A preliminary estimate of drug-related deaths indicates 636 people died in Maine as a result of drug overdoses in 2021, a 23% increase from the previous year. According to Marcella Sorg, a research professor at the University of Maine’s Margaret Chase Smith Policy Center, that number may change because of delays caused by COVID-19 and because of a 10-week delay in the processing of toxicology results.
Sorg briefed the Maine Legislature’s Health and Human Services Committee on January 18. According to Sorg, preliminary numbers indicate fentanyl was present in 590, or 77%, of documented drug-related deaths. That number includes suicides and deaths that occurred as a result of unknown causes, which comprise approximately 10% of deaths. It is an increase from 2020, when fentanyl was present in 336, or 67% of drug-related deaths.
According to Sorg, most deaths are induced by opioids, either alone or in combination with other drugs. In the average drug-related death, three different substances are present. Of the 258 accidental overdoses recorded between January and June 2021, all had one or more types of opioid listed and 88% had fentanyl listed.
Sorg provided four primary reasons why Maine is experiencing an increase in deaths. She named fentanyl, an increase in isolation made worse by the pandemic, international drug trafficking that is resistant to Maine’s anti-drug policies and workforce shortages as playing a role in the increased number of deaths.
According to Sorg, Maine, which is seeing the percent of drug deaths due to fentanyl increase, reflects the national trend. Sorg also noted that deaths are a biased sample for evaluating substance abuse disorder (SUD) because lethal drugs are overrepresented.
Nor are they the best outcome to measure the success or failure of state SUD programs. According to Sorg, the supply of many different types of drugs is spiked with fentanyl, which is easier to manufacture than heroin and requires less to get the same opioid effect, and many users are not aware they are ingesting it.
Fentanyl is also more lethal than other drugs and faster acting. According to Sorg, many people who die from a fentanyl overdose due so accidently and because of its lethality. Fentanyl is more toxic in smaller amounts, making it easy to misjudge the dosing, and faster acting than many types of drugs. Sorg noted that many fentanyl overdose deaths occur before the individual is able to remove the needle from their arm.
Fentanyl overdoses also produce a unique symptom, called wooden chest syndrome, which can prevent resuscitation. According to Sorg, many drug users also use drugs in isolation, which can make discovery and rescue too late in the case of fentanyl deaths and prevent naloxone from being administered.
Sorg noted that distributors of naloxone have reported the pandemic has impacted drug overdoses by reducing social supports, increasing psychological stressors and reducing access to treatment. Increased reliance on telehealth during the pandemic may also have played a role, as marginalized populations often can’t access these services.
Isolation also reduced opportunities for bystanders to intervene and prevent overdoses. Limitations on the drug supply have also resulted in people taking riskier substances. And, finally, according to Sorg, the public safety workforce has been reduced.
But Sorg also said the news on drug overdoses is “not all bad.” Intervention saves lives in overdose cases 93% of the time. Maine’s emergency response and distribution of naloxone has also improved. In 2021, the Maine Naloxone Distribution Initiative distributed 77,480 doses between January and November.
Sorg also noted that the data is limited. The prevalence of SUD in Maine is unknown, but the best available evidence, taken from the National Survey of Drug Use and Health conducted in 2019, suggests it’s about 8.6% of the state’s population, or around 119,000 people.
According to Sorg, the data regarding what drugs are being used in nonfatal overdoses is also unknown. She further noted it is safe to assume deaths are not a representative sample of generalized drug use and that, as a result, drug death statistics are not a valid way to measure the effectiveness of SUD policies.
The Maine Drug Data Hub recently began reporting on monthly overdoses. Between January and November of 2021, deaths represented 7% of reported overdoses. During the same time period, 93% of overdose victims were saved.