Download the entire PDF report here: Maine Monthly Overdose Report for September 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 September, the proportion of fatal overdoses averaged 6.7% of total overdoses. Monthly proportion of 2023 fatalities fluctuated from a low of 4.1% in March and a high of 8.1% in April. During September 2023, there were an estimated 830 fatal and nonfatal drug overdoses statewide, of which 56 (6.7%) were suspected and confirmed fatal overdoses. The remaining 774 (93.3%) were nonfatal overdoses: 387 (46.6%) emergency department visits; 231 (27.8%) EMS patents who were not transported to the emergency room, 141 (17.0%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 15 (1.8%) 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 Overdoses | Emergency Department Nonfatal | EMS Not Transported to the ED Nonfatal | Reported Community Reversals Nonfatal | Law Enforcement Without EMS Nonfatal (estimated) | Total Overdoses | |
| Jan ’22 | 45 | 295 | 206 | 178 | 39 | 763 |
| Feb ’22 | 48 | 333 | 185 | 153 | 37 | 756 |
| Mar ’22 | 65 | 458 | 201 | 202 | 30 | 956 |
| Apr ’22 | 60 | 290 | 178 | 189 | 26 | 743 |
| May ’22 | 47 | 402 | 248 | 186 | 41 | 924 |
| Jun ’22 | 66 | 482 | 250 | 177 | 44 | 1013 |
| Jul ’22 | 66 | 347 | 287 | 183 | 40 | 923 |
| Aug ’22 | 64 | 385 | 272 | 255 | 37 | 1013 |
| Sep ’22 | 55 | 458 | 256 | 153 | 33 | 955 |
| Oct ’22 | 65 | 283 | 238 | 177 | 27 | 790 |
| Nov ’22 | 66 | 287 | 206 | 200 | 20 | 779 |
| Dec ’22 | 76 | 362 | 212 | 198 | 14 | 862 |
| 2022 Total | 723 | 4,382 | 2,739 | 2,251 | 388 | 10,483 |
| 2022 Total % | 6.9% | 41.8% | 26.1% | 21.5% | 3.7% | 100% |
| Jan ’23 | 54 | 296 | 219 | 184 | 43 | 796 |
| Feb ’23 | 49 | 348 | 226 | 192 | 27 | 842 |
| Mar ’23 | 40 | 382 | 256 | 237 | 58 | 974 |
| Apr ’23 | 63 | 270 | 218 | 202 | 26 | 779 |
| May ’23 | 49 | 295 | 221 | 165 | 32 | 762 |
| Jun ’23 | 58 | 378 | 228 | 219 | 28 | 911 |
| Jul ’23 | 50 | 339 | 248 | 173 | 33 | 853 |
| Aug ’23 | 42 | 329 | 247 | 152 | 31 | 801 |
| Sep ’23 | 56 | 387 | 231 | 141 | 15 | 830 |
| 2023 Total | 462 | 3,024 | 2,094 | 1,665 | 293 | 7,538 |
| 2023 Total % | 6.1% | 40.1% | 27.8% | 22.1% | 3.9% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine September 2023
Fatal Drug Overdoses in Maine Jan – Sep 2023
During 2023, the proportion of fatal overdoses averaged 6.1% of total overdoses. From January to September 2023, there were a total 462 fatal drug overdoses consisting of 435 confirmed and 27 suspected drug deaths. In September, 2023 there were 56 fatal drug overdoses consisting of 31 confirmed and 25 suspected cases. The graph below shows the considerable monthly fluctuation since January of 2022. The range extends from 76 (December 2022) to 40 (March 2023). During 2023, the monthly proportions fluctuated from a low of 4.1% in March and a high of 8.1% in April. During the first nine months of 2023, fatal overdoses comprised 6.1% of all overdoses; this proportion slightly lower than the 6.9% for 2022. There were 462 confirmed and suspected fatal overdoses in the first nine months of 2023; this is 10.5% lower than the 516 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 – September 2023 as well as 2022.
| Maine EMS | Law Enforcement | |
| Fatal Overdose Response 2022 | 582 | 672 |
| Nonfatal Overdose Response 2022 | 9,376 | 1,471 |
| Total Overdose Response 2022 | 9,958 | 2,143 |
| Fatal Overdose Response Jan – Sep 2023 | 369 | 430 |
| Nonfatal Overdose Response Jan – Sep 2023 | 6,801 | 867 |
| Total Overdose Response Jan – Sep 2023 | 7,170 | 1,297 |
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 September 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 – September 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 two percentage points higher than the 2020 census proportion. York County is 4 percentage points lower than the 2020 census proportion.
Nonfatal Drug Overdoses in Maine, September 2023
Nonfatal Drug Overdoses in Maine, Jan 2023 – Sep 2023
| County | % of 2020 Census Population | Jan-Dec 2022 N=9377 | Jan-Sep 2023 Est. N=6801 | Sep 2023 Est. N=771 |
|---|---|---|---|---|
| Androscoggin | 8% | 1055 (11%) | 709 (10%) | 65 (8%) |
| Aroostook | 5% | 490 (5%) | 321 (5%) | 37 (5%) |
| Cumberland | 22% | 2194 (23%) | 1567 (23%) | 176 (23%) |
| Franklin | 2% | 140 (1%) | 104 (2%) | 18 (2%) |
| Hancock | 4% | 287 (3%) | 207 (3%) | 20 (3%) |
| Kennebec | 9% | 922 (10%) | 686 (10%) | 79 (10%) |
| Knox | 3% | 245 (3%) | 229 (3%) | 19 (2%) |
| Lincoln | 3% | 162 (2%) | 128 (2%) | 18 (2%) |
| Oxford | 4% | 410 (4%) | 270 (4%) | 34 (4%) |
| Penobscot | 11% | 1293 (14%) | 982 (14%) | 112 (15%) |
| Piscataquis | 1% | 90 (1%) | 82 (1%) | 9 (1%) |
| Sagadahoc | 3% | 130 (1%) | 103 (2%) | 11 (1%) |
| Somerset | 4% | 392 (4%) | 332 (5%) | 48 (6%) |
| Waldo | 3% | 199 (2%) | 150 (2%) | 17 (2%) |
| Washington | 2% | 221 (2%) | 138 (2%) | 20 (3%) |
| York | 16% | 1147 (12%) | 793 (12%) | 88 (11%) |
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 – September 2023 percentages of deaths in most counties fall within plus or minus 0 to 2 percentage points of the 2020 census distribution. Penobscot County is 5 percentage points higher and Androscoggin County is 4 percentage points higher that the 2020 census proportion. York County is 5 percentage points lower than the 2020 census proportion.
| County | % of 2020 Census Population | Jan-Dec 2022 N=723 | Jan-Sep 2023 Est. N=462 | Sep 2023 Est. N=56 |
|---|---|---|---|---|
| Androscoggin | 8% | 69 (10%) | 51 (11%) | 2 (4%) |
| Aroostook | 5% | 47 (7%) | 27 (6%) | 4 (7%) |
| Cumberland | 22% | 134 (19%) | 90 (19%) | 7 (13%) |
| Franklin | 2% | 13 (2%) | 6 (1%) | 0 (0%) |
| Hancock | 4% | 24 (3%) | 14 (3%) | 3 (5%) |
| Kennebec | 9% | 54 (7%) | 49 (11%) | 8 (14%) |
| Knox | 3% | 20 (3%) | 12 (3%) | 3 (5%) |
| Lincoln | 3% | 14 (2%) | 5 (1%) | 0 (0%) |
| Oxford | 4% | 36 (5%) | 17 (3%) | 5 (9%) |
| Penobscot | 11% | 109 (15%) | 74 (16%) | 13 (23%) |
| Piscataquis | 1% | 9 (1%) | 12 (3%) | 0 (0%) |
| Sagadahoc | 3% | 11 (2%) | 5 (1%) | 0 (0%) |
| Somerset | 4% | 35 (5%) | 25 (5%) | 3 (5%) |
| Waldo | 3% | 21 (3%) | 5 (1%) | 1 (2%) |
| Washington | 2% | 24 (3%) | 17 (4%) | 1 (2%) |
| York | 16% | 103 (14%) | 53 (11%) | 6 (11%) |
Race, ethnicity, and other demographic indicators of decedents
During the first nine months of 2023, out of 452 confirmed and suspected fatal overdoses for which race was reported, 413 (90%) of the victims were identified as White, 19 (4%) as Black or African American, and 8 (2%) as American Indian/Alaska Native. Out of the 452 fatal overdoses for whom ethnicity was reported, 448 (99%) were reported as not Hispanic, and 4 (1%) were identified as Hispanic.
Out of the 462 cases for which military background was reported in January – September 2023, 25 (6%) were identified as having a military background. Out of the 56 cases in September 2023 where military background was reported, 2 (4%) were identified as having a military background.
Of 462 total suspected and confirmed overdose cases in 2023, undomiciled or transient housing status was reported for 52 (11%) of the victims. The largest totals of undomiciled persons were found in Cumberland County (17, 33%), Penobscot County (13, 25%) and Androscoggin County (8, 15%). In September 2023, 4 decedents (7%) were identified as undomiciled.
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2022 Race N=720 Ethnicity N=706 | Jan-Sep 2023 Est. Race N=461 Ethnicity N=452 | Sep 2023 Est. Race N=56 Ethnicity N=55 |
|---|---|---|---|---|
| Race and Ethnicity | ||||
| White | 91% | 670 (90%) | 413 (90%) | 42 (93%) |
| Black or African American | 2% | 17 (2%) | 19 (4%) | 3 (7%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 8 (2%) | 0 (0%) |
| Other race, 2+ races combined, non-hispanic | 7% | 12 (2%) | 8 (2%) | 0 (0%) |
| Not Hispanic | 98% | 699 (99%) | 448 (99%) | 55 (100%) |
| Hispanic | 2% | 7 (1%) | 4 (1%) | 0 (0%) |
| Military Background | 81 (11%) | 25 (6%) | 2 (4%) | |
| Undomiciled/Transient Housing Status | 81 (11%) | 52 (11%) | 4 (7%) |
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 74% in the first nine months in 2023. The cumulative age distribution in January – September 2023 compared to 2022 shows 3 deaths under 18 in 2022 and 2 deaths 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 Census Population | Jan-Dec 2022 N=723 | Jan-Sep 2023 Est. N=462 | Sep 2023 Est. N=56 | |
|---|---|---|---|---|
| Percent Males | 49% | 527…(73%) | 303 (74%) | 39 (70%) |
| Percent under 18 | 19% | 3…(<1%) | 1 (<1%) | 1 (2%) |
| Percent 18-39 | 26% | 295…(41%) | 172 (37%) | 23 (41%) |
| Percent 40-59 | 27% | 333..(46%) | 230 (50%) | 28 (50%) |
| Percent 60+ | 29% | 92…(13%) | 58 (13%) | 4 (7%) |
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 (73%) 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 462 confirmed or suspected fatal overdoses in 2023, 160 (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 one percentage point higher than 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 14% (64) 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 368 suspected and confirmed drug death cases with EMS involvement during the first nine months of 2023, 209 (57%) of victims were already deceased when EMS arrived. In the remaining 159 (43%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 159 who were still alive when EMS arrived, only 46 (29%) remained alive long enough to be transported but died during transport or at the emergency room and 112 (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 – Sep 2023 Est. N=462 | Sep 2023 Est. N=56 | |
|---|---|---|---|
| Public safety response | |||
| ……EMS alone | 38….(5%) | 29 (6%) | 3 (5%) |
| ……Law enforcement alone | 131…(18%) | 90 (19%) | 12 (21%) |
| ……EMS and law enforcement | 541…(75%) | 339 (73%) | 40 (71%) |
| ……Private transport to the Emergency. Dept. | 13…..(2%) | 3 (<1%) | 1 (2%) |
| Naloxone administration | |||
| Naloxone administration reported at the scene | 182..(25%) | 121 (26%) | 18 (32%) |
| ……Bystander only | 44…(6%) | 28 (6%) | 3 (5%) |
| ……Law enforcement only | 31….(4%) | 11 (2%) | 3 (5%) |
| ……EMS only | 49….(7%) | 36 (8%) | 5 (9%) |
| ……EMS and law enforcement | 11….(2%) | 10 (2%) | 3 (5%) |
| ……EMS and bystander | 26….(4%) | 30 (6%) | 3 (5%) |
| ……Law enforcement and bystander | 5….(1%) | 9 (2%) | 0 (0%) |
| ……EMS, bystander, and law enforcement | 6….(1%) | 3 (1%) | 0 (0%) |
| ……Naloxone administered by unspecified person | 0…(0%) | 1 (<1%) | 0 (0%) |
| History of Prior Overdose | 269.(37%) | 160 (35%) | 11 (20%) |
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 435 confirmed cases in 2023, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 341 (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% (10) 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% (137) of the overdoses, a slight decrease from 33% in 2022. Cocaine-involved fatalities January – September constituted 35% (153) of cases, an increase from 30% in 2022 and 25% in 2021. Fentanyl is found as a co-intoxicant with cocaine in 82% (126) of 2023 cocaine-involved cases, and as a co-intoxicant with methamphetamine in 83% (114) of methamphetamine-involved cases. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 377 confirmed deaths in 2023 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 38 (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 complete cases only | Jan-Dec 2022 N=723 | Jan-Sep 2023 N=435 | *Sep 2023 N=31 |
|---|---|---|---|
| Nonpharmaceutical opioids | |||
| ……Fentanyl or fentanyl analogs | 560..(77%) | 341 (78%) | 26 (84%) |
| ……Heroin | 19….(3%) | 10 (2%) | 1 (3%) |
| Nonpharmaceutical Stimulants | |||
| ……Cocaine | 213.(29%) | 153 (35%) | 12 (39%) |
| ……Methamphetamine | 234.(32%) | 137 (31%) | 11 (35%) |
| Pharmaceutical opioids** | 156..(22%) | 79 (18%) | 4 (13%) |
| Key combinations | |||
| ……Fentanyl and heroin | 18….(2%) | 10 (2%) | 1 (3%) |
| ……Fentanyl and cocaine | 171..(24%) | 126 (29%) | 10 (32%) |
| ……Fentanyl and methamphetamine | 189..(26%) | 114 (26%) | 9 (29%) |
| ……Fentanyl and xylazine | 46….(6%) | 38 (9%) | 3 (10%) |
| ……Fentanyl and tramadol | 10….(1%) | 3 (1%) | 1 (3%) |
**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
expansion of options BEHAVIORAL health liaisons initiative
In January 2023, Governor Janet T. Mills announced an expansion of the OPTIONS (Overdose Prevention Through Intensive Outreach, Naloxone and Safety Initiative) Program, representing a doubling of the number of behavioral health liaisons from 16 to 32. The expansion will allow for an additional liaison in several counties and an additional two liaisons in the counties of York, Cumberland, Androscoggin, Penobscot and Aroostook. The counties receiving one
additional liaison are Knox, Waldo, Washington, Kennebec, Oxford and Franklin. The allocation was based upon the number of overdoses in each county along with the relative availability of
treatment. The funds for the expansion will come from that portion of the opioid litigation settlements held by Attorney General Aaron Frey. The contracts with the four behavioral health firms which hire and supervise the liaisons are in the process of being amended and it is hoped that the new liaisons can be hired and in place by the end of the calendar year. The OPTIONS program began in late 2021 and has proven to be an effective program. The
licensed behavioral health liaisons de-escalate behavioral health crises, engage in post-overdose follow-up visits and refer persons in need as well as affected others to community and state-based resources/services to address problematic drug use. Since the beginning of the program, law enforcement officers have made 2,698 referrals to liaisons (data as of August 31, 2023). Other referrals come from treatment providers, recovery coaches, EMS providers and
Emergency Departments. In turn, the liaisons have made nearly 2500 referrals to community-based treatment with over 75% of the individuals making it to their first appointment. The liaisons are embedded in various law enforcement agencies across the state.
More data on the OPTIONS program is available on the Maine Drug Data Hub at www.mainedrugdata.org. Metrics on the OPTIONS data dashboard include:
-Proactive referrals made to the liaisons
-The number of overdose education and anti-stigma trainings conducted by OPTIONS
liaisons as well as the number of individuals trained
-Referrals to treatment, harm reduction, prevention and recovery services by liaisons
-The amount of naloxone distributed by the liaisons
-The housing status of the individuals referred to liaisons
Appreciation is expressed to the four behavioral health organizations who partner with the State to hire and supervise the liaisons: Sweetser, Tri-County Mental Health Services, Community Health and Counseling Services and The Aroostook Mental Health Center.
Appreciation too for the efforts of the several law enforcement agencies who welcome the liaisons to work within their organizations.