November 2023 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for November 2023

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 7.4% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.2% in March and a high of 7.8% in April. During November 2023, there were an estimated 638 fatal and nonfatal drug overdoses statewide, of which 47 (7.4%) were suspected and confirmed fatal overdoses. The remaining 591 (92.6%) were nonfatal overdoses: 253 (40.0%) emergency department visits; 213 (33.4%) EMS patents who were not transported to the emergency room, 101 (15.8%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 24 (3.8%) 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
Jan ’224529520617839763
Feb ’224833318515337756
Mar ’226545820120230956
Apr ’226029017818926743
May ’224740224818641924
Jun ’2266482250177441013
Jul ’226634728718340923
Aug ’2264385272255371013
Sep ’225545825615333955
Oct ’226528323817727790
Nov ’226628720620020779
Dec ’227636221219814862
2022 Total7234,3822,7392,25138810,483
2022 Total %6.9%41.8%26.1%21.5%3.7%100%
Jan ’235429621918462815
Feb ’234934822619245860
Mar ’234138225623768984
Apr ’236327021820251804
May ’234929522116561791
Jun ’235837822821952935
Jul ’235033924817349859
Aug ’234033024715244813
Sep ’235438923114141856
Oct ’235431622914734780
Nov ’234725321310124638
2023 Total5593,5962,5361,9135319,135
2023 Total %6.1%39.4%27.8%20.9%5.8%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 2023

Fatal Drug Overdoses in Maine Jan – Nov 2023

During 2023, the proportion of fatal overdoses averaged 6.1% of total overdoses. From January to November 2023, there were a total 559 fatal drug overdoses consisting of 521 confirmed and 38 suspected drug deaths. In November, 2023 there were 47 fatal drug overdoses consisting of 24 confirmed and 23 suspected cases. The graph below shows the considerable monthly fluctuation since January of 2022. The range extends from 76 (December 2022) to 41 (March 2023). During 2023, the monthly proportions fluctuated from a low of 4.2% in March and a high of 8.1% in April. During the first eleven months of 2023, fatal overdoses comprised 6.1% of all overdoses; this proportion slightly lower than the 6.9% for 2022. There were 559 confirmed and suspected fatal overdoses in the first eleven months of 2023; this is 13.6% lower than the 647 fatal overdoses during the same time period in 2022. The total number of nonfatal overdose January-November, 2023 is 8,576, 4.4% lower than the total confirmed nonfatal overdoses for the same period in 2022, 8,974.

For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report.

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 activity of law enforcement officials and EMS is under represented in the above chart. See the full report for the process involved. The table below shows the public safety response to fatal and nonfatal overdose events in January – November 2023 as well as 2022.

Maine EMSLaw Enforcement
Fatal Overdose
Response 2022
Nonfatal Overdose
Response 2022
Total Overdose
Response 2022
Fatal Overdose
Response Jan – Nov 2023
Nonfatal Overdose
Response Jan – Nov 2023
Total Overdose
Response Jan – Nov 2023
*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

The following table shows the distribution of nonfatal overdoses at the county level. Due to how overdose reversals are reported by community partners and emergency departments, only EMS overdoses are included. The October 2023 monthly totals can be compared to the percentage of census population, the percentages of nonfatal overdoses in the center column, or the percentages of nonfatal overdoses during 2023. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. The January – October percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Penobscot County is 3 percentage points higher and Androscoggin County is 2 percentage points higher than the 2020 census proportion. York County is 4 percentage points lower and Sagadahoc County is 2 percentage points lower than the 2020 census proportion.

Nonfatal Drug Overdoses in Maine, November 2023

Nonfatal Drug Overdoses in Maine, Jan 2023 – Nov 2023

 % 2020 estimated
Census population
Jan–Dec 2022
Est. N = 9377
Jan-Nov 2023
Est. N = 8177
Nov 2023
Est. N = 630

County Distribution of Suspected and Confirmed Fatal Overdoses

The following table shows the frequency distribution of deaths at the county level. The monthly total can be compared either to the percent of the census population on the far left, the percent of all Maine drug deaths for 2022, or the percent of drug deaths in 2023. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.

The cumulative January – November 2023 percentages of deaths in most counties fall within plus or minus 0 to 2 percentage points of the 2020 census distribution. Penobscot County and Androscoggin County are 4 percentage points higher than the 2020 census proportion. York County is 5 percentage points lower than the 2020 census proportion.

 % 2020 estimated
Census population
Jan–Dec 2022Jan-Nov 2023Nov-2023
Est. N = 723Est. N = 557Est N = 46

Race, ethnicity, and other demographic indicators of decedents

During the first eleven months of 2023, out of 558 confirmed and suspected fatal overdoses for which race was reported, 495 (89%) of the victims were identified as White, 23 (4%) as Black or African American, and 9 (2%) as American Indian/Alaska Native. Out of the 544 fatal overdoses for whom ethnicity was reported, 538 (99%) were reported as not Hispanic, and 6 (1%) were identified as Hispanic.

Out of the 559 cases for which military background was reported in January – November 2023, 31 (6%) were identified as having a military background. Out of the 47 cases in November 2023 where military background was reported, 3 (6%) were identified as having a military background.

Of 559 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 65 (12%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (22, 34%), Penobscot County (15, 23%), Androscoggin County (9, 14%), and Kennebec County (6, 9%). In November 2023, 8 decedents (17%) were identified as undomiciled.

Demographic Indicator% of 2020
Census Population
Race N=720
Ethnicity N=706
2023 Est.
Race N=558
Ethnicity N=544
2023 Est.
Race N=47
Ethnicity N=45
Race and Ethnicity
White91%670 (90%)495 (89%)41 (87%)
Black or African American2%17 (2%)23 (4%)2 (4%)
American Indian/Alaska Native1%14 (2%)9 (2%)0 (0%)
Other race,
2+ races combined, non-hispanic
7%12 (2%)11 (2%)1 (2%)
Not Hispanic98%699 (99%)544 (99%)44 (98%)
Hispanic2%7 (1%)6 (1%)1 (2%)
Military Background81 (11%)31 (6%)3 (6%)
Undomiciled/Transient Housing Status81 (11%)65 (12%)8 (17%)
*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 in recent years from 68% in 2019 to 71% in 2020 and 2021, 73% in 2022, and 73% in the first eleven months in 2023. The cumulative age distribution in January – November 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 3 deaths under 18 in 2023, a 5 percentage point decrease in the proportion of those aged 18-39, a 4 percentage point increase in those aged 40-59, and no change in the proportion 60 and above.

% of 2020
Jan-Dec 2022
Jan-Nov 2023
Est. N=559
Nov 2023
Est. N=47
Percent Males49%527(73%)409 (73%)36 (77%)
Percent under 1819%3(<1%)3 (<1%)0 (0%)
Percent 18-3926%295(41%)204 (36%)14 (30%)
Percent 40-5927%333..(46%)277 (50%)26 (55%)
Percent 60+29%92(13%)75 (13%)7 (15%)
*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 (74%) in 2023. In 2023, law enforcement was more likely to respond to a scene alone (19%) than EMS (6%). The overwhelming majority (93%) of drug overdoses were ruled, or suspected of being, accidental manner of death. Of the 559 confirmed or suspected fatal overdoses in 2023, 196 (35%) had a history of prior overdose.

During 2023, 26% 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, and slightly higher than the proportion in 2022 (21%). 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 14% (78) of the fatal overdoses, often in addition to EMS and/or law enforcement. This is higher than 2022 (12%), 2021 (9%), and 2020 (4%).

Based on 447 suspected and confirmed drug death cases with EMS involvement during the first eleven months of 2023, 251 (56%) of victims were already deceased when EMS arrived. In the remaining 196 (44%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 196 who were still alive when EMS arrived, only 59 (30%) remained alive long enough to be transported but died during transport or at the emergency room and 136 (69%) did not survive to be transported and 1 had an unknown status. 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 2022Jan–Nov 2023Nov-2023
Est. N = 723Est. N = 559Est. N = 47
EMS response alone385%336%24%
Law enforcement alone13118%10619%919%
EMS and law enforcement54175%41374%3472%
Private transport to Emergency Dept.132%41%12%
Naloxone administration reported at the scene18225%14326%1430%
Bystander only administered446%366%613%
Law enforcement only administered314%153%24%
EMS only administered497%387%12%
EMS and law enforcement administered112%132%24%
EMS and bystander administered264%346%12%
Law enforcement and bystander administered51%122%24%
EMS, bystander, and law enforcement administered61%41%00%
Naloxone administered by unspecified person00%10%00%
History of prior overdose26937%19635%2043%

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 513 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 403 (77%).

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% (12) of 2023 deaths and 3% (19) of 2022 deaths, compared to 11% (57) in 2020. Methamphetamine was cited as a cause of death in 31% (162) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – November constituted 36% (189) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 84% (158) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 82% (133) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 513 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 42 (8%) of confirmed overdose deaths, and 3 (1%) with tramadol listed along with fentanyl. 

Cause of death (alone or in combination with other drugs) Sample size for confirmed cases onlyJan–Dec 2022Jan–Nov 2023Nov-2023
Est. N = 723Est. N = 513Est. N = 18
Fentanyl or fentanyl analogs56077%40377%1875%
Pharmaceutical opioids**15622%9618%417%
Fentanyl and heroin182%122%14%
Fentanyl and cocaine17124%15830%1042%
Fentanyl and methamphetamine18926%13326%625%
Fentanyl and xylazine466%428%14%
Fentanyl and tramadol101%31%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.

Highlight of the Month

1,000 Maine Lives Campaign

The Maine Medical Association (MMA), the Maine Osteopathic Association (MOA), the Maine Hospital Association (MHA) and over 20 additional medical and professional specialty societies earlier this month launched the 1000 Maine Lives Campaign which is intended to reduce fatal drug overdoses in the state by 1000 lives over the next five years.  

Erik Steele, D.O., Immediate Past President of the MMA conceived the Campaign during his year as President of the physician group. “Our goal is expansion of access to lifesaving OUD care into every corner of Maine, and engage every part of the healthcare delivery system in this lifesaving work – we want you to be able to walk in to any emergency department, your doctor’s office, any hospital, and get this help,” said Dr. Steele.

“1000 of our fellow Mainers – people we know, work with, love.  We are committed to trying to prevent the loss of the equivalent of a small Maine town during the next five years”, added Dr. Steele.

In addition to MMA, MOA and MHA, additional participants in the campaign include Greater Portland Health, the Maine Primary Care Association, The Maine Association of Physician Assistants, the Maine Academy of Family Physicians, the Maine Association of Psychiatric Physicians, the Maine Chapter of the American College Physicians, Maine Health and Northern Light Health Care.

Governor Mills applauded this effort when Dr. Steele described it during the Governor’s 5th Annual Opioid Response Summit on July 20.  The State of Maine is a partner in the Campaign.  “We welcome the leadership of Maine’s medical community in combatting the opioid epidemic and strongly support the goal of the 1000 Lives Campaign”, said Gordon Smith, the State’s Director of Opioid Response. “Although overdoses in Maine have lessened this year, Maine people are still losing too many friends and family members to substance use disorder and highly lethal drugs like fentanyl.  This effort is a welcome step to helping more individuals enter treatment, find recovery supports, and most important, stay alive.”

This campaign is indebted to the work of Dr. Donald Berwick and the Institute for Healthcare Improvement (IHI).  Over twenty years ago, the Institute launched its 100,000 lives campaign focused on saving 100,000 lives in this country by reducing the number of medical errors in the nation’s hospitals.  Thousands of hospitals joined the campaign and over time, hundreds of thousands of lives were saved.  Similar to this effort, the new campaign seeks to prevent OUD deaths by implementing a set of health care site-and clinician-specific interventions to improve the treatment of substance use disorder (OUD).  The interventions will be chosen based on their ability to reduce deaths.  The campaign will be led by Maine’s physician and other clinician leadership, partnering with the State of Maine, opioid treatment providers, outpatient and residential treatment centers and other key stakeholders.  Health care organizations and clinicians will assume the leadership role that this effort requires, and take the lead in convincing health care organizations and clinicians to sign on to these increased efforts.

“Despite strong efforts, too many Mainers continue to die each year of opioid overdoses.  It is time for the entire healthcare continuum to recognize substance use disorder for the chronic illness that it is and to embrace every opportunity to treat this disease when patients are ready and to provide harm reduction treatment and support for those who continue to use substances,” said Renee Fay-LeBlanc, MD, Medical Director of Greater Portland Health. 

The Campaign formally began on Jan. 1, 2024.