Monthly Overdose Report

Download the entire report here: Maine Monthly Overdose Report for January 2021

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 January 2021

The January 2021 total of 58 drug overdoses consists of 29 confirmed drug deaths and 29 suspected drug deaths. The graph below shows the considerable monthly fluctuation over the past year. Although the 2020 average is 42, the range extends from 34 to 53. The high January 2021 number of 58 fatal drug overdoses can be expected to decline in February 2021. For more information regarding definitions of fatal overdoses, including data collected and case completion timelines see the full report. The increase in overdose deaths in 2020 is related to effects of the COVID-19 pandemic, and the increase is seen nationally. For more information on the effects of COVID-19 on fatal overdoses see the Health Alert Network, Increase in Fatal Drug Overdose Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic.

Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for January 2021.


Distribution of drug deaths by Maine county

The following table shows the frequency distribution of deaths at the county level. The January 2021 totals can be compared either to the percent of the census population on the left or the percent of all Maine drug deaths for 2020 on the right. Caution must be exercised with these small numbers. They are likely to fluctuate randomly, without any significant statistical meaning. In general, the percentages for January accord with both the 2020 patterns and the census distribution.

CountyPercent of 2019
Census Population
January 2021
Est. N=58
Jan-Dec 2020
Est. N=503
Androscoggin8%8.(14%)51.(10%)
Aroostook5%0(0%)17(3%)
Cumberland22%12.(21%)98.(19%)
Franklin2%0(0%)8(2%)
Hancock4%2(3%)13(3%)
Kennebec9%6.(10%)48.(10%)
Knox3%0(0%)17(3%)
Lincoln3%3(5%)9(2%)
Oxford4%3(5%)14(3%)
Penobscot11%8.(14%)94.(19%)
Piscataquis1%1(2%)10(2%)
Sagadahoc3%1(2%)7….(1%)
Somerset4%1(2%)13(3%)
Waldo3%3(5%)9(2%)
Washington2%2(3%)20..(4%)
York15%9.(16%)75.(15%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for January 2021.

Age and gender composition of decedents

The following table displays the age and gender composition of the monthly fatal overdose population. The larger number of males at 62% is slightly lower than most of Maine’s drug death periods in the past, which are closer to 70%, but can be expected to trend toward the 2020 average. The age distribution is clustered in two middle categories from 18-39 and 40-59. There are no decedents that were under 18, and few over 60.

January 2021
Est. N=58
Jan-Dec 2020
Est. N=503
Percent Males36.(62%)356..(71%)
Percent under 180….(0%)1..(<1%)
Percent 18-3920.(34%)213.(42%)
Percent 40-5930.(52%)235.(47%)
Percent 60+8..(14%)52.(10%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for January 2021.

Basic incident patterns in fatal overdoses

The following table highlights some event characteristics among suspected and confirmed overdoses. Similar to 2020, in January 2021, both EMS and police responded to most fatal overdoses, 75%. Law enforcement is more likely to respond to a scene alone than EMS. The overwhelming majority of January drug overdoses were ruled as accidental manner of death. Naloxone was administered to 21% of the victims, mostly by EMS (13%). Unfortunately, many victims have already died before first responders arrive. Further, non-opioid drugs will not respond to naloxone administration. In the future, this monthly report will tally how many decedents have bystanders present at the time of death.

January 2021
Est. N=58
Jan-Dec 2020
Est. N=503
EMS or law enforcement response
……EMS response alone3….(7%)29(6%)
……Law enforcement response alone11..(18%)108.(21%)
……Both EMS and law enforcement45.(75%)361.(72%)
Manner of death (suspected or confirmed)
……Accident57.(95%)456.(91%)
……Suicide1….(2%)33(7%)
……Undetermined0(0%)12(2%)
Naloxone administration12.(21%)74.(15%)
……Bystander only2(3%)11(2%)
……Law enforcement only0(0%)11(2%)
……EMS only8.(13%)42..(8%)
……EMS and law enforcement1(2%)4(1%)
……EMS and bystander1(2%)9..(2%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for January 2021.

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, non pharmaceutical fentanyl is the most frequent cause of death, at 69%, similar to 2020. Heroin involvement has been declining during the last several years, with only one case in January. The stimulants have been increasing in recent years, and in January cocaine-involved fatalities constituted 28% of cases and methamphetamine 31%. Amphetamine is a metabolite of methamphetamine, and is frequently found with it. Fentanyl is found in combination with cocaine in 17% of cases, the same percentage as is fentanyl and methamphetamine. Pharmaceutical opioids were found in only four cases, 14%, all in combination with other drugs.

Cause of death (alone or in
combination with other drugs)
January 2021
N=29
Jan-Dec 2020
N=501
Nonpharmaceutical opioids
……Fentanyl or fentanyl analogs20.(69%)337.(67%)
……Heroin1(3%)53..(11%)
Nonpharmaceutical Stimulants
……Cocaine8.(28%)119.(24%)
……Methamphetamine/amphetamine9.(31%)102.(20%)
Pharmaceutical opioids4.(14%)119.(24%)
Key combinations
……Fentanyl and cocaine5.(17%)97.(19%)
……Fentanyl and methamphetamine/amphetamine5.(17%)72.(14%)
Source: Maine Office of the Attorney General and Maine Office of Behavioral Health, Maine Monthly Overdose Report for January 2021.

Five partially overlapping metrics that estimate the number of nonfatal overdoses in a given month

There is not a precise way to calculate nonfatal overdoses. Several metrics can be used to estimate numbers of nonfatal overdoses from different perspectives (see the chart below). This includes, for example, counting the number of responses by EMS in which the EMT or paramedic suspects an overdose and administers naloxone. However, many persons involved with an overdose event do not call 911. One syringe access program in Maine estimates that as many as 74% of overdose events do not include a 911 call. Put another way, the 911 calls may represent only 26% of the overdoses, whereas 74% constitute “private overdoses.” Some of these persons will unfortunately die. In about 15% of EMS overdose cases, the patient is revived, but refuses to be transported to the emergency room. Some may receive naloxone, but are found later not to have had an overdose, but were unconscious or had stopped breathing for another reason.

Metrics frequently used to estimate overdose numbersUnduplicated monthly estimate based on 4th quarter 2020
Number of EMS runs in which naloxone was administered1105
Number of emergency department visits likely involving a drug overdose2277
Number of overdose reversals reported by community naloxone distributors and users of the OD-ME app, minus the number of fatal overdoses in which bystanders administered naloxone (163-2=161)3161
Number of incidents in which law enforcement administered naloxone.421
1.) Sources: Maine EMS; Maine Office of Chief Medical Examiner. 2) Source: Maine CDC, Syndromic Surveillance. 3.) Sources: Maine Naloxone Distribution Initiative, OD-ME Mobile App. 4) Sources: Maine Office of the Attorney General; OD MAP Initiative.

Highlight of the month regarding substance use disorder public policy response

The Overdose Prevention Through Intensive Outreach Naloxone and Safety (OPTIONS) initiative (website: https://knowyouroptions.me) aims to improve the health of Mainers using substances through harm reduction strategies, helping them on the road to recovery, and dramatically reducing the number of fatal and nonfatal overdose deaths.

The OPTIONS Public Health Campaign

Through interviews with over 53 state and community leaders, the OPTIONS public health campaign strives to reflect and amplify the voices of Mainers affected by the opioid epidemic. In doing so, the campaign aims to:

  • Improve the understanding of the Good Samaritan law and increase calls to 9-1-1 for medical assistance in the event of an overdose emergency.
  • Invigorate the Have it on Hand campaign to increase the distribution and availability of life saving naloxone across the state.
  • Educate those at-risk on safer drug use practices that reduce the risk of both fatal and nonfatal overdose.
  • Connect people affected by the opioid epidemic with local prevention, harm reduction, recovery, treatment, and general support resources

For more information about OPTIONS public health campaign contact: Rowland Robinson rowland.robinson@maine.gov

The OPTIONS Liaison Initiative

The OPTIONS liaison initiative embeds licensed behavioral health clinicians within local emergency medical services (EMS) and law enforcement agencies in every county across Maine. Liaisons work alongside their first responder counterparts to:

  • Engage in post-overdose followup and help with referrals.
  • Conduct proactive outreach with at-risk communities.
  • De-escalate behavioral health crises when possible.
  • Provide short-term counseling interventions when appropriate.

Each OPTIONS liaison serves the entire county in which they are located. As part of the OPTIONS liaison initiative, the Office of Behavioral Health and the Maine Center for Disease Control and Prevention are working to better integrate the varying levels of support services in each county. These services include Syringe Access Programs, naloxone distribution, Recovery Centers, medication-assisted treatment providers, food and housing support among others.

For more information about the OPTIONS liaison program contact: Sybil Mazerolle sybil.mazerolle@maine.gov

OPTIONS Liaisons listed by county. (Note that the OPTIONS program is currently being implemented. This list will be updated as liaisons come on board.)

CountyLiaisonEmail
AndroscogginDave Bilodeaudbilodea@tcmhs.org
KennebecJasmine Danielsjdaniels@crisisandcounseling.org
OxfordGlenn Gordonglenn.gordon@ocmhs.org

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.