Download the entire PDF report here: Maine Monthly Overdose Report for October 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 October, the proportion of fatal overdoses averaged 7.9% 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 8.1% in April. So far for 2022, the total number of overdoses January – October is 4.8% higher than during January – October 2021 (9.0% fatal and 4.5% nonfatal). During the period January – October 2022, fatal overdoses comprised 6.7% of all overdoses, just slightly higher than the 6.4% for the first ten months of 2021.
From January 2022 to October 2022, there were an estimated 8,488 fatal and nonfatal drug overdoses statewide, of which 565 (6.7%) were suspected and confirmed fatal overdoses. The remaining 7,923 (93.3%) were nonfatal overdoses: 3,717 (43.8%) emergency department visits; 2,319 (27.3%) EMS patents who were not transported to the emergency room, 1,800 (21.2%) reversals reported by community members to the Maine Naloxone Distribution Initiative, and an estimated 87 (1.0%) 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 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 | 165 | 127 | 18 | 634 |
| February ’21 | 41 | 277 | 120 | 100 | 5 | 543 |
| March ’21 | 58 | 329 | 177 | 156 | 15 | 735 |
| April ’21 | 46 | 334 | 191 | 136 | 6 | 713 |
| May ’21 | 47 | 409 | 165 | 100 | 3 | 724 |
| June ’21 | 54 | 411 | 223 | 189 | 11 | 888 |
| July ’21 | 44 | 482 | 227 | 167 | 20 | 940 |
| August ’21 | 50 | 428 | 237 | 222 | 12 | 949 |
| September ’21 | 59 | 473 | 237 | 276 | 7 | 1,052 |
| October ’21 | 65 | 383 | 250 | 208 | 17 | 923 |
| November ’21 | 61 | 308 | 226 | 195 | 10 | 800 |
| December ’21 | 52 | 344 | 201 | 176 | 4 | 777 |
| 2021 Total | 631 | 4,448 | 2,419 | 2,052 | 128 | 9,678 |
| 2021 Total % | 6.5% | 46.0% | 25.0% | 21.2% | 1.3% | 100% |
| January ’22 | 44 | 296 | 206 | 178 | 5 | 729 |
| February ’22 | 48 | 333 | 185 | 153 | 8 | 727 |
| March ’22 | 65 | 457 | 201 | 202 | 7 | 932 |
| April ’22 | 59 | 290 | 178 | 189 | 9 | 725 |
| May ’22 | 46 | 402 | 248 | 186 | 12 | 894 |
| June ’22 | 66 | 482 | 250 | 177 | 12 | 987 |
| July ’22 | 64 | 348 | 287 | 170 | 8 | 877 |
| August ’22 | 61 | 385 | 271 | 241 | 12 | 970 |
| September ’22 | 54 | 451 | 256 | 140 | 10 | 911 |
| October ’22 | 58 | 273 | 237 | 164 | 4 | 736 |
| 2022 Total | 565 | 3,717 | 2,319 | 1,800 | 87 | 8,488 |
| 2022 Total % | 6.7% | 43.8% | 27.3% | 21.2% | 1.0% | 100% |
Number of suspected and confirmed fatal overdoses
Fatal Drug Overdoses in Maine October 2022
Fatal Drug Overdoses in Maine January – October 2022
During the first ten months of 2022, the proportion of fatal overdoses averaged 6.7% of total overdoses. From January to October 2022 there was a total 565 fatal drug overdoses consisting of 505 confirmed and 60 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 (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 8.1% in April. The proportion of fatalities in January – October 2022 (565) is 9.1% higher than the first ten months of 2021 (518) 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-Oct 2022 Est. N=565 | Oct 2022 Est. N=58 |
|---|---|---|---|---|---|---|
| Androscoggin | 8% | 33…….(9%) | 52.(10%) | 69…..(11%) | 53 (9%) | 5 (9%) |
| Aroostook | 5% | 14…….(4%) | 17…(3%) | 39……(6%) | 38 (7%) | 6 (10%) |
| Cumberland | 22% | 100…..(26%) | 97.(19%) | 114….(28%) | 108 (19%) | 6 (10%) |
| Franklin | 2% | 5……..(1%) | 8…(2%) | 8…….(1%) | 12 (2%) | 0 (0%) |
| Hancock | 4% | 9…….(2%) | 13…(3%) | 22……(3%) | 15 (3%) | 0 (0%) |
| Kennebec | 9% | 42……(11%) | 49.(10%) | 64….(10%) | 45 (8%) | 4 (7%) |
| Knox | 3% | 7…….(2%) | 16…(3%) | 11……(2%) | 16 (3%) | 2 (3%) |
| Lincoln | 3% | 11…….(3%) | 9…(2%) | 16……(3%) | 11 (2%) | 2 (3%) |
| Oxford | 4% | 9…….(2%) | 15…(3%) | 28……(4%) | 28 (5%) | 8 (14%) |
| Penobscot | 11% | 53…..(14%) | 94.(19%) | 106…..(17%) | 85 (15%) | 11 (19%) |
| Piscataquis | 1% | 3…….(1%) | 10…(2%) | 11……(2%) | 8 (1%) | 2 (3%) |
| Sagadahoc | 3% | 8……(2%) | 8….(1%) | 7……(1%) | 7 (1%) | 0 (0%) |
| Somerset | 4% | 16……(4%) | 13…(3%) | 26…..(4%) | 28 (5%) | 2 (3%) |
| Waldo | 3% | 3…….(1%) | 9…(2%) | 15…..(2%) | 17 (3%) | 2 (3%) |
| Washington | 2% | 10……(3%) | 20..(4%) | 25…..(4%) | 16 (3%) | 2 (3%) |
| York | 16% | 57….(15%) | 74.(15%) | 70….(11%) | 78 (14%) | 6 (10%) |
Race, ethnicity, and other demographic indicators of decedents
During January – October of 2022, out of 562 confirmed and suspected fatal overdoses for which race was reported, 528 (94%) of the victims were identified as White, 13 (2%) as Black or African American, 9 (2%) as American Indian/Alaska Native, and 1 (<1%) Hawaiian/Pacific Islander. Out of the 550 fatal overdoses for whom ethnicity was reported, 543 (99%) were reported as not Hispanic, and 7 (1%) were identified as Hispanic. Out of the 564 cases for which military background was reported, 46 (8%) were identified as having a military background. Prior overdose history was reported for 222 (39%) of the victims. Transient housing status was reported for 63 (11%) of the victims. The largest totals of undomiciled persons (January – October 2022) were found in Cumberland County (25, 40%), and Penobscot County (17, 27%).
| Demographic Indicator | % of 2020 Census Population | Jan-Dec 2021 Est. N=627 Race N=621 Ethnicity | Jan-Oct 2022 Est. N=562 Race N=550 Ethnicity |
|---|---|---|---|
| Race and Ethnicity | |||
| White | 91% | 585 (93%) | 528 (94%) |
| Black or African American | 2% | 21 (3%) | 13 (2%) |
| American Indian/Alaska Native | 1% | 14 (2%) | 9 (2%) |
| Other race, 2+ races combined, non-hispanic | 7% | 7 (1%) | 10 (2%) |
| Not Hispanic | 98% | 611 (99%) | 543 (99%) |
| Hispanic | 2% | 10 (2%) | 7 (1%) |
| Military Background | 46 (8%) | ||
| Prior Overdose History | 222 (39%) | ||
| Undomiciled/Transient Housing Status | 63 (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 ten months of 2022. The cumulative age distribution in January – October 2022 compared to 2021 shows 1 fewer decedent under age 18, a 2 percentage point increase in the proportion of those aged 18-39, a 3 percentage point decrease in those aged 40-59, and a 2 percentage point 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-Oct 2022 Est. N=565 | Oct 2022 Est. N=58 | |
|---|---|---|---|---|---|---|
| Percent Males | 49% | 258..(68%) | 357…(71%) | 451.(71%) | 414…(73%) | 44 (76%) |
| Percent under 18 | 19% | 0….(0%) | 2…(<1%) | 2..(<1%) | 1…..(<1%) | 0 (0%) |
| Percent 18-39 | 26% | 171..(45%) | 213..(42%) | 247.(39%) | 229…(41%) | 21 (36%) |
| Percent 40-59 | 27% | 175..(46%) | 235..(47%) | 316.(50%) | 265..(47%) | 29 (50%) |
| Percent 60+ | 29% | 33….(9%) | 54…(11%) | 66..(10%) | 70…..(12%) | 8 (14%) |
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 ten months of 2022. In the first ten 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, 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, but 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 458 suspected and confirmed drug death cases with EMS records during January – October of 2022, 245 (53%) of victims were already deceased when EMS arrived. In the remaining 213 (47%) cases, resuscitation was attempted either at the scene or in the ambulance during transport to the emergency room. Of those 213 who were still alive when EMS arrived, only 66 (31%) remained alive long enough to be transported but died during transport or at the emergency room and 147 (69%) 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-Oct 2022 Est. N=565 | Oct 2022 Est. N=58 | |
|---|---|---|---|---|
| Public safety response | ||||
| ……EMS alone | 28…(6%) | 30….(5%) | 27….(5%) | 2 (3%) |
| ……Law enforcement alone | 107.(21%) | 104..(16%) | 104…(18%) | 11 (19%) |
| ……EMS and law enforcement | 365.(72%) | 485..(77%) | 431…(76%) | 45 (78%) |
| ……Private transport to the Emergency. Dept. | — | 7….(1%) | 2…..(<1%) | 0 (0%) |
| Naloxone administration | ||||
| Naloxone administration reported at the scene | 83.(22%) | 187..(30%) | 139..(25%) | 6 (10%) |
| ……Bystander only | 11…(2%) | 36….(6%) | 35…(6%) | 3 (5%) |
| ……Law enforcement only | 8…(2%) | 22….(3%) | 23….(4%) | 0 (0%) |
| ……EMS only | 55..(11%) | 84..(13%) | 40….(7%) | 3 (5%) |
| ……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…(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, for those 505 cases in 2022, nonpharmaceutical fentanyl was the most frequent cause of death mentioned on the death certificate at 399 (79%), this is a slightly higher than the rate in 2021 (77%) and 12 percentage points 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 – October constituted 29% of cases, a slight increase from 25% in 2021 and 23% in 2020. Fentanyl is found as a co-intoxicant with cocaine in 82% 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 505 confirmed deaths in 2022 the number and percent of cases with xylazine listed as an additional cause in fentanyl deaths is 31 (6%) of confirmed overdose deaths, and 8 (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-Oct 2022 N=434 | *Oct 2022 N=5 |
|---|---|---|---|---|
| Nonpharmaceutical opioids | ||||
| ……Fentanyl or fentanyl analogs | 336.(67%) | 489..(77%) | 399..(79%) | 4 (80%) |
| ……Heroin | 57..(11%) | 22….(3%) | 13….(3%) | 0 (0%) |
| Nonpharmaceutical Stimulants | ||||
| ……Cocaine | 118.(23%) | 156..(25%) | 146.(29%) | 0 (0%) |
| ……Methamphetamine | 99.(20%) | 172..(27%) | 161.(32%) | 2 (40%) |
| Pharmaceutical opioids** | 118.(23%) | 130..(21%) | 103..(20%) | 0 (0%) |
| Key combinations | ||||
| ……Fentanyl and heroin | 47…(9%) | 20….(3%) | 13….(3%) | 0 (0%) |
| ……Fentanyl and cocaine | 97.(19%) | 127..(20%) | 100..(24%) | 0 (0%) |
| ……Fentanyl and methamphetamine | 70.(14%) | 133..(21%) | 130..(26%) | 0 (0%) |
| ……Fentanyl and xylazine | 0…(0%) | 53….(8%) | 31….(6%) | 2 (40%) |
| ……Fentanyl and tramadol | 0…(0%) | 24….(4%) | 8….(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
The Role of Recovery Community Centers in Maine’s Opioid Response Strategic Plan
Maine’s seventeen Recovery Community Centers play a pivotal role in Governor Janet T. Mills’ Opioid Response Strategic Action Plan. Strategy 3 under Priority A commits the state to: Support local andregional community engagement efforts. Subsection a. includes supporting the growth and sustainability of Recovery Community Centers. Since the Plan was initially adopted in the Fall of 2019, the number of Recovery Community Centers has doubled with additional centers about to open in Farmington, Sanford and Piscataquis County. Within a few months, the state plans to be supporting financially, at some level, at least one such Center in each county, consistent with legislation passed in 2021 requiring the state to prioritize for funding any county which does not have a state-assisted center.
The Bangor Area Recovery Network (BARN) in Brewer was Maine’s first recovery community center when it opened its doors more than a decade ago. It’s mission is to provide peer-based services, education, outreach and advocacy. It offers a safe haven for those seeking recovery, their loved ones and their communities. Recovery community centers are free to anyone and support all recovery pathways. In Maine, The Portland Recovery Community Center operates as a hub and assists most of the other centers in the state. As described in Alison Webb’s recent book, Recovery Allies (2022 North Atlantic Books), recovery centers are recovery sanctuaries that provide recovery coaching, telephone support, skill development like relapse protection and naloxone trainings. RCCs are also safe spaces with access to computers and the internet, links to employment and job training opportunities, volunteer opportunities in the community and recovery housing (where available). They host group meetings, including 12-step meetings. And they are hubs of substance free recreational and social events.
Recovery Community Centers come in all sizes and shapes and take on many of the characteristics of the communities they serve. Some host only a few events a month and do not have a large amount of traffic in and out. But others, such as PRCC and the BARN, welcome hundreds of people a week and host thousands of programs and events in a year. Most importantly, these centers provide a welcome space for persons in early recovery and provide support for these individuals, many of whom later train to become recovery coaches and volunteers or paid staff at the center. The centers also play an important role in breaking down the stigma too commonly associated with substance use disorders.
Support for recovery community centers and their activities will continue to receive regcognition and support in Governor Mills’ Opioid Response Strategic Plan.