November 2021 Monthly Overdose Report

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

*Note: The timing of the monthly overdose report has been substantially delayed during the last several months due to pandemic-related issues. The toxicology reports are currently returning to the Office of the Chief Medical Examiner in as much as 6-8 weeks following death; this is 3 to 4 times longer than the prepandemic turn around time. For more information see the full report.

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 November 2021

Fatal Drug Overdoses in Maine January – November 2021

The November 2021 total of 64 fatal drug overdoses consists of 1 confirmed drug deaths and 63 suspected drug deaths. The cumulative January – November 2021 total is 578. The graph below shows the considerable monthly fluctuation since January 2020. Although the 2020 average is 42, the range extends from 33 to 53. The average so far for 2021 is 52.7, and the range is 41 to 64. For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report. The proportion of fatal to nonfatal overdoses decreased from 9% to 7% between January and November of this year.

*Note: The timing of the monthly overdose report has been substantially delayed during the last several months due to pandemic-related issues. The toxicology reports are currently returning to the Office of the Chief Medical Examiner in as much as 6-8 weeks following death; this is 3 to 4 times longer than the prepandemic turn around time. For more information see the full report.

Comprehensive total of fatal and nonfatal overdoses

The month of November included the greatest number of fatal overdoses in 2021, but the increase has not been steady or consistent. Nonfatal overdoses for November are down slightly from October, but still greater than the beginning of the year. During November, there were an estimated 773 fatal and nonfatal drug overdoses statewide, of which 64 (8%) were suspected and confirmed fatal overdoses. The remaining 709 (92%) were nonfatal overdoses: 293 (38%) emergency department visits; 219 (29%) EMS patents who were not transported to the emergency room, 195 (25%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 2 (<1%) law enforcement reversals without EMS present. The minimum total of reported nonfatal overdose incidents for January – November 2021 was 8,619 which was compiled by deduplicating data derived from multiple statewide sources. 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
Community Reversals
Law Enforcement
Without EMS 
Nonfatal (estimated)
Total Overdoses
Total %7%46%25%22%<1%100%
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses. Fatal overdoses in those categories have been removed.

Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The November 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-November 2021. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.

The cumulative January-November 2021 percentages of deaths in many counties fall within plus or minus 0%-1% of the 2019 census distribution, including Aroostook, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Piscataquis, Somerset, and Waldo. Counties that are 2% or more higher than the census proportions include Androscoggin (+4%), Penobscot (+6%), and Washington (+5%). Counties that are 2% or more lower than the census proportion include Cumberland (-4%), Sagadahoc (-2%), and York (-4%).

CountyPercent of 2019
Census Population
Jan-Dec 2020
Nov 2021
Est. N=64
Cumulative Jan-Nov 2021
Est. N=578
Androscoggin8%33…….(9%)52.(10%) 5…..(8%)68…..(12%)

Race, ethnicity, and other demographic indicators of decedents

During January – November of 2021, out of 578 confirmed and suspected fatal overdoses for which race was reported, 540 (93%) of the victims were identified as White, 20 (4%) as Black or African American, and 11 (2%) as American Indian/Alaska Native. Out of the 568 fatal overdoses for whom ethnicity was reported, 560 (99%) were reported as not Hispanic, and 8 (1%) were identified as Hispanic. Out of the 578 cases, 40 (7%) were identified as having a military background. Prior overdose history was reported for 193 (33%) of the victims. Transient housing status was reported for 56 (10%) of the victims.

Demographic IndicatorNumber of decedents
Percent of decedents
Race and Ethnicity
Black or African American204%
American Indian/Alaska Native112%
Not Hispanic56099%
Military Background407%
Prior Overdose History19333%
Person Experiencing Homelessness5610%

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 stayed roughly the same since 2019. In the first eleven months of 2021, it was 406 (70%), which is slightly lower than the 71% level in 2020 and slightly higher than the same as the level in 2019 (68%). In November it increased to 73%. The cumulative age distribution in January – November 2021 compared to 2020 and 2019 shows increasingly more decedents in older categories. The percentage of those 18-39 decreased overall by 5%. The percentage of those 40-59 rose by 3%, and the percentage of those over 60 rose 1%. There has been 1 decedent under 18 in 2021.

Jan-Dec 2020
Jan-Nov 2021
Est. N=578
Est. N=64
Percent Males258..(68%)357(71%)406.(70%)47(73%)
Percent under 180….(0%)2(<1%)1..(<1%)1…..(2%)
Percent 18-39171..(45%)213..(42%)232.(40%)25(39%)
Percent 40-59175..(46%)235..(47%)284.(49%)33(52%)
Percent 60+33….(9%)54(11%)60..(10%)5…..(8%)
*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 January – November of 2021, both EMS and police responded to most fatal overdoses, 78%. Law enforcement was more likely to respond to a scene alone (17%) than EMS (4%). The overwhelming majority (95%) of drug overdoses were ruled as accidental manner of death.

Based on the death investigation records, during January – November of 2021, naloxone was administered to 36% of the victims at the scene or in the ambulance, whether by EMS, bystanders, or law enforcement. This is higher than the 33% reported as administered by EMS, bystanders, or law enforcement at the scene in 2020 and considerably higher than the 28% found in the toxicology reports for 2020 fatal overdose victims. 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. 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 11% of the fatal overdoses, often in addition to EMS and/or law enforcement. The 2020 drug death report documents only 4% of victims who had received bystander-administered naloxone.

Based on 473 suspected and confirmed drug death cases with EMS records during January – November of 2021, 232 (49%) of victims were already deceased when EMS arrived. Of the remaining 241 (51%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of the 241 cases who were still alive when EMS arrived, 68 were transported, and 173 did not survive to be transported. Thus, out of 473 fatal cases with EMS response, only 68 (14%) remained alive long enough to be transported, but died during transport or at the emergency room.

Jan-Dec 2020
Jan-Nov 2021
Est. N=578
Est. N=64
Public safety response
……EMS alone28(6%)24….(4%)4……(6%)
……Law enforcement alone107.(21%)98..(17%)9….(14%)
……EMS and law enforcement365.(72%)449..(78%)50(78%)
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%)176..(31%)20..(31%)
……Bystander only11(2%)34….(6%)6….(9%)
……Law enforcement only8(2%)19….(3%)2….(3%)
……EMS only55..(11%)81..(14%)8..(13%)
……EMS and law enforcement4(1%)20….(4%)1….(2%)
……EMS and bystander8..(2%)15….(3%)1….(2%)
……Law enforcement and bystander0..(0%)6…..(1%)1….(2%)
……EMS, bystander, and law enforcement…….1..(<1%)0….(0%)

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 was the most frequent cause of death mentioned on the death certificate so far for 2021 at 341 (76%), 9% higher than in 2020 (67%). 

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 4% of 2021 deaths, compared to 11% last year. Methamphetamine was cited as a cause in 25% of the overdoses, which is 5% more than 2020. Cocaine-involved fatalities January – November constituted 26% of cases, slightly more than the 23% in 2020. Fentanyl is found in combination with cocaine in 21% of 2021 cases, and in combination with methamphetamine in 19%. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 441 confirmed deaths caused by fentanyl from January – November, the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 41 (9%) of confirmed overdose deaths, and 19 (4%) with tramadol listed as one of the causes of death. 

Cause of death (alone or in
combination with other drugs)
Sample size for complete cases only
Jan-Dec 2020
Jan-Nov 2021
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)341..(76%)0..(0%)
Nonpharmaceutical Stimulants
Pharmaceutical opioids**118.(23%)96..(21%)0..(0%)
Key combinations
……Fentanyl and heroin47(9%)18….(4%)0..(0%)
……Fentanyl and cocaine97.(19%)95..(21%)0..(0%)
……Fentanyl and methamphetamine/amphetamine70.(14%)85..(19%)0..(0%)
……Fentanyl and xylazine0(0%)41….(9%)0..(0%)
……Fentanyl and tramadol0(0%)19….(4%)0..(0%)
**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 no longer counter as a pharmaceutical opioid.

Highlight of the month regarding substance use disorder public policy response

Department of Public Safety Receives $6 million Department of Justice Comprehensive Opioid, Stimulant, and Substance Abuse Site-based Program (COSSAP) grant

On Dec. 24, 2021 the Department of Public Safety (DPS) received notice that it was awarded a $6 million COSSAP grant from the U.S. Department of Justice.  DPS sought the funding to assist in the ongoing statewide response to the opioid epidemic.  The proposal offers creative statewide strategies that are built on existing systems to ensure sufficient support and offer capacity for long-term sustainability.  The grant will financially support the following activities:

  • Administration of medication assisted treatment by emergency medical services personnel, after prescribing by a licensed health professional.
  • Creation and implementation of a statewide naloxone leave-behind program within EMS, as authorized by enactment of L.D. 1333 in 2021, which authorized EMS clinicians to dispense naloxone to persons experiencing a substance use disorder, their family, and/or their friends.  
  • Implement a recovery coach training program that will be delivered quarterly throughout the state.  This training will focus on law enforcement professionals working in the field, including those working for the MDEA.
  • Connect with the OPTIONS program that is staffed with behavioral health professionals in each county.
  • Partial funding of salary and benefit costs of the community outreach coordinator at the Sanford Police Department.  This individual will work closely with the OPTIONS liaison for York County.
  • Comprehensive evaluation of the grant activities by the University of Maine.

These activities will begin in early 2022.

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.