October 2023 Monthly Overdose Report

Download the entire PDF report here: Maine Monthly Overdose Report for October 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 October, the proportion of fatal overdoses averaged 7.1% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.2% in March and a high of 8.1% in April. During October 2023, there were an estimated 758 fatal and nonfatal drug overdoses statewide, of which 54 (7.1%) were suspected and confirmed fatal overdoses. The remaining 704 (92.9%) were nonfatal overdoses: 313 (41.3%) emergency department visits; 229 (30.2%) EMS patents who were not transported to the emergency room, 147 (19.4%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 15 (2.0%) 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 ’235429621918444797
Feb ’234934822619227842
Mar ’234138225623754970
Apr ’236327021820227780
May ’234929522116530760
Jun ’235837822821926909
Jul ’235033924817318828
Aug ’234133024715214784
Sep ’235439023114115831
Oct ’235431322914715758
2023 Total5133,3412,3231,8122708,259
2023 Total %6.2%40.5%28.1%21.9%3.3%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 October 2023

Fatal Drug Overdoses in Maine Jan – Oct 2023

During 2023, the proportion of fatal overdoses averaged 6.2% of total overdoses. From January to October 2023, there were a total 513 fatal drug overdoses consisting of 480 confirmed and 33 suspected drug deaths. In October, 2023 there were 54 fatal drug overdoses consisting of 27 confirmed and 27 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 ten months of 2023, fatal overdoses comprised 6.2% of all overdoses; this proportion slightly lower than the 6.9% for 2022. There were 513 confirmed and suspected fatal overdoses in the first ten months of 2023; this is 11.7% lower than the 581 fatal overdoses during the same time period in 2022.

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 – October 2023 as well as 2022.

Maine EMSLaw Enforcement
Fatal Overdose
Response 2022
Nonfatal Overdose
Response 2022
Total Overdose
Response 2022
Fatal Overdose
Response Jan – Oct 2023
Nonfatal Overdose
Response Jan – Oct 2023
Total Overdose
Response Jan – Oct 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, October 2023

Nonfatal Drug Overdoses in Maine, Jan 2023 – Oct 2023

 2020 estimated
Census population
Jan–Dec 2022
N = 9377
Jan-Oct 2023
Est. N = 7544
Oct 2023 
Est. N = 743

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 – October 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. Cumberland County is 3 percentage points lower and York County is 5 percentage points lower than the 2020 census proportion.

 % 2020 estimated
Census population
Jan–Dec 2022
N = 723
Jan-Oct 2023
Est. N = 512
Oct 2023
Est N = 53

Race, ethnicity, and other demographic indicators of decedents

During the first ten months of 2023, out of 512 confirmed and suspected fatal overdoses for which race was reported, 512 (89%) of the victims were identified as White, 21 (4%) as Black or African American, and 9 (2%) as American Indian/Alaska Native. Out of the 500 fatal overdoses for whom ethnicity was reported, 495 (99%) were reported as not Hispanic, and 5 (1%) were identified as Hispanic.

Out of the 513 cases for which military background was reported in January – October 2023, 28 (5%) were identified as having a military background. Out of the 54 cases in October 2023 where military background was reported, 2 (4%) were identified as having a military background.

Of 513 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 57 (11%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (19, 33%), Penobscot County (15, 26%), Androscoggin County (8, 14%), and Kennebec County (5, 9%). In October 2023, 5 decedents (9%) were identified as undomiciled.

Demographic Indicator% of 2020
Census Population
Race N=720
Ethnicity N=706
2023 Est.
Race N=512
Ethnicity N=500
2023 Est.
Race N=54
Ethnicity N=51
Race and Ethnicity
White91%670 (90%)454 (89%)44 (81%)
Black or African American2%17 (2%)21 (4%)2 (4%)
American Indian/Alaska Native1%14 (2%)9 (2%)1 (2%)
Other race,
2+ races combined, non-hispanic
7%12 (2%)11 (2%)3 (6%)
Not Hispanic98%699 (99%)495 (99%)50 (98%)
Hispanic2%7 (1%)5 (1%)1 (2%)
Military Background81 (11%)28 (2%)2 (4%)
Undomiciled/Transient Housing Status81 (11%)57 (12%)5 (9%)
*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 ten months in 2023. The cumulative age distribution in January – October 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 3 deaths under 18 in 2023, a 4 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-Oct 2023
Est. N=513
Oct 2023
Est. N=54
Percent Males49%527(73%)375 (73%)37 (69%)
Percent under 1819%3(<1%)3 (<1%)1 (2%)
Percent 18-3926%295(41%)190 (37%)19 (35%)
Percent 40-5927%333..(46%)254 (50%)25 (46%)
Percent 60+29%92(13%)66 (13%)9 (17%)
*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 513 confirmed or suspected fatal overdoses in 2023, 178 (35%) had a history of prior overdose.

During 2023, 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, and the same proportion as 2022. 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 13% (69) 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 412 suspected and confirmed drug death cases with EMS involvement during the first ten months of 2023, 209 (56%) of victims were already deceased when EMS arrived. In the remaining 180 (44%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 180 who were still alive when EMS arrived, only 53 (29%) remained alive long enough to be transported but died during transport or at the emergency room and 126 (70%) 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 2022
N = 723
Jan–Oct 2023
Est. N = 513
Oct 2023
Est N = 54
EMS response alone38(5%)316%36%
Law enforcement alone131(18%)9719%815%
EMS and law enforcement541(75%)38174%4278%
Private transport to Emergency Dept.13(2%)2<1%00%
Naloxone administration reported at the scene182(25%)12925%1019%
Bystander only administered44(6%)306%24%
Law enforcement only administered31(4%)133%24%
EMS only administered49(7%)377%36%
EMS and law enforcement administered11(2%)112%12%
EMS and bystander administered26(4%)336%36%
Law enforcement and bystander administered5(1%)102%12%
EMS, bystander, and law enforcement administered6(1%)41%12%
Naloxone administered by unspecified person0(0%)1<1%00%
History of prior overdose269(37%)17835%1833%

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 480 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 373 (78%).

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% (11) 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% (151) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – October constituted 36% (173) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 83% (143) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 82% (124) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 480 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 41 (9%) 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 only
Jan–Dec 2022
N = 723
Jan–Oct 2023
Est. N = 480
Oct 2023
Est. N = 27
Fentanyl or fentanyl analogs560(77%)37378%1763%
Pharmaceutical opioids**156(22%)8919%622%
Fentanyl and heroin18(2%)112%14%
Fentanyl and cocaine171(24%)14330%933%
Fentanyl and methamphetamine189(26%)12426%519%
Fentanyl and xylazine46(6%)419%27%
Fentanyl and tramadol10(1%)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


The State of Maine, through the Office of Behavioral Health, recently contracted with Pinetree Institute to pilot Recovery Friendly Workplace programming in the state. The two-year contract
provides up to $600,000 from the Opioid Prevention and Treatment Fund to encourage healthy and safe environments where employers, employees and communities can collaborate to create positive change and eliminate barriers to employment for those individuals impacted by addiction. The program is intended to ensure all Maine employers have access to training, technical assistance, and recovery support resources necessary to support employees and/or job seekers who may be struggling either directly or indirectly with issues related to SUD and recovery. The program is advised by an Advisory Committee of over twenty leaders in various segments of Maine’s business community. The Committee met for its initial meeting on Nov. 28.

It was announced at the meeting that LePage Bakery in Lewiston has been designated as the first certified Recovery Friendly Workplace in Maine under the new program.

Recovery Friendly Workplaces (RFWs) support their communities by recognizing recovery from a substance use disorder as a strength and by working intentionally with people in recovery.

The benefits include:

  • Access to highly skilled talent
  • Increased retention and lower absenteeism
  • Increased brand equity
  • Healthier workforce

There is no cost associated with this program. Reach out to schedule an appointment with a Maine RFW business advisory by contacting: info@rfwmaine.org. For further information, visit
the new RFW Maine website at www.rfwmaine.org. The program is also partnering with Maine’s network of 17 Recovery Community Centers, all of which will be active supporters of the program and assist to grow the number of employers who apply to be certified as a
Recovery Friendly Workplace.