During the first quarter of 2020, total fatalities from drugs are 23% higher than the fourth quarter of 2019: 127 compared to 103. The estimated total for the second quarter is 132, with a total of 259 estimated for the first half of 2020. The overall increase, comparing 2019 and the estimate for the first half of 2020, is statistically significant.

It is comparable to increases being seen nationally, which are attributed to the effects of the pandemic, including social isolation, economic difficulty and reluctance to seek medical attention. Interruptions in drug supplies internationally have resulted in substitutions and combinations that may be contributing to additional vulnerabilities to overdose.

Opioids, both pharmaceutical and nonpharmaceutical, were implicated in 82% of first quarter deaths.

Nonpharmaceutical fentanyl drugs in particular were implicated in 61% of deaths, and 68% of opioid deaths, which is a reduction since 2019, when fentanyl caused 68% of all drug deaths, and 81% of opioid deaths. Most first quarter deaths, which is 80%, involved two or more drugs listed as a cause of death.

Nonpharmaceutical opioid deaths were very likely to have co-intoxicant stimulants, cocaine or methamphetamine, increasing since 2019. Pharmaceutical opioids caused 27% of deaths, many in combination with nonpharmaceutical opioids. About a third of opioid deaths (34%) received naloxone, a higher number but the same proportion as in the fourth quarter 2019 (34%).

Using data from April and May as an estimate for the second quarter, the same general patterns continue from the first quarter, but with a higher proportion of deaths involving two or more drugs (87%), a higher proportion of deaths due to opioids (86%), and a higher proportion of deaths due to nonpharmaceutical fentanyl and its analogs (71%).

There is a rise in the proportion of deaths including cocaine as a cause of death, 36% compared to 30% in the first quarter, but a lower proportion caused by methamphetamine, which is 12% compared to 16%.

Pharmaceutical opioids were implicated in 24% of deaths, slightly lower than 27% in the first quarter; they were frequently in combination with nonpharmaceutical opioids. Naloxone was present in 35% of the opioid deaths, approximately the same proportion as the first quarter.

Manners of death:

Of these 127 deaths, 114 were accidental overdoses and 10 were suicides.

Overall patterns:

• Most (80%) drug deaths were caused by two or more drugs, which is greater in number and less in proportion than the fourth quarter 2019 (91%). The average cause of death involved three drugs.

• The vast majority of overdoses (82%) were caused by at least one opioid, including both pharmaceutical and illicit (nonpharmaceutical) opioid drugs. This is greater in number and nearly the same proportion as in the fourth quarter 2019 (83%).

• Nonpharmaceutical fentanyl (and/or its analogs) caused 77 (61%) deaths, alone or in combination with other drugs, which is higher in number but much lower in proportion than the fourth quarter of 2019 (70%).

• Heroin/morphine caused 18 (14%) deaths, in combination with other drugs, which is about the same in number but lower in proportion than fourth quarter 2019 (17%).

• Cocaine or crack caused 38 (30%) deaths, in combination with other drugs, which is higher in number but about the same proportion compared to fourth quarter 2019 (29%).

• Methamphetamine caused 20 (16%) deaths, in combination with other drugs, which is slightly higher in number and slightly lower in proportion compared to fourth quarter 2019 (17%).

• Pharmaceutical opioid deaths caused 34 (27%) deaths, alone or in combination with other drugs, which is higher in number and about the same proportion as in fourth quarter 2019 (26%).

• Naloxone was given in 35 (28%) opioid deaths, which is higher in number and the same proportion as in fourth quarter 2019 (28%).

• There has been an increase in the involvement of mitragynine-2 (“Kratom”) in Maine deaths, five in this quarter, compared with one in the fourth quarter 2019, and 10 in 2019 as a whole.

Nonpharmaceutical Fentanyl and/or Fentanyl Analog Deaths

This category includes deaths caused by nonpharmaceutical – illicitly manufactured – fentanyl or fentanyl analogs. All cases that involved known pharmaceutical fentanyl from these totals were removed. There were 77 overdoses due to nonpharmaceutical fentanyl and/or fentanyl analogs in the first quarter of 2020.

The total has risen sharply beginning in the fourth quarter of 2013 (Figure 2). The gender distribution for first quarter 2020 is 59 (77%) male and 18 (23%) female. The average age is 40, in an age range consideration of 21 to 65).

Heroin/Morphine Deaths

Heroin/morphine deaths include any death in which the cause of death identifies “heroin” or “morphine.” All cases involving known pharmaceutical morphine were removed, so the heroin/morphine deaths are all suspected heroin overdoses.

In the first quarter of 2020 there were 18 deaths due to (nonpharmaceutical) heroin/morphine alone or in combination with other drugs, 14% of all drug deaths. In the fourth quarter of 2019 there were 17 heroin deaths, 16% of all drug deaths.

Stimulants Cocaine and Methamphetamine

Deaths involving the illicit stimulants cocaine and methamphetamine have been increasing in the past few years (Figure 3). The vast majority of these deaths also include co-intoxicant nonpharmaceutical opioids fentanyl, fentanyl analogs, or heroin.

In the first quarter of 2020 there were 38 cocaine deaths; of these, 29 (76%) were caused by cocaine in combination with nonpharmaceutical fentanyl. Likewise, during the first quarter of 2020, there were 34 methamphetamine deaths; of these, 16 (80%) were caused by methamphetamine in combination with nonpharmaceutical fentanyl.

Pharmaceutical Opioids

The frequency of deaths in which at least one pharmaceutical opioid is mentioned on the death certificate as a cause of death has declined slightly over the past decade, although there was a slight increase between fourth quarter 2019 and first quarter 2020, from 27 to 34 (see Figure 4).

Of the 34 pharmaceutical opioid death cases, 18 (53%) had a current prescription for one of the opioids listed as a cause of death. Key pharmaceutical opioids included buprenorphine (32%), oxycodone (29%), and methadone (18%).

All of the pharmaceutical opioid deaths included other drugs or alcohol listed as a co-intoxicant cause of death. Most had three or more. Half (17, 50%) had at least one illicit drug listed as a cause of death.

About one third (32%) included nonpharmaceutical fentanyl, and about a fifth (21%) included cocaine.

County Totals

The table provides totals for counties during the first three months of 2019. The reader is cautioned that, because the numbers for individual counties are relatively small, fluctuations are likely to be due more to random fluctuations than to actual changes in underlying epidemiological trends.