Download the entire PDF report here: Maine Monthly Overdose Report for September 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 September, the proportion of fatal overdoses averaged 6.1% 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 8.3% in April. So far for 2022, the total number of overdoses January-September is 9.3% higher than during January-September 2021 (13.2% fatal and 9.0% nonfatal). During the period January – September 2022, fatal overdoses comprised 6.6% of all overdoses, just slightly higher than the 6.4% for the first nine months of 2021.
From January 2022 to September 2022, there were an estimated 7,724 fatal and nonfatal drug overdoses statewide, of which 513 (6.6%) were suspected and confirmed fatal overdoses. The remaining 7,211 (93.4%) were nonfatal overdoses: 3,444 (44.6%) emergency department visits; 2,082 (27.0%) EMS patents who were not transported to the emergency room, 1,635 (21.2%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 50 (0.6%) 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 Overdoses | Emergency Department Nonfatal | EMS Not Transported to the ED Nonfatal | Reported Community Reversals Nonfatal | Law Enforcement Without EMS Nonfatal (estimated) | Total Overdoses | |
| January ’21 | 54 | 270 | 164 | 127 | 0 | 612 |
| February ’21 | 41 | 277 | 118 | 100 | 0 | 536 |
| March ’21 | 58 | 329 | 172 | 156 | 2 | 717 |
| April ’21 | 46 | 334 | 190 | 136 | 0 | 706 |
| May ’21 | 47 | 409 | 163 | 100 | 1 | 720 |
| June ’21 | 54 | 411 | 223 | 189 | 0 | 877 |
| July ’21 | 44 | 482 | 225 | 167 | 0 | 918 |
| August ’21 | 50 | 428 | 232 | 222 | 3 | 935 |
| September ’21 | 59 | 473 | 234 | 276 | 2 | 1,044 |
| October ’21 | 65 | 383 | 246 | 208 | 2 | 904 |
| November ’21 | 61 | 308 | 219 | 195 | 2 | 785 |
| December ’21 | 52 | 344 | 198 | 176 | 11 | 784 |
| 2021 Total | 631 | 4,448 | 2,384 | 2,052 | 23 | 9,538 |
| 2021 Total % | 6.6% | 46.6% | 25.0% | 21.5% | 0.2% | 100% |
| January ’22 | 44 | 296 | 206 | 178 | 1 | 725 |
| February ’22 | 48 | 333 | 185 | 153 | 4 | 724 |
| March ’22 | 66 | 457 | 201 | 202 | 9 | 936 |
| April ’22 | 59 | 290 | 177 | 189 | 7 | 721 |
| May ’22 | 46 | 402 | 248 | 186 | 12 | 894 |
| June ’22 | 66 | 482 | 250 | 177 | 11 | 986 |
| July ’22 | 64 | 348 | 287 | 170 | 5 | 877 |
| August ’22 | 65 | 385 | 272 | 241 | 1 | 995 |
| September ’22 | 55 | 451 | 256 | 139 | 0 | 901 |
| 2022 Total | 513 | 3,444 | 1,635 | 1,635 | 50 | 7,724 |
| 2022 Total % | 6.6% | 44.6% | 27.0% | 21.2% | 0.6% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine September 2022
Fatal Drug Overdoses in Maine January – September 2022
During the first 9 months of 2022, the proportion of fatal overdoses averaged 6.6% of total overdoses. From January to September 2022 there was a total 513 fatal drug overdoses consisting of 426 confirmed and 87 suspected drug deaths. The graph below shows the considerable monthly fluctuation since January 2020. Although the average since 2020 is 50, the range extends from 33 (October 2020) to 66 (March and June 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 8.3% in April. The proportion of fatalities in January – September 2022 (513) is 13.2% higher than the first nine months of 2021 (453) 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-September 2022. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning.
The cumulative January-September 2022 percentages of deaths in all counties except Cumberland, Sagadahoc, Penobscot and York fall within plus or minus 0%-1% of the 2020 census distribution. Cumberland County, Sagadahoc County and York County are all 2% lower than the 2020 census proportion in 2022 and Penobscot County is 4% higher.
| County | % of 2020 Census Population | Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Sep 2022 Est. N=513 | Sep 2022 Est. N=55 |
|---|---|---|---|---|---|---|
| Androscoggin | 8% | 33…….(9%) | 52.(10%) | 69…..(11%) | 48 (9%) | 3 (6%) |
| Aroostook | 5% | 14…….(4%) | 17…(3%) | 39……(6%) | 32 (6%) | 3 (6%) |
| Cumberland | 22% | 100…..(26%) | 97.(19%) | 114….(28%) | 100 (19%) | 13 (24%) |
| Franklin | 2% | 5……..(1%) | 8…(2%) | 8…….(1%) | 12 (2%) | 2 (4%) |
| Hancock | 4% | 9…….(2%) | 13…(3%) | 22……(3%) | 16 (3%) | 4 (7%) |
| Kennebec | 9% | 42……(11%) | 49.(10%) | 64….(10%) | 42 (8%) | 3 (6%) |
| Knox | 3% | 7…….(2%) | 16…(3%) | 11……(2%) | 14 (3%) | 3 (6%) |
| Lincoln | 3% | 11…….(3%) | 9…(2%) | 16……(3%) | 9 (2%) | 0 (0%) |
| Oxford | 4% | 9…….(2%) | 15…(3%) | 28……(4%) | 21 (4%) | 3 (6%) |
| Penobscot | 11% | 53…..(14%) | 94.(19%) | 106…..(17%) | 75 (15%) | 7 (13%) |
| Piscataquis | 1% | 3…….(1%) | 10…(2%) | 11……(2%) | 6 (1%) | 0 (0%) |
| Sagadahoc | 3% | 8……(2%) | 8….(1%) | 7……(1%) | 6 (1%) | 1 (2%) |
| Somerset | 4% | 16……(4%) | 13…(3%) | 26…..(4%) | 26 (5%) | 4 (7%) |
| Waldo | 3% | 3…….(1%) | 9…(2%) | 15…..(2%) | 17 (3%) | 1 (2%) |
| Washington | 2% | 10……(3%) | 20..(4%) | 25…..(4%) | 16 (3%) | 2 (4%) |
| York | 16% | 57….(15%) | 74.(15%) | 70….(11%) | 73 (14%) | 6 (11%) |
Race, ethnicity, and other demographic indicators of decedents
During January – September of 2022, out of 502 confirmed and suspected fatal overdoses for which race was reported, 476 (95%) of the victims were identified as White, 12 (2%) as Black or African American, 6 (1%) as American Indian/Alaska Native, and 1 (<1%) Hawaiian/Pacific Islander. Out of the 499 fatal overdoses for whom ethnicity was reported, 491 (98%) were reported as not Hispanic, and 8 (2%) were identified as Hispanic. Out of the 513 cases for which military background was reported, 39 (8%) were identified as having a military background. Prior overdose history was reported for 187 (36%) of the victims. Transient housing status was reported for 55 (11%) of the victims. The largest totals of undomiciled persons (January – September 2022) were found in Cumberland County (23, 42%), and Penobscot County (13, 24%).
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2021 Est. N=627 Race N=621 Ethnicity | Jan-Sep 2022 Est. N=502 Race N=499 Ethnicity |
|---|---|---|---|
| Race and Ethnicity | |||
| White | 91% | 585 (93%) | 476 (95%) |
| Black or African American | 2% | 21 (3%) | 12 (2%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 6 (1%) |
| Other race, 2+ races combined, non-hispanic | 7% | 7 (1%) | 8 (2%) |
| Not Hispanic | 98% | 611 (99%) | 492 (98%) |
| Hispanic | 2% | 10 (2%) | 8 (2%) |
| Military Background | 39 (8%) | ||
| Prior Overdose History | 187 (36%) | ||
| Undomiciled/Transient Housing Status | 55 (11%) |
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 nine months of 2022. The cumulative age distribution in January – September 2022 compared to 2021 shows 1 fewer decedent under age 18, a 3% increase in the proportion of those aged 18-39, a 3% decrease in those aged 40-59, and a 3% increase in the proportion 60 and above.
| % of 2020 Census Population | Jan-Dec 2019 N=380 | Jan-Dec 2020 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Sep 2022 Est. N=513 | Sep 2022 Est. N=55 | |
|---|---|---|---|---|---|---|
| Percent Males | 49% | 258..(68%) | 357…(71%) | 451.(71%) | 373…(73%) | 44 (80%) |
| Percent under 18 | 19% | 0….(0%) | 2…(<1%) | 2..(<1%) | 1…..(<1%) | 0 (0%) |
| Percent 18-39 | 26% | 171..(45%) | 213..(42%) | 247.(39%) | 208…(41%) | 20 (36%) |
| Percent 40-59 | 27% | 175..(46%) | 235..(47%) | 316.(50%) | 239..(47%) | 25 (45%) |
| Percent 60+ | 29% | 33….(9%) | 54…(11%) | 66..(10%) | 65…..(13%) | 10 (18%) |
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 nine months of 2022. In the first nine 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, 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, but slightly 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 12% 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 418 suspected and confirmed drug death cases with EMS records during January – September of 2022, 216 (52%) of victims were already deceased when EMS arrived. In the remaining 202 (48%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 202 who were still alive when EMS arrived, only 68 (16%) remained alive long enough to be transported but died during transport or at the emergency room and 134 (67%) 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 N=504 | Jan-Dec 2021 Est. N=631 | Jan-Sep 2022 Est. N=513 | Sep 2022 Est. N=55 | |
|---|---|---|---|---|
| Public safety response | ||||
| ……EMS alone | 28…(6%) | 30….(5%) | 26….(5%) | 4 (7%) |
| ……Law enforcement alone | 107.(21%) | 104..(16%) | 93…(18%) | 8 (15%) |
| ……EMS and law enforcement | 365.(72%) | 485..(77%) | 392…(76%) | 43 (78%) |
| ……Private transport to the Emergency. Dept. | — | 7….(1%) | 3…..(1%) | 0 (0%) |
| Naloxone administration | ||||
| Naloxone administration reported at the scene | 83.(22%) | 187..(30%) | 132..(26%) | 10 (18%) |
| ……Bystander only | 11…(2%) | 36….(6%) | 31…(6%) | 3 (5%) |
| ……Law enforcement only | 8…(2%) | 22….(3%) | 23….(4%) | 2 (4%) |
| ……EMS only | 55..(11%) | 84..(13%) | 38….(7%) | 5 (9%) |
| ……EMS and law enforcement | 4…(1%) | 20….(3%) | 10….(2%) | 0 (0%) |
| ……EMS and bystander | 8..(2%) | 15….(2%) | 21….(4%) | 0 (0%) |
| ……Law enforcement and bystander | 0..(0%) | 5…..(1%) | 5….(1%) | 0 (0%) |
| ……EMS, bystander, and law enforcement | —……. | 2..(<1%) | 4….(1%) | 0 (0%) |
| ……Naloxone administered by unspecified person | —……. | 3..(<1%) | 8…(2%) | 1 (2%) |
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 434 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 344 (79%), this is a slightly higher than the rate in 2021 (77%) and 12% 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 3% of 2022 deaths, 3% of 2021 deaths, compared to 11% in 2020. Methamphetamine was cited as a cause in 32% of the overdoses, a substantial increase from 27% in 2021. Cocaine-involved fatalities January – September constituted 28% of cases, a slight increase from 25% in 2021 and 23% in 2020. Fentanyl is found as a co-intoxicant with cocaine in 81% of 2022 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 81% of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 434 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 28 (6%) of confirmed overdose deaths, and 7 (2%) 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 N=504 | Jan-Dec 2021 N=627 | Jan-Sep 2022 N=434 | *Sep 2022 N=1 |
|---|---|---|---|---|
| Nonpharmaceutical opioids | ||||
| ……Fentanyl or fentanyl analogs | 336.(67%) | 489..(77%) | 344..(79%) | 1 (100%) |
| ……Heroin | 57..(11%) | 22….(3%) | 12….(3%) | 0 (0%) |
| Nonpharmaceutical Stimulants | ||||
| ……Cocaine | 118.(23%) | 156..(25%) | 123.(28%) | 1 (100%) |
| ……Methamphetamine | 99.(20%) | 172..(27%) | 139.(32%) | 0 (0%) |
| Pharmaceutical opioids** | 118.(23%) | 130..(21%) | 90..(21%) | 0 (0%) |
| Key combinations | ||||
| ……Fentanyl and heroin | 47…(9%) | 20….(3%) | 12….(3%) | 0 (0%) |
| ……Fentanyl and cocaine | 97.(19%) | 127..(20%) | 100..(23%) | 1 (100%) |
| ……Fentanyl and methamphetamine | 70.(14%) | 133..(21%) | 113..(26%) | 0 (0%) |
| ……Fentanyl and xylazine | 0…(0%) | 53….(8%) | 28….(6%) | 0 (0%) |
| ……Fentanyl and tramadol | 0…(0%) | 24….(4%) | 7….(2%) | 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
Somerset County Jail Extended-Release Buprenorphine Pilot Project
Earlier this year, the Somerset County Jail began a one-year pilot project to expand access for jail residents to OUD treatment using extended -release buprenorphine (XRB). XRB is a monthly injection that provides OUD treatment for at least 28 days. While the cost of the medication is substantial, the project leaders believe these costs will be largely offset by the substantial reduction in staffing time. Using the extended-release medication also enables jail residents to continue to receiving treatment for up to 28 days post-release, giving them more time to connect with community treatment resources.
Somerset County Jail is the first correctional facility in Maine and only the second in the nation to offer a comprehensive XRB treatment plan.
Somerset County Sheriff Dale Lancaster, Jail Programs Manager Michael Welch and Maine Medical Center’s Alane O’Connor, DNP, and many other members of the medical and corrections team developed the project over a year’s time, with encouragement and financial support from the state’s Director of Opioid Response and the Office of Behavioral Health
Financial support during the planning phase was also provided by HRSA through an RCORP project provided to partners in Somerset County. This grant supported Dr. O’Connor’s time to implement and evaluate the pilot and write the XRB treatment manual. An article about the project is the featured HRSA RCORP project in HRSA’s monthly publication in November. In addition, the project’s leaders presented a review of the project during Governor Mills’ 4th Annual Opioid Response Summit in Bangor in July 2022. As part of its work, the Somerset County Jail team is writing a best practices manual for the use of XRB in a correctional setting. Upon completion, the manual will be available publicly.