September 2024 Monthly Overdose Report

Download the entire PDF report: Maine Monthly Overdose Report for September 2024

Overview: Composite total of fatal and nonfatal overdoses

This report documents suspected and confirmed fatal and nonfatal drug overdoses in Maine during September 2024 aswell as for the period January 2023–September 2024 (Table 1). The total number of confirmed and suspected fatal overdoses January–September 2024 is 372, 18.8% lower than the total confirmed fatal overdoses for the same period in 2023, 458. The total number of nonfatal overdoses January–September 2024 is 6,324, 12.8% lower than the total reported nonfatal overdoses for the same period in 2023, 7,252. During September 2024, the proportion of fatal overdoses averaged 5.1 of totaloverdoses. Monthly proportions of 2024 fatalities fluctuated from a low of 4.8% in May to a high of 7.2% in March. During the first nine months of 2024, fatal overdoses constituted 5.6% of all overdoses, lower than January–September 2023 (5.9%).  

Data derived from multiple statewide sources were compiled and deduplicated to calculate fatal and nonfatal overdosetotals (Table 1). These include nonfatal overdose incidents reported by hospital emergency departments (ED), nonfatal emergency medical service (EMS) responses without transport to the ED, overdose reversals reported by law enforcement in the absence of EMS, and overdose reversals reported by community members or agencies receiving state-supplied naloxone through the Maine Naloxone Distribution Initiative. There are also an unknown number of private overdose reversals that were not reported and an unknown number of community-reported reversals that may have overlapped with emergency responseby EMS or law enforcement. The total number of fatal overdoses in this report includes those that have been confirmed, as well asthose that are suspected but not yet confirmed for June, August and September 2024 (see Figure 1).

The total number of suspected and confirmed fatal overdoses and reported nonfatal overdoses for September 2024, 671,is displayed in Table 1 near the bottom row.  Of those 671, there were 34 (5.6%) confirmed and suspected fatal overdoses, 317 (47.2%) nonfatal emergency department visits, 200 (29.8%) nonfatal EMS responses not transported to the emergencydepartment, 114 (17.0%) reported community overdose reversals, and 6 (0.9%) law enforcement reversals in incidents that did not include EMS.

Table 1: Composite reported overdose totals, all drugs, January 2023-August 2024
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 ’235529623818448821
Feb ’234934820419230823
Mar ’234138226023754974
Apr ’236327023220229796
May ’234929523816547794
Jun ’235837823221935922
Jul ’235034030717334904
Aug ’234033026615222810
Sep ’235339025614126866
Oct ’235531727414717809
Nov ’234725521410120637
Dec ’234632520212923724
2023 Total6063926292120423859880
2023 Total %6.1%39.7%29.6%20.7%3.9%100%
Jan ’24432692261399687
Feb ’244430524213620750
Mar ’245937923311913802
Apr ’244325320519010699
May ’243831125616516779
Jun ’244334423220211833
Jul ’243529323516614743
Aug ’243629021311914669
Sep ’24343172001146671
2024 Total3722761204313501706696
2024 Total %5.7%41.2%30.5%20.2%2.5%100%
*Emergency department, EMS Not Transported, Community Reversals, and Law Enforcement Without EMS are nonfatal overdoses. Fatal overdoses in those categories have been removed.

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 total activity of both law enforcement officials and EMS agencies is underrepresented in Table 1 because of the overlap between them. The process used to deduplicate overdoses begins by removing fatal overdoses from the emergency department and EMS overdose incidents. Then the number of patients transported to emergency departments by Maine EMS are removed from the EMS overdose incidents. Finally, EMS involvement and fatal overdose incidents are removed from law enforcement responses.

Table 2 shows the public safety response to fatal and nonfatal overdose events in January–August 2024 as well as January–December 2023. During January–September 2024, law enforcement officers responded to a reported 913 overdose incidents (340 fatal; 573 nonfatal), and Maine EMS responded to a reported 7,382 incidents (300 fatal; 7,082 nonfatal). During 2023, law enforcement officers responded to a reported 1,617 incidents (564 fatal; 1,053 nonfatal), and Maine EMS responded to a reported 10,318 incidents (480 fatal; 9,838 nonfatal).

Table 2. Fatal and nonfatal overdose emergency response count from law enforcement and Maine EMergency Medical Services, including overlapping cases
Fatal overdose response
Jan–Dec 2023
Nonfatal overdose response
Jan–Dec 2023
Total overdose response
Jan–Dec 2023
Fatal overdose response
Jan–Sep 2024
Nonfatal overdose response
Jan–Sep 2024
Total Overdose
Response
Jan–Sep
2024
Maine EMS48098381031830070827382
Law Enforcement56410531617340573913
*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

Table 3 shows the frequency distribution of nonfatal overdoses to which EMS responded at the county level. Overdose reversal totals reported by community partners and emergency departments are not reported by county; only EMS case data include county frequencies. The August 2024 monthly totals in the far right column can be compared to the percentage of the census population on the far left, the percentage of nonfatal overdoses for the year in 2023, or the January–September 2024 year-to-date total. Caution must be exercised viewing single counties, especially for a single month, due to small numbers. These may fluctuate randomly, without reflecting any statistically significant trend.

January–September 2024 percentage totals for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Compared to the 2020 census proportion, Cumberland County is 3 percentage points higher,  Androscoggin County is 2 percentage points higher, and York County is 4 percentage points lower.

Nonfatal Drug Overdoses in Maine, August 2024

Nonfatal Drug Overdoses in Maine, Jan 2024 – Aug 2024

Table 3. County of EMS Incident among suspected and confirmed nonfatal overdoses
% 2020 estimated Census populationJan–Dec 2023 
Est. N = 9838
Jan–Sep 2024  
Est. N = 7082
Sep 2024  
Est. N = 741
Androscoggin8%100910%73010%709%
Aroostook5%4855%4096%476%
Cumberland22%230923%176325%17724%
Franklin2%1602%1222%142%
Hancock4%2763%1993%233%
Kennebec9%96310%71010%8411%
Knox3%3273%2053%152%
Lincoln3%2272%1242%61%
Oxford4%3974%2624%274%
Penobscot11%135114%86912%9713%
Piscataquis1%1141%721%101%
Sagadahoc3%1512%1172%172%
Somerset4%4715%3134%213%
Waldo3%2202%1522%193%
Washington2%2152%1762%152%
York16%116312%85912%9913%

Age and Gender Distribution of Suspected Nonfatal Overdoses with EMS Response

Table 4 displays the age composition of individuals suspected of experiencing nonfatal overdoses involving EMS response in September 2024, January–September 2024, as well as January–December 2023. Overdose reversal totals reported by community partners and emergency departments are not categorized and reported by age; only EMS case data include monthly age frequencies. Age group totals can be compared to the 2020 census proportion in the far left column. Caution must be exercised as the small number of cases in each month is vulnerable to random fluctuation that may not reflect a significant statistical trend. The age distribution for both 2023 and 2024 year to date compared to the 2020 census proportion shows a disproportionately large impact of suspected nonfatal overdose victims with EMS involvement for those aged 25–54. This impact is illustrated by looking at the 25–54 year age groups, which comprise 36% in the 2020 census compared to 64% in the overdose population during 2023 and 62% in during the first nine months of 2024. In 2024 there are 14 percentage points fewer overdose victims among those under the age of 18 compared to the percentage of the census population in that age group. Similarly, there were 3 percentage points fewer overdose victims among those aged 55–64, and 11 percentage points fewer overdose victims among those 65 and older compared to the percentages of the census population for those age groups.  

Table 4. Reported age group among suspected nonfatal overdose victims involving EMS response
% 2020 estimated Census populationJan–Dec 2023
Est. N = 9775
Jan-Sep 2024
Est. N = 7120
Sep 2024
Est. N = 751
< 1818%4024%3074%324%
18-247%9039%6529%638%
25-3412%208521%139820%15320%
35-4412%260327%182526%20227%
45-5412%152216%115516%11816%
55-6416%131713%92713%8211%
> 6423%94410%85612%10113%

Table 5 displays the reported gender of individuals experiencing nonfatal overdoses involving EMS response in September 2024, January–September 2024, as well as January–December 2023. Overdose reversal totals reported by community partners and emergency departments are not categorized by gender; only EMS case data include monthly gender categories. Gender group totals can be compared to the 2020 census proportion by age group in the far left column or the January–December 2023 totals in the center column. When comparing the January–September 2024 with 2023, aswell as the census population proportion, caution must be exercised as the small number of cases in each month isvulnerable to random fluctuation that may not reflect a significant statistical trend. Males represent 49% of the 2020 estimated census population and 59% of the nonfatal overdose victims with EMS involvement during January–September 2024. 

Table 5. Reported Gender among suspected nonfatal overdose victims involving ems response
% 2020 estimated Census populationJan–Dec 2023 
Est. N = 9794
Jan–Sep 2024 
Est. N = 6847
Sep 2024
Est. N = 726
Male49%597061%401059%38753%
Female51%379839%283641%33947%
TransgenderNot collected260.3%10%00%

County Distribution of Suspected and Confirmed Fatal Overdoses

Table 6 shows the frequency distribution of fatal overdoses at the county level. The September 2024 monthly totals in the far right column can be compared either to the percentage of the census population in the far left column, the percentage of county fatal overdoses for 2023, or the January–September 2024 year-to-date percentages. Caution must be exercised when viewing single counties with small numbers for a single month. These may fluctuate randomly, without reflecting any significant statistical trend. The January–September 2024 percentages for most counties fall within 0 to 1 percentage points of the 2020 census distribution. Compared to the 2020 census proportion, Aroostook County is 3 percentage points higher, Penobscot County, Knox County and Washington County are 2 percentage points higher, York County is 5 percentage points lower, Cumberland County is 4 percentage points lower, and Hancock County is 2 percentage points lower.

Table 6. County of death among suspected and confirmed fatal overdoses
% 2020 estimated Census populationJan–Dec 2023 
Est. N = 606
Jan–Sep 2024 
Est. N = 372
Sep 2024 
Est. N = 34
Androscoggin8%6911%359%721%
Aroostook5%407%298%00%
Cumberland22%11819%6718%412%
Franklin2%61%21%00%
Hancock4%224%92%13%
Kennebec9%6010%3810%26%
Knox3%163%175%00%
Lincoln3%71%113%26%
Oxford4%254%195%39%
Penobscot11%9115%4713%39%
Piscataquis1%173%31%00%
Sagadahoc3%71%72%39%
Somerset4%295%175%13%
Waldo3%102%164%39%
Washington2%254%144%412%
York16%6411%4111%13%

Fatal Drug Overdoses in Maine August 2024

Fatal Drug Overdoses in Maine Jan – Aug 2024


Age and Sex Distribution of Fatal Overdose Victims

Table 7 displays the age and sex composition of the fatal overdose population for September 2024, January–September 2024, and January to December 2023, compared to the 2020 estimated census population. When comparing the September 2024 data with 2023 as well as the census population proportion, caution must be exercised as the small number ofcases in each month is vulnerable to random fluctuation that may not reflect a significant statistical trend.

The cumulative proportion of males is lower in January–September 2024 (65%) compared to January–December 2023 (73%). 

The age distribution for 2024 compared to the 2020 census proportion shows a disproportionately large impact of fatal overdoses in those aged 35–64, as was true in 2023. That group includes 36% of the 2020 estimated census population, compared to 75% in the fatal overdose population in 2023 as well as 75% during January–September 2024. Compared to the census population, in 2024 year to date, there were 4 percentage points fewer fatal overdoses among those aged 18–24 and 15 percentage points fewer among those 65 and older compared to the census estimated population for those age groups. 

There were, however, differences between the age structures of the nonfatal overdoses (Table 4) and the fatal overdoses.  In 2024 year to date,  the highest proportion of overdoses was among those aged 35–44 (26% among nonfatal and 28% among fatal). The second highest age group for nonfatal overdoses was 25–34 (20%) among nonfatal, but 45–54 (27%) among the fatal overdoses. 


Table 7. Decedent Reported Age Group and Sex among suspected and confirmed fatal overdoses
% 2020 estimated Census populationJan–Dec 2023 
Est. N = 606
Jan–Sep 2024 
Est. N = 372
Sep 2024 
Est. N = 36
Male49%44073%24265%2059%
< 1818%30%31%00%
18-247%285%103%00%
25-3412%8514%4813%618%
35-4412%19933%10628%926%
45-5412%13522%9927%926%
55-6416%11819%7520%618%
> 6423%386%318%412%

Race, ethnicity, and other demographic indicators of decedents

Table 8 displays the reported race and ethnicity of confirmed and suspected fatal overdoses in July 2024, January–September 2024, and January–December 2023 compared to the 2020 estimated census population. Note that race and ethnicity are not finalized until the full death certificate is entered into Vital Records, and a small number of decedents’ records currently lack information about these variables. Out of 369 decedents for whom race was reported January–September 2024,92% of the victims were identified as White, 0% as Black/African American, and 2% as American Indian/Alaska Native. Outof 363 decedents for whom Hispanic ethnicity status was reported, 3% were identified as Hispanic.

Table 8. Decedent race and ethnicity among suspected and confirmed fatal overdoses
A: Race% 2020 Estimated Census PopulationJan–Dec 2023 
Race N = 605
Jan–Sep 2024 
Race N = 369
Sep 2024
Race Est. N = 33
White alone94%55492%34192%3194%
Black/African American alone2%254%10%00%
American Indian/Alaska Native alone1%122%82%00%
Other race and 2+ races combined3%142%195%26%
B: Ethnicity% 2020 estimated Census populationJan–Dec 2023
Ethnicity N = 589
Jan–Sep 2024
Ethnicity N = 363
Sep 2024
Ethnicity Est. N = 33
Hispanic/Latinx 2%71%113%26%
military status and housing stability of fatal overdose victims

Out of the 371 cases for which military background was reported January–September 2024, 18 (5%) were identified as having a military background. Out of the 33 cases in September 2024 where military background was reported, 1 (3%) was identified as having a military background. Of the 372 total suspected and confirmed fatal overdose cases year to date in 2024, undomiciled or transient housing status was reported for 49 (13%) victims. Among those 49, the largest proportions of undomiciled persons were found in Cumberland County (13, 27%), Androscoggin County (11, 22%) and Penobscot County (7, 14%). In September 2024, 6 fatal overdose victims (18%) were identified as undomiciled.


Basic incident patterns in fatal overdoses

Table 9 reports basic incident patterns for fatal overdoses. September 2024 can be compared to 2023 as a whole or to January–September 2024 year to date totals. Caution must be exercised interpreting a single month of data as numbers may fluctuate randomly and not reflect a statistically significant trend. In addition, data totals may change slightly as suspected cases are confirmed or eliminated. 

Both EMS and police responded together to most fatal overdoses (72%) in 2024 year to date. Law enforcement wasmore likely to respond to a scene alone (19%) than EMS (8%). The overwhelming majority (92%) of confirmed fatal drug overdoses were ruled as, or suspected of being, accidental manner of death. 

Of the 372 confirmed or suspected fatal overdoses in 2024, 122 (33%) had a history of prior overdose.

Although most cases had bystanders or witnesses present at the scene by the time first responders arrived, the detailsabout who was present at the time of the overdose were frequently unclear. However, responding family and friends or otherbystanders administered naloxone for 51 (14%) of the 2024 fatal overdoses, slightly higher than the proportion in 2023 (13%). Often, EMS and/or law enforcement administered naloxone in addition to bystanders or witnesses. During 2024, 26% of suspected and confirmed fatal overdose cases had naloxone administered at the scene by EMS, bystanders, and/or lawenforcement. This rate is the same as 2023 (26%).

Of the 300 suspected or confirmed drug death cases with EMS involvement during 2024, 154 (51%) victims were alreadydeceased when EMS arrived. In the remaining 146 (49%) cases, resuscitation was attempted either at the scene or presumablyin the ambulance during transport to the emergency room. One case had an unreported response once EMS arrived. Of those146 who were still alive when EMS arrived, 57 (39%) were transported, and 89 (61%) did not survive to be transported.Thus, out of 300 ultimately fatal cases with EMS response, only 57 (19%) remained alive long enough to be transported but died during transport or at the emergency room. This outcome is likely due to a combination of the high number of cases withfentanyl as a cause of death and individuals using alone. Fentanyl acts more quickly than other opioids, and there is less timefor bystanders to find an overdose victim alive, administer naloxone, and call 911.

Table 9. Incident CHARACTERISTICS among suspected and confirmed fatal overdoses
 Jan–Dec 2023
Est. N = 606
2024 Jan–Sep
Est. N = 372
 Sep 2024
Est. N = 34
EMS response alone366%318%412%
Law enforcement alone12020%7119%824%
EMS and law enforcement44373%26972%2265%
Private transport to Emergency Dept.51%00%00%
Naloxone administration reported at the scene15526%9826%721%
Bystander only administered396%3910%13%
Law enforcement only administered152%82%26%
EMS only administered437%329%412%
EMS and law enforcement administered102%10%00%
EMS and bystander administered305%72%00%
Law enforcement and bystander administered81%41%00%
EMS, bystander, and law enforcement administered41%10%00%
Naloxone administered by unspecified person30%21%00%
History of prior overdose20534%12233%1544%

Key drug categories and combinations causing overdose deaths

Table 10 displays the frequencies of the most prominent drug categories causing death among confirmed drug deaths. As expected, within the confirmed drug death cases so far in 2024, nonpharmaceutical fentanyl was the most frequent cause of death, mentioned on the death certificate of 252 (74%) victims.

Fentanyl is nearly always found in combination with multiple other drugs. Heroin involvement, declining rapidly in recentyears, was reported as a cause of death in 11 (3%) of 2024 year-to-date deaths and 12 (2%) of 2023 deaths. Xylazine and nonpharmaceutical tramadol were identified as co-intoxicants with fentanyl for the first time in 2021. Among 342 confirmed deaths in 2024, there were 47 cases (14%) with xylazine listed in addition to fentanyl as a cause of death, and 1 case (<1%) with tramadol listed along with fentanyl.

Stimulants continue to increase as a cause of death, usually in combination with other drugs, particularly fentanyl. Cocaine-involved fatalities constituted 150 (44%) of confirmed cases so far in 2024, higher than 2023 (37%) and an increase from 29% in 2022. Fentanyl is mentioned as a cause in combination with cocaine in 117 cases, 78% of 2024 year-to-date cocaine cases. Methamphetamine was cited as a cause of death in 129 (38%) of the confirmed fatal overdoses so far in 2024, higher than in 2023 (33%); 102 (79%) of the methamphetamine deaths also involved fentanyl as a co-intoxicant cause of death. Cocaine and methamphetamine are named together on 35 (9%) death certificates in 2024, in most of those cases (29, 83%) as co-intoxicants of fentanyl.

Cause of death (alone or in combination with other drugs) Sample size for confirmed cases onlyJan–Dec 2023 
Est. N = 606
Jan–Sep 2024 
Est. N = 342
 Sep 2024 
Est. N = 16
Fentanyl or fentanyl analogs47278%25274%1275%
Heroin122%113%16%
Cocaine22637%15044%1275%
Methamphetamine19933%12938%638%
Pharmaceutical opioids**10818%5416%16%
Fentanyl and heroin122%113%16%
Fentanyl and cocaine19232%11734%956%
Fentanyl and methamphetamine16327%10230%638%
Fentanyl and xylazine6010%4714%16%
Fentanyl and tramadol30%10%00%

The Role of Community Coalitions in Maine’s Opioid Response Plan

As Maine’s overdose rate, both fatal and non-fatal, continues to decline, the positive role of community coalitions cannot be over-stated.  Since 2018, there has been a significant increase in the number of communities/counties which have formed robust coalitions to address substance use disorder (SUD) in their communities.  A recent review showed that at least twenty such coalitions are active across the state.  While a complete listing is beyond the scope of this Highlight note, some of the more active coalitions include the following:

Cumberland County Coalition on Substance Use Prevention (CCCSUP)

Lewiston Auburn Area Recovery Collaborative (LAARC)

Washington County Substance Use Response Collaborative (SURC)

Somerset County Substance Use Task Force (SCSUTF)

Maine Re-entry Network (MERN)

Waldo County Recovery Committee

Western Maine Addiction Recovery Initiative (WMARI)

Downeast Substance Treatment Network (DSTN)

Bangor Area Recovery Community Coalition

Greater Bangor Leadership Board (GBLB)

Knox County Recovery Collaborative

Midcoast Recovery Alliance

Rural York County Consortium

Choose to be Healthy and Youth Resilience Coalition (York County)

Healthy Community Coalition (Franklin)

Race to Recovery Consortium 

River Valley Recovers Strong (Oxford County)

While no two coalitions are exactly alike, there are several features that most of the coalitions share:  (1) They are homegrown and made up primarily of local citizens, many of whom are in recovery or are recovery allies who have family members or friends with SUD; (2) They engage in weekly, bi-weekly, monthly or quarterly meetings, frequently via zoom but many also meet in person; (3) They engage in many community activities which are educational and help to break down the stigma all too frequently associated with SUD. 

Many of the coalitions have been instrumental in establishing recovery community centers in their region.  Perhaps there is no better example of this phenomenon than the Western Maine Addiction Recovery Initiative, established in 2019, which successfully applied for grants allowing it to open Hills Recovery Center in Norway in 2023.  The Center held a grand opening attended by Governor Mills and other state and regional leaders and has been active ever since hosting 12 step meeting, community events and offering recovery coaching. 

Strategy 3 in the state’s Opioid Response Strategic Action Plan calls upon the state to support community-based and faith-based organizations and networks, prioritizing populations that are disproportionately impacted by substance use disorder and opioid use disorder.  Strategy 31 calls for increasing the availability of recovery coaching services while Strategy 34 calls upon the state to promote stories of connection, hope, and recovery in Maine communities.  The activities implementing these three strategies are supported by these coalitions.

Hundreds of individuals are part of the opioid response effort through the work of these coalitions.  The state will continue to evaluate the work of these important groups and will invest in them to ensure their long-term sustainability.  While appropriate and compassionate state and federal drug policies can help, lives are saved at the community level.  And these community coalitions and their accompanying recovery community centers, are making a difference every day.

Gordon Smith

Director of Opioid Response