November 2022 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for November 2022

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 November, the proportion of fatal overdoses averaged 10.2% of total overdoses. The monthly proportion of 2022 fatalities has fluctuated, however, including a low of 5.1% in May 2022 and a high of 10.2% in November. So far for 2022, the total number of overdoses January – November is 4.0% higher than during January – November 2021 (12.3% fatal and 3.4% nonfatal). During the period January – November 2022, fatal overdoses comprised 7.0% of all overdoses, just slightly higher than the 6.5% for the first eleven months of 2021.

From January 2022 to November 2022, there were an estimated 9,253 fatal and nonfatal drug overdoses statewide, of which 650 (7.0%) were suspected and confirmed fatal overdoses. The remaining 8,603 (93.0%) were nonfatal overdoses: 4,009 (43.3%) emergency department visits; 2,524 (27.3%) EMS patents who were not transported to the emergency room, 2,002 (21.6%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 68 (0.7%) 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 OverdosesEmergency Department
EMS Not Transported
to the ED Nonfatal
Community Reversals
Law Enforcement
Without EMS 
Nonfatal (estimated)
Total Overdoses
January ’215427016512718634
February ’21412771201005543
March ’215832917715615735
April ’21463341911366713
May ’21474091651003724
June ’215441122318911888
July ’214448222716720940
August ’215042823722212949
September ’215947323727671,052
October ’216538325020817923
November ’216130822619510800
December ’21523442011764777
2021 Total6314,4482,4192,0521289,678
2021 Total %6.5%46.0%25.0%21.2%1.3%100%
January ’22442962061781729
February ’22483331851534727
March ’22654572012027932
April ’22592901781894725
May ’224640224818612894
June ’226648225017710987
July ’22643482871704877
August ’22613852712417970
September ’22554512561406911
October ’22642732371646736
November ’22782752052027767
2022 Total6504,0092,5242,002689,253
2022 Total %7.0%43.3%27.3%21.6%0.7%100%
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses. Fatal overdoses in those categories have been removed.

Number of suspected and confirmed fatal overdoses

Fatal Drug Overdoses in Maine November 2022

Fatal Drug Overdoses in Maine January – November 2022

During the first eleven months of 2022, the proportion of fatal overdoses averaged 7.0% of total overdoses. From January to November 2022 there was a total 650 fatal drug overdoses consisting of 551 confirmed and 99 suspected drug deaths. The graph below shows the considerable monthly fluctuation since January 2020. Although the average since 2020 is 51, the range extends from 33 (October 2020) to 78 (November 2022). The proportion of fatal to nonfatal overdoses decreased from 9% to 7% between January and December of 2021. During 2022, the monthly proportions fluctuated from a low of 5.1% in May and 8.1% in April. The proportion of fatalities in January – November 2022 (650) is 12.3% higher than the first eleven months of 2021 (579). For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.

*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 10 weeks following death; this is 3 to 4 times longer than the prepandemic turn around time. For more information see the full report.

Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The monthly 2022 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, 2021 and January-November 2022. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.

The cumulative January-November 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 2020

Jan-Dec 2021
Est. N=631
Jan-Nov 2022
Est. N=650
Nov 2022
Androscoggin8%33…….(9%)52.(10%)69…..(11%)64 (10%)11 (14%)
Aroostook5%14…….(4%)17(3%)39……(6%)45 (7%)5 (6%)
Cumberland22%100…..(26%)97.(19%)114….(28%)119 (18%)11 (14%)
Franklin2%5……..(1%)8(2%)8…….(1%)13 (2%)1 (3%)
Hancock4%9…….(2%)13(3%)22……(3%)21 (3%)5 (6%)
Kennebec9%42……(11%)49.(10%)64….(10%)51 (8%)6 (8%)
Knox3%7…….(2%)16(3%)11……(2%)17 (3%)1 (3%)
Lincoln3%11…….(3%)9(2%)16……(3%)12 (2%)1 (3%)
Oxford4%9…….(2%)15(3%)28……(4%)32 (5%)3 (4%)
Penobscot11%53…..(14%)94.(19%)106…..(17%)97 (15%)12 (15%)
Piscataquis1%3…….(1%)10(2%)11……(2%)9 (1%)1 (3%)
Sagadahoc3%8……(2%)8….(1%)7……(1%)8 (1%)0 (0%)
Somerset4%16……(4%)13(3%)26…..(4%)35 (5%)6 (8%)
Waldo3%3…….(1%)9(2%)15…..(2%)19 (3%)2 (3%)
Washington2%10……(3%)20..(4%)25…..(4%)18 (3%)2 (3%)
York16%57….(15%)74.(15%)70….(11%)90 (14%)11 (14%)

Race, ethnicity, and other demographic indicators of decedents

During January – November of 2022, out of 647 confirmed and suspected fatal overdoses for which race was reported, 602 (93%) of the victims were identified as White, 16 (2%) as Black or African American, 11 (2%) as American Indian/Alaska Native, and 1 (<1%) Hawaiian/Pacific Islander. Out of the 635 fatal overdoses for whom ethnicity was reported, 628 (99%) were reported as not Hispanic, and 7 (1%) were identified as Hispanic. Out of the 649 cases for which military background was reported, 51 (8%) were identified as having a military background. Prior overdose history was reported for 241 (37%) of the victims. Transient housing status was reported for 71 (11%) of the victims. The largest totals of undomiciled persons (January – November 2022) were found in Cumberland County (25, 35%), and Penobscot County (17, 24%).

Demographic Indicator% of 2020
Census Population
2021 Est.
N=627 Race
N=621 Ethnicity
2022 Est.
N=647 Race
N=635 Ethnicity
Race and Ethnicity
White91%585 (93%)602 (93%)
Black or African American2%21 (3%)16 (2%)
American Indian/Alaska Native1%14 (2%)11 (2%)
Other race,
2+ races combined, non-hispanic
7%7 (1%)11 (2%)
Not Hispanic98%611 (99%)628 (99%)
Hispanic2%10 (2%)7 (1%)
Military Background51 (8%)
Prior Overdose History241 (37%)
Undomiciled/Transient Housing Status71 (11%)
*Table totals may not add up to 100% due to rounding.

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 from 68% in 2019 to 71% in 2020 and 2021, and to 73% in the first eleven months of 2022. The cumulative age distribution in January – November 2022 compared to 2021 shows 2 deaths under 18 in 2021 and 2 deaths in 2022, a 3 percentage point increase in the proportion of those aged 18-39, a 4 percentage point decrease in those aged 40-59, and a 2 percentage point increase in the proportion 60 and above.

% of 2020
Jan-Dec 2020

Jan-Dec 2021
Est. N=631
Jan-Nov 2022
Est. N=565
Nov 2022
Est. N=78
Percent Males49%258..(68%)357(71%)451.(71%)477(73%)58 (74%)
Percent under 1819%0….(0%)2(<1%)2..(<1%)2…..(<1%)1 (1%)
Percent 18-3926%171..(45%)213..(42%)247.(39%)270(42%)39 (50%)
Percent 40-5927%175..(46%)235..(47%)316.(50%)298..(46%)30 (38%)
Percent 60+29%33….(9%)54(11%)66..(10%)80…..(12%)8 (10%)
*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. Both EMS and police responded to most fatal overdoses, that is, 76% in the first eleven months of 2022. In the first eleven months of 2022, law enforcement was more likely to respond to a scene alone (18%) than EMS (5%). The overwhelming majority (95%) of drug overdoses were ruled, or suspected of being, accidental manner of death.

During 2022, 25% of fatal overdose cases had naloxone administered at the scene by EMS, bystanders, or law enforcement. This rate is higher than the 22% of fatal overdose cases in which naloxone was reportedly administered at the scene in 2020, but lower than the 30% recorded in 2021. 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% (73) 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 and increased to only 9% of victims in 2021.

Based on 528 suspected and confirmed drug death cases with EMS involvement during January – November of 2022, 277 (52%) of victims were already deceased when EMS arrived. In the remaining 251 (48%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 251 who were still alive when EMS arrived, only 79 (31%) remained alive long enough to be transported but died during transport or at the emergency room and 172 (69%) 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 2020

Jan-Dec 2021
Est. N=631
Jan-Nov 2022
Est. N=650
Nov 2022
Est. N=78
Public safety response
……EMS alone28(6%)30….(5%)34….(5%)5 (6%)
……Law enforcement alone107.(21%)104..(16%)117(18%)14 (18%)
……EMS and law enforcement365.(72%)485..(77%)494(76%)58 (74%)
……Private transport to the Emergency. Dept.7….(1%)5…..(1%)1 (1%)
Naloxone administration
Naloxone administration reported at the scene83.(22%)187..(30%)165..(25%)24 (31%)
……Bystander only11(2%)36….(6%)39(6%) 4 (5%)
……Law enforcement only8(2%)22….(3%)28….(4%)5 (6%)
……EMS only55..(11%)84..(13%)52….(8%)9 (12%)
……EMS and law enforcement4(1%)20….(3%)11….(2%)1 (1%)
……EMS and bystander8..(2%)15….(2%)24….(4%)3 (4%)
……Law enforcement and bystander0..(0%)5…..(1%)5….(1%)1 (1%)
……EMS, bystander, and law enforcement…….2..(<1%)8….(1%)1 (1%)
……Naloxone administered by unspecified person…….3..(<1%)8(1%)1 (1%)

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 553 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 434 (78%), this is a slightly higher than the rate in 2021 (77%) and 11 percentage points higher than the rate 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 2% of 2022 deaths, 3% of 2021 deaths, compared to 11% in 2020. Methamphetamine was cited as a cause in 32% (177) of the overdoses, a substantial increase from 27% in 2021. Cocaine-involved fatalities January – November constituted 29% (161) of cases, a slight increase from 25% in 2021 and 23% in 2020. Fentanyl is found as a co-intoxicant with cocaine in 82% (131) of 2022 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 81% (144) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 553 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 34 (6%) of confirmed overdose deaths, and 8 (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 2020

Jan-Dec 2021
Jan-Nov 2022
*Nov 2022
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs336.(67%)489..(77%)434..(78%)3 (75%)
……Heroin57..(11%)22….(3%)13….(2%)0 (0%)
Nonpharmaceutical Stimulants
……Cocaine118.(23%)156..(25%)161.(29%)3 (75%)
……Methamphetamine99.(20%)172..(27%)177.(32%)1 (25%)
Pharmaceutical opioids**118.(23%)130..(21%)112..(20%)1 (25%)
Key combinations
……Fentanyl and heroin47(9%)20….(3%)13….(2%)0 (0%)
……Fentanyl and cocaine97.(19%)127..(20%)131..(24%)2 (50%)
……Fentanyl and methamphetamine70.(14%)133..(21%)144..(26%)1 (25%)
……Fentanyl and xylazine0(0%)53….(8%)34….(6%)1 (25%)
……Fentanyl and tramadol0(0%)24….(4%)8….(1%)0 (0%)
*Note, the low N for monthly cases is due to toxicology not being confirmed by the national testing lab before report closeout.
**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

Opioid Data Sharing Committee

Opioid Data Sharing Committee

In 2019, during the first year of the administration of Governor Janet T. Mills, Opioid Response Director Gordon Smith convened state officials from each State Department or Office who had any responsibility for data relating to the opioid epidemic.  Nearly two dozen individuals met and discussed the data each office had, whether there were any legal restrictions on the ability to share the data and what additional data each office wanted.  Data experts associated with the Margaret Chase Smith Policy Center at the University of Maine also were included as Dr. Marcella Sorg and her team at the Center had been preparing fatal overdose reports for the Office of the Chief Medical Examiner for several years. By the conclusion of the first meeting, it was decided that the group would continue to meet and what became known as Maine’s Opioid Data Sharing Committee (ODSC) was born. Remarkable, the Committee has met monthly (with some rare exceptions) for the past nearly four years.  

Many of the individuals participating in the committee were, prior to 2019, participating in the Opioid Subcommittee of the State Epidemiological Outcomes Workgroup (SEOW).  The SEOW work has been contracted to Public Consulting Group for several years and Tim Diomede has led this work which was an important precedent to the work of the ODSC. Within a few months, it was agreed that the SEOW opioid subcommittee would be merged into the ODSC. Tim remains an active member of the Committee which is very able staffed by the data team at the Margaret Chase Smith Center noted above.

The ODSC is currently co-chaired by Rebecca Taylor, Deputy Director of Research and Evaluation in the DHHS Office of Behavioral Health and Opioid Response Director Gordon Smith.  Offices and departments active in the work of the committee include the Maine CDCP, the Office of Child and Family Services, the Office of MaineCare Services, the Office of Emergency Medical Services, the Maine Health Data Organization, the Northern New England Poison Control Center, the Maine Drug Enforcement Agency, and New England HIDTA (High Intensity Drug Trafficking Areas).  The Committee has been fortunate to receive pro bono services from the accounting/consulting firm of Berry Dunn.

Among the many successful activities of the Committee is the website built and operated by the University of Maine.  This site is the repository of our monthly overdose reports and all other reports produced by the Committee and many other reports produced by other offices within state government.  The committee was recently recognized by the Office of National Drug Control Policy (ONDCP) for its cutting-edge work in tracking non-fatal overdoses and including this metric in the monthly reports.  

The Committee expects to continue to meet, virtually, the third Friday of every month from 9:00am to 10:30am.  Meetings are open to the public.