experiencing nonfatal overdoses involving EMS response in January–May 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–May 2024 with 2023,as well as the census population proportion, caution must be exercised as the small number of cases in each month isvulnerable to random fluctuation that may not reflect a significant statistical trend. Males represent 49% of the 2020 estimated census population and 59% of the nonfatal overdose victims with EMS involvement during January–May 2024.

Table 5. Reported Gender among suspected nonfatal overdose victims involving ems response
% 2020 estimated
Census population
Jan–Dec 2023
Est. N = 9794
Jan–May 2024 
Est. N = 3749
May 2024
Est. N = 800
Male49%597061%222859%47359%
Female51%379839%152041%32741%
TransgenderNot collected260.3%10%00%

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–May 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–May 2024 percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Compared to the 2020 census proportion, Aroostook County is 5 percentage points higher, Androscoggin County, Kennebec County, Knox County, and Waldo County are 2 percentage points higher, York County is 6 percentage points lower, Cumberland County is 4 percentage points lower, and Hancock County and Sagadahoc County are 2 percentage points lower.


Table 6. County of death among suspected and confirmed fatal overdoses
% 2020 estimated
Census population
Jan–Dec 2023 
Est. N = 603
Jan–May 2024 
Est. N = 231
May 2024 
Est. N = 40
Androscoggin8%6911%2210%410%
Aroostook5%396%2210%410%
Cumberland22%11619%4218%1025%
Franklin2%61%31%13%
Hancock4%224%52%13%
Kennebec9%6010%2511%615%
Knox3%163%125%00%
Lincoln3%71%83%00%
Oxford4%254%104%00%
Penobscot11%9115%2611%718%
Piscataquis1%173%31%00%
Sagadahoc3%71%31%00%
Somerset4%295%104%13%
Waldo3%102%115%25%
Washington2%254%73%13%
York16%6411%2210%38%

Fatal Drug Overdoses in Maine May 2024

Fatal Drug Overdoses in Maine Jan – May 2024


Age and Sex Distribution of Fatal Overdose Victims

Table 7 displays the age and sex composition[of the fatal overdose population for May 2024, January–May 2024, and January to December 2023, compared to the 2020 estimated census population. When comparing the May 2024 data with 2023 as well as the census population proportion, caution must be exercised as the small number of cases in each monthis vulnerable to random fluctuation that may not reflect a significant statistical trend. The cumulative proportion of males is lower in January–May 2024 (67%) compared to January–December 2023 (73%). 

The age distribution for 2024 compared to the 2020 census poportion shows a disproportionately large impact of fatal overdoses in those aged 35–64, as was true in 2023. That group includes 36% of the 2020 estimated census population, compared to 69% in the fatal overdose population in 2023 and 65% during January–May 2024. In 2024 year-to-date, there were 3 percentage points fewer fatal overdoses among those aged 18–24 and 17 percentage points fewer among those 65 and older compared to the census estimated population for those age groups. 

There were, however differences between the age structures of the nonfatal overdoses (Table 4) and the fatal overdoses.  In 2024 year to date,  the highest proportion of overdoses was among those aged 35–44 (25% among nonfatal and 29% among fatal) The second highest age group for nonfatal overdoses was 25–34 (21%) among nonfatal, but 45–54 among the fatal overdoses (24%). 


Table 7. Decedent Reported Age Group and Sex among suspected and confirmed fatal overdoses
% 2020 estimated
Census population
Jan–Dec 2023
Est. N = 605
Jan–May 2024
Est. N = 231
May 2024
Est. N = 40
Male49%44073%15567%2255%
< 1818%30%31%00%
18–247%285%94%38%
25–3412%8514%2712%513%
35–4412%19833%6829%1128%
45–5412%13522%5624%923%
55–6416%11820%5323%923%
> 6423%386%156%38%

Race, ethnicity, and other demographic indicators of decedents

Table 8 displays the reported race and ethnicity of confirmed and suspected fatal overdoses in May 2024, January–May 2024, and January–December 2023 compared to the 2020 estimated 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 228 decedents for whom race was reported January–May 2024, 92% of the victimswere identified as White, 0% as Black/African American, and 3% as American Indian/Alaska Native. Out of 223 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 = 604 Ethnicity N = 588
Jan–May 2024 
Race N = 228 Ethnicity N = 223
May 2024
Race Est. N = 39 Ethnicity Est. N = 37
White alone, non-Hispanic91%55091%21092%3692%
Black/African American alone, non-Hispanic2%244%00%00%
American Indian/Alaska Native, non-Hispanic1%122%63%13%
Other race and 2+ races combined, non-Hispanic7%112%42%13%
Hispanic/Latinx alone or in combination2%71%84%13%
*Race and ethnicity data for some cases are unavailable until drug deaths are confirmed. †Percentages may not total 100 due to rounding.
military status and housing stability of fatal overdose victims

Out of the 230 cases for which military background was reported January–May 2024, 11 (5%) were identified as having a military background. Out of the 39 cases in May 2024 where military background was reported, 3 (8%) were identified as having a military background. 

Of the 231 total suspected and confirmed fatal overdose cases year to date in 2024, undomiciled or transient housing status was reported for 27 (12%) victims. Among those 27, the largest proportions of undomiciled persons were found in Cumberland County (8, 30%), Androscoggin County (7, 26%) and Penobscot County (4, 15%). In May 2024, 4 fatal overdose victims (10%) were identified as undomiciled. 

Basic incident patterns in fatal overdoses

Table 9 reports basic incident patterns for fatal overdoses. May 2024 can be compared to 2023 as a whole or to January–May 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 (72%) in 2024 year to date. Law enforcement wasmore likely to respond to a scene alone (22%) than EMS (6%). The overwhelming majority (92%) of confirmed fatal drug overdoses were ruled as, or suspected of being, accidental manner of death. 

Of the 231 confirmed or suspected fatal overdoses in 2024, 76 (33%) had a history of prior overdose.

Although most cases had bystanders or witnesses present at the scene by the time first responders arrived, the detailsabout who was present at the time of the overdose were frequently unclear. However, responding family and friends or otherbystanders administered naloxone for 33 (14%) of the 2024 fatal overdoses, slightly higher than  2023 (13%). Often, EMS and/or law enforcement administered naloxone in addition to bystanders or witnesses. During 2024, 29% of suspected and confirmed fatal overdose cases had naloxone administered at the scene by EMS, bystanders, and/or law enforcement. This rate is also slightly higher than 2023 (26%).

Of the 181 suspected or confirmed drug death cases with EMS involvement during 2024, 92 (51%) victims were alreadydeceased when EMS arrived. In the remaining 88 (49%) cases, resuscitation was attempted either at the scene or presumablyin the ambulance during transport to the emergency room. One case had an unreported response once EMS arrived. Of those88 who were still alive when EMS arrived, 33 (38%) were transported, and 55 (62%) did not survive to be transported. Thus,out of 181 ultimately fatal cases with EMS response, only 33 (18%) 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 = 605
2024 Jan–May 
Est. N = 231
 May 2024 
Est. N = 40
EMS response alone366%146%513%
Law enforcement alone12020%5022%1025%
EMS and law enforcement44173%16672%2563%
Private transport to Emergency Dept.51%10%13%
Naloxone administration reported at the scene15526%6227%1128%
Bystander only administered396%2310%718%
Law enforcement only administered152%42%00%
EMS only administered437%219%25%
EMS and law enforcement administered102%10%00%
EMS and bystander administered305%52%00%
Law enforcement and bystander administered81%31%13%
EMS, bystander, and law enforcement administered41%10%00%
Naloxone administered by unspecified person30%10%13%
History of prior overdose20434%7633%1333%

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 confirmed drug death cases so far in 2024, nonpharmaceutical fentanyl was the most frequent cause of death, mentioned on the death certificate of 137 (77%) victims.

Fentanyl is nearly always found in combination with multiple other drugs. Heroin involvement, declining rapidly in recentyears, was reported as a cause of death in 5 (2%) of 2024 year-to-date 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 136 confirmed deaths in 2024, there were 30 cases (17%) with xylazine listed in addition to fentanyl as a cause of death, and 1 case (1%) 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 76 (42%) of confirmed cases so far in 2024, higher than 2023 (37%) and an increase from 29% in 2022. Fentanyl is mentioned as a cause in combination with cocaine in 60 cases, 79% of 2024 year-to-date cocaine cases. Methamphetamine was cited as a cause of death in 64 (36%) of the confirmed fatal overdoses so far in 2024, higher than in 2023 (33%); 53 (83%) of the methamphetamine deaths also involved fentanyl as a co-intoxicant cause of death. Cocaine and methamphetamine are named together on 16 (9%) death certificates in 2024, in most of those cases (14, 88%) as co-intoxicants of fentanyl.

Cause of death (alone or
in combination with other
drugs) Sample size for
confirmed cases only
Jan–Dec 2023 
Est. N = 605
Jan–May 2024 
Est. N = 179
 May 2024 
Est. N = 9
Fentanyl or fentanyl analogs47278%13777%556%
Heroin122%53%111%
Cocaine22637%7642%444%
Methamphetamine19833%6436%222%
Pharmaceutical opioids**10818%2715%333%
Fentanyl and heroin122%53%111%
Fentanyl and cocaine19232%6034%333%
Fentanyl and methamphetamine16327%5330%111%
Fentanyl and xylazine6010%3017%00%
Fentanyl and tramadol30%11%00%
**Nonpharmaceutical tramadol is now being combined with fentanyl in pills and powders for illicit drug use. When found in combination with fentanyl, and in the absence of a known prescription, tramadol is categorized as a nonpharmaceutical opioid.

SIXTH ANNUAL GOVERNOR’S OPIOID RESPONSE SUMMIT

Governor Mills’ 6th Annual Opioid Response Summit will be held on Thursday, July 25, 2024 at Central Maine Community College in Auburn, Maine.  Over 1000 people are expected to attend and to hear keynote speakers and choose from twenty-four breakout sessions.  The program runs from 8:00am to 4:30pm.  The keynote speaker is SAMSHA Administrator Miriam Delphin-Rittmon who will speak after welcoming comments from Opioid Response Director Gordon Smith, Auburn Mayor Jeff Harmon, CMCC President Betsy Libby,  Attorney General Aaron Frey, U.S. Attorney Darcie McElwee, Acting DHHS Commissioner Sara Gagne-Holmes and Maine CDC Director Puthiery Va, M.D.  OBH Director Sarah Squirrell will also make opening remarks and introduce Dr. Delphin-Rittmon. Governor Mills will speak at 11:25am following an introduction by Hannah Pingree, Director of the Governor’s Office of Policy Innovation and the Future.

Continuing the tradition started in 2019, each of the talks and breakout sessions will begin with a brief presentation by an individual in recovery or an affected other.  The day will feature 26 such stories.

The theme of the summit is Building a Brighter Future for Individuals, Families and Communities.  The annual summit provides an opportunity for the state to showcase the many projects that are underway in the areas of prevention, treatment, harm-reduction and recovery support.  But it also features national presenters including Traci Green, PhD, an epidemiologist who is one of the nation’s leading researchers in drug checking, Elizabeth Salisbury-Afshar, M.D., MPH, a nationally recognized leader in harm reduction, Daniel Blaney-Koen, J.D., Senior Attorney with the American Medical Association, Robert Morrison, Executive Director/Director of Legislative Affairs at the National Association of State Alcohol and Drug Abuse Directors (NASADAD) and Steven Murray of the MA Overdose Prevention Helpline.  

Breakout sessions will cover the following areas:

  • Maine’s Treatment and Recovery Courts
  • New SUD Initiatives at the Office of EMS
  • Massachusetts SafeSpot Overdose Hotline
  • Current Research in Precision Medicine and Addiction with Jackson Lab
  • Strengthening Community though Maine’s Recovery Friendly Workplace Initiative
  • Better Together:  OCFS Initiatives to Support Families with Substance Use Disorders
  • Empowering Recovery:  Methadone’s Role in Treating Opioid Use Disorder
  • Illicit and Prescription Drug Surveillance Systems:  A National Panel Presents Models from Across the Country
  • How a Regional Corrections Collaborative is Improving SUD Treatment for Jail Residents
  • Engaging Communities in Harm Reduction Strategies
  • Queer Voices of Recovery – Points North Institute Panel Discussion
  • OPTIONS Community Partnerships in Action:  Improving Continuum of Care Response Panel Discussion
  • Collaboration:  Addiction Medicine Team in a Small Rural Hospital
  • Caring for Adolescents with SUD:  An Update
  • Maine Recovery Council:  Mission, Goals, Accomplishments, and the Future
  • Establishing and Enhancing Prevention and Pharmacy Connections in Communities
  • Identifying and Helping Affected Others:  Understanding CRAFT
  • Navigating the Continuum of Care – spotlight on MaineCare’s Whole-Persons Models of Care
  • Diversion and Deflection:  Waldo/Franklin County Pilot
  • Recovery Coaches – Healthy Acadia/Safe Harbor Recovery Residence for Women with Children
  • Intersections of the SUD Continuum of Care
  • Compassionate Overdose Response:  Insights from Maine’s Naloxone Distribution Initiative
  • The Critical Role of Youth Development Organizations in Preventing Adolescent Substance Use

Registration is available at www.maine.gov/future/opioids