Download the entire PDF report here: Maine Monthly Overdose Report for September 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 September 2021
Fatal Drug Overdoses in Maine January – September 2021
The September 2021 total of 58 fatal drug overdoses consists of 25 confirmed drug deaths and 33 suspected drug deaths. The cumulative January – September 2021 total is 455, which is 19% higher than the same period in 2020. The graph below shows the considerable monthly fluctuation since January 2020. Although the 2020 average is 42, the range extends from 34 to 53. The average so far for 2021 is 51, and the range is 41 to 58. 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 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
During September 2021, there were an estimated 1,020 fatal and nonfatal drug overdoses statewide, of which 58 (6%) were suspected and confirmed fatal overdoses. The remaining 962 (94%) were nonfatal overdoses: 450 (44%) emergency department visits; 234 (23%) EMS patents who were not transported to the emergency room, 276 (27%) 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 – September 2021 was 6,892 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 Overdoses | Emergency Department Nonfatal | EMS Not Transported Nonfatal | Reported Community Reversals Nonfatal | Law Enforcement Without EMS Nonfatal (estimated) | Total Overdoses | |
| January | 54 | 263 | 163 | 127 | 5 | 612 |
| February | 41 | 263 | 117 | 100 | 5 | 526 |
| March | 58 | 399 | 169 | 158 | 5 | 789 |
| April | 46 | 326 | 187 | 136 | 5 | 700 |
| May | 48 | 323 | 157 | 101 | 5 | 634 |
| June | 54 | 396 | 213 | 189 | 5 | 857 |
| July | 46 | 449 | 214 | 167 | 4 | 880 |
| August | 50 | 392 | 204 | 225 | 3 | 874 |
| September | 58 | 450 | 234 | 276 | 2 | 1,020 |
| Total | 455 | 3,261 | 1,658 | 1,479 | 39 | 6,892 |
| Total % | 7% | 47% | 24% | 21% | 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 September 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-September 2021. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.
The cumulative January-September 2021 percentages of deaths in many counties fall within plus or minus 0%-1% of the 2019 census distribution, including Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Piscataquis, Somerset, and Waldo. Counties that are 2% or more higher than the census proportions include Androscoggin (+3%), Kennebec (+3%), Penobscot (+4%), and Washington (+2%). Counties that are 2% or more lower than the census proportion include Cumberland (-4%), Sagadahoc (-2%), and York (-4%).
| County | Percent of 2019 Census Population | Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Sep 2021 Est. N=58 | Cumulative Jan-Sep 2021 Est. N=455 |
|---|---|---|---|---|---|
| Androscoggin | 8% | 33…….(9%) | 52.(10%) | 3…(5%) | 52…..(11%) |
| Aroostook | 5% | 14…….(4%) | 17…(3%) | 2…(4%) | 21……(5%) |
| Cumberland | 22% | 100…..(26%) | 97.(19%) | 14.(24%) | 82….(18%) |
| Franklin | 2% | 5……..(1%) | 8…(2%) | 0…(0%) | 6…….(1%) |
| Hancock | 4% | 9…….(2%) | 13…(3%) | 2…(4%) | 17……(4%) |
| Kennebec | 9% | 42……(11%) | 49.(10%) | 7.(12%) | 53….(12%) |
| Knox | 3% | 7…….(2%) | 16…(3%) | 3…(5%) | 10……(2%) |
| Lincoln | 3% | 11…….(3%) | 9…(2%) | 1….(2%) | 14……(3%) |
| Oxford | 4% | 9…….(2%) | 15…(3%) | 2…(4%) | 17……(4%) |
| Penobscot | 11% | 53…..(14%) | 94.(19%) | 7..(12%) | 69…..(15%) |
| Piscataquis | 1% | 3…….(1%) | 10…(2%) | 3…(5%) | 10……(2%) |
| Sagadahoc | 3% | 8……(2%) | 8….(1%) | 1….(2%) | 5……(1%) |
| Somerset | 4% | 16……(4%) | 13…(3%) | 3…(5%) | 14…..(3%) |
| Waldo | 3% | 3…….(1%) | 9…(2%) | 3…(5%) | 13…..(3%) |
| Washington | 2% | 10……(3%) | 20..(4%) | 2…(4%) | 20…..(4%) |
| York | 15% | 57….(15%) | 74.(15%) | 5…(9%) | 52….(11%) |
Race, ethnicity, and other demographic indicators of decedents
During January – September of 2021, out of 451 confirmed and suspected fatal overdoses where race was reported, 422 (94%) of the victims were identified as White, 18 (4%) as Black or African American, and 11 (2%) as American Indian/Alaska Native. Out of the 448 fatal overdoses where ethnicity was reported, 444 (99%) were reported as not Hispanic, and 4 (1%) were identified as Hispanic. Out of the 455 cases, 30 (7%) were identified as having a military background. Prior overdose history was reported for 150 (33%) of the victims. Transient housing status was reported for 40 (9%) of the victims.
| Demographic Indicator | Number of decedents N=455 | Percent of decedents |
|---|---|---|
| Race and Ethnicity | ||
| White | 422 | 94% |
| Black or African American | 18 | 4% |
| American Indian/Alaska Native | 11 | 2% |
| Not Hispanic | 444 | 99% |
| Hispanic | 4 | 1% |
| Military Background | 30 | 7% |
| Prior Overdose History | 150 | 33% |
| Person Experiencing Homelessness | 40 | 9% |
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 nine months of 2021, it was 314 (69%), which is slightly lower than the 71% level in 2020 and slightly higher than the same as the level in 2019 (68%). In September it increased to 72%. The cumulative age distribution in January – September 2021 compared to 2020 and 2019 shows increasingly more decedents in older categories. The percentage of those 18-39 decreased by 5%. The percentage of those 40-59 rose by 3%, and the percentage of those over 60 rose 3%. There has been 1 decedents under 18 in 2021.
| Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Cumulative Jan-Aug 2021 Est. N=455 | September 2021 Est. N=58 | |
|---|---|---|---|---|
| Percent Males | 258..(68%) | 357…(71%) | 314.(69%) | 42…(72%) |
| Percent under 18 | 0….(0%) | 2…(<1%) | 1..(<1%) | 0…..(0%) |
| Percent 18-39 | 171..(45%) | 213..(42%) | 182.(40%) | 22…(38%) |
| Percent 40-59 | 175..(46%) | 235..(47%) | 222.(49%) | 30…(52%) |
| Percent 60+ | 33….(9%) | 54…(11%) | 50..(11%) | 6…(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. Roughly similar to 2020, during January – September 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 (96%) of drug overdoses were ruled as accidental manner of death.
Based on the death investigation records, during January – September of 2021, naloxone was administered to 39% 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 374 suspected and confirmed drug death cases with EMS records during January – September of 2021, 179 (48%) of victims were already deceased when EMS arrived. Of the remaining 195 (52%), resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of the 195 cases who were still alive when EMS arrived, 56 were transported, and 139 did not survive to be transported. Thus, out of 374 fatal cases with EMS response, only 56 (15%) remained alive long enough to be transported, but died during transport or at the emergency room.
| Jan-Dec 2020 N=504 | Cumulative Jan-Sep 2021 Est. N=455 | September 2021 Est. N=58 | |
|---|---|---|---|
| Public safety response | |||
| ……EMS alone | 28…(6%) | 19….(4%) | 2……(4%) |
| ……Law enforcement alone | 107.(21%) | 77..(17%) | 6….(10%) |
| ……EMS and law enforcement | 365.(72%) | 355..(78%) | 46…(79%) |
| Manner of death (suspected or confirmed) | |||
| ……Accident | 457.(91%) | 434..(96%) | 53..(91%) |
| ……Suicide | 33…(7%) | 16….(3%) | 5…..(9%) |
| ……Undetermined | 14…(2%) | 5….(1%) | 0…..(0%) |
| Naloxone administration | |||
| Naloxone administration at the scene and/or (presumably) in ambulance during transport to emergency room | 127.(33%) | 178..(39%) | 23..(40%) |
| Naloxone administration reported at the scene | 83.(22%) | 145.(32%) | 18..(31%) |
| ……Bystander only | 11…(2%) | 26….(6%) | 4….(7%) |
| ……Law enforcement only | 8…(2%) | 16….(4%) | 2….(4%) |
| ……EMS only | 55..(11%) | 65..(14%) | 5….(9%) |
| ……EMS and law enforcement | 4…(1%) | 17….(4%) | 2….(4%) |
| ……EMS and bystander | 8..(2%) | 12….(3%) | 1….(2%) |
| ……Law enforcement and bystander | 0..(0%) | 5…..(1%) | 3….(5%) |
| ……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 319 (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 – September constituted 26% of cases, slightly more than the 23% in 2020. Fentanyl is found in combination with cocaine in 20% 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 399 confirmed deaths caused by fentanyl from January – September, the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 34 (8%) of confirmed overdose deaths, and 18 (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 N=504 | Cumulative Jan-Sep 2021 N=420 | September 2021 N=25 |
|---|---|---|---|
| Nonpharmaceutical opioids | |||
| ……Fentanyl or fentanyl analogs | 336.(67%) | 319..(76%) | 20..(80%) |
| ……Heroin | 57..(11%) | 18….(4%) | 1….(4%) |
| Nonpharmaceutical Stimulants | |||
| ……Cocaine | 118.(23%) | 107..(26%) | 8..(32%) |
| ……Methamphetamine/amphetamine | 99.(20%) | 105..(25%) | 4..(16%) |
| Pharmaceutical opioids** | 118.(23%) | 88.(21%) | 2…(8%) |
| Key combinations | |||
| ……Fentanyl and heroin | 47…(9%) | 17….(4%) | 1…..(0%) |
| ……Fentanyl and cocaine | 97.(19%) | 85..(20%) | 6..(24%) |
| ……Fentanyl and methamphetamine/amphetamine | 70.(14%) | 78..(19%) | 2….(8%) |
| ……Fentanyl and xylazine | 0…(0%) | 34….(8%) | 4…(16%) |
| ……Fentanyl and tramadol | 0…(0%) | 18….(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
Maine Health Access Foundation funded Maternal Overdose Death Prevention Quality Improvement Project
MeHAF supports this project based at Franklin Memorial Hospital, which distributes first aid kits to all postpartum patients, with Narcan offered as part of the kit. The kit is offered to all such patients, not just to those individuals who have a diagnosed SUD. Why? Because postpartum patients are considered at high risk, as up to 50% of overdoses that occur postpartum have been found to occur in those without previous identification of an SUD.
This project began on May 1, 2021, and the early data are encouraging. During the first five months, a significant majority of the patients offered the first aid kit have chosen to include Narcan. In August, of 17 deliveries, 16 accepted the kit and 13 included Narcan. Cumulatively since the initiation of the project, there have been 70 deliveries, 64 kits distributed and in 46 kits Narcan was included. The program is operated under the guidance of retired OB-GYN Jay Naliboff, M.D., and Nell Tharp, RN, CNM.
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.