This report, funded by the Maine Office of Attorney General, provides a summary of statistics regarding drug fatalities in Maine during 2017. Data for the report were collected at the Office of Chief Medical Examiner. A “drug death” is identified when one or more drugs are mentioned on the death certificate as a cause or significant contributing factor for the death. Drug deaths totaled 380 in 2019, a 7% increase over the 354 drug deaths in 2018 but still lower than the 417 peak in 2017

Sorg, Marcella H

English

University of Maine

The University of Maine DigitalCommons@UMaine Health & Public Safety Margaret Chase Smith Policy Center 4-8-2020 Maine Drug Death Report for 2019 Marcella H. Sorg Follow this and additional works at: https://digitalcommons.library.umaine.edu/mcspc_healthsafety This Report is brought to you for free and open access by DigitalCommons@UMaine. It has been accepted for inclusion in Health & Public Safety by an authorized administrator of DigitalCommons@UMaine. For more information, please contact um.library.technical.services@maine.edu.  1 MAINE DRUG DEATH REPORT FOR 2019 Marcella H. Sorg, PhD Margaret Chase Smith Policy Center University of Maine  This report, funded by the Maine Office of Attorney General, provides a summary of statistics regarding drug fatalities in Maine during 2019.  Data for the report were collected at the Office of Chief Medical Examiner. A drug death is identified when one or more drugs are mentioned on the death certificate as a cause or significant contributing factor for the death.   Executive Summary  Drug deaths totaled 380 in 2019, a 7% increase over 354 in 2018, but still lower than the 417 peak in 2017. Of these 380, 84% were caused by opioids, nearly always in combination with other drugs or alcohol. This increase over 2018 was largely driven by a 16% rise in deaths due to non-pharmaceutical drugs, primarily fentanyl, fentanyl analogs, as well as cocaine and methamphetamine. The number of deaths due to non-pharmaceutical opioids with or without co-intoxicant pharmaceutical opioids increased from 200 to 253 (26%), whereas the number due to pharmaceutical opioids without non-pharmaceutical opioids declined from 52 to 48 (8%). The largest impacts are due to drug trafficking from outside the state. Figure 1 highlights changes in the major categories of pharmaceutical opioid versus non-pharmaceutical opioid deaths. Maine has seen a dramatic increase in the involvement of non-opioid illicit drugs in general.  This includes the more recent rise in deaths due to illicit stimulants. Cocaine deaths increased from 90 to 110 (22%) this past year, and methamphetamine deaths from 26 to 47 (81%).  These drugs are usually combined with non-pharmaceutical opioids.  Cocaine was included as a cause of death in 29% of all drug deaths, 34% of fentanyl deaths and 36% of heroin deaths. Methamphetamine was combined with 13% of fentanyl deaths and 18% of heroin deaths.   Figure 1. Comparison of pharmaceutical opioid and non-pharmaceutical opioid trends, alone and in combination  2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019Nonpharm Op without Pharm Op 10 4 7 18 33 54 126 192 228 205 220Pharm Op and Nonpharm Op 2 4 0 10 7 24 31 51 53 26 48Pharm Op Without Nonpharm Op 118 119 108 93 100 87 81 72 71 52 48050100150200250300350400NUMBER OF DEATHS DUE TOPHARMACEUTICAL OPIOIDS VERSUS NON-PHARMACEUTICAL OPIOIDS, ALONE AND IN COMBINATION  2 Overview  • Total: In 2019 there were 380 drug-induced deaths statewide, which is 26 (7%) more than in 2018. Of the 380 total, 318 (84%) deaths were caused by opioids alone or in combination with other drugs and/or alcohol, compared to 283 (80%) in 2018.  This is an increase of 12%, mostly due to illicit drugs: particularly non-pharmaceutical opioids, cocaine and methamphetamine (Figures 2 and 3).  The number of deaths due to non-pharmaceutical opioids rose 16% over last year, and deaths due to pharmaceutical opioids rose 23% (Figure 4). But some deaths in these two categories overlap; there are 48 deaths that were due to pharmaceutical opioids combined with non-pharmaceutical opioids, and 48 that were not. It is important to note that, within those deaths due to pharmaceutical opioids, the subset of deaths due to pharmaceutical opioids that had not been combined with non-pharmaceutical opioids, declined by 8%.  This decline can be seen in Figure 1. Two-thirds (68%) of drug deaths overall are male, and all were 18 or older.  • Manners of death: Of the 380 drug deaths, 341 (90%) were accidental overdoses, 34 (9%) were suicides, and 5 (1%) were certified as undetermined manner of death.   • Overall patterns of note in 2019:  o Most (323, 85%) drug deaths were caused by two or more drugs. This is greater in number and percent than in 2018 (283, 80%). The average cause of death involved three drugs.  o Deaths due to opioids totaled 318 (84%), a 12% increase in number compared to 2018 (283, 80%). o Deaths due to non-pharmaceutical opioids such as illicit fentanyl and heroin totaled 268 (70% of all deaths and 84% of opioid deaths), a 16% increase compared to 2018 levels (231, 65% of all deaths and 82% of opioid deaths).  o Deaths due to pharmaceutical opioids totaled 96 (30% of opioid deaths), a 23% increase in number compared to 2018 (78, 28% of opioid deaths). o Fentanyl and its analogs caused 259 deaths (81% of opioid deaths), a 19% increase in number compared to 2018 (217, 77% of opioid deaths). o Heroin caused 73 deaths (19% of opioid deaths), about the same number as in 2018 (74, 26% of opioid deaths).  o Cocaine-involved deaths totaled 110 (29% of drug deaths), a 22% increase in number compared to 2018 (90, 25% of drug deaths). Cocaine is a co-intoxicant in 34% of fentanyl deaths and 36% of heroin deaths. o Deaths involving methamphetamine totaled 47, an 81% increase from 26 in 2018.  • Demographic patterns:   Table 1. Demographic patterns by manner of death, 2019  Total Average Age Age Range Percent Male All drug deaths 380 43 18-88 257 (68%) Accidents 341 41 18-88 242 (71%) Suicides 34 54 25-86 13 (38%)   3 • County/City frequencies:   Table 2.  Frequency of drug deaths by county and major city, 2019    COUNTY      CITY TOTAL NUMBER (PERCENT) OF OVERDOSE DEATHS 2019 N=380 TOTAL NUMBER (PERCENT) OF OPIOID DEATHS 2019 N=318 PERCENT OF MAINE CENSUS POPULATION 2019 (1,332,813) Androscoggin   33 (9%) 29 (9%) 8%         Lewiston   18 (5%) 17 (5%) 3% Aroostook   14 (4%) 11 (3%) 5% Cumberland 100 (26%) 80 (25%) 22%          Portland 55 (14%) 41 (12%) 5%          South Portland   14 (4%) 14 (4%) 2% Franklin     5 (1%) 5 (2%) 2% Hancock   9 (2%)  6 (2%) 4% Kennebec 42 (11%) 33 (10%) 9%          Augusta 14 (4%) 9 (2%) 1%         Waterville 11 (3%) 9 (2%) 1% Knox 7 (2%) 6 (2%) 3% Lincoln 11 (3%) 8 (3%) 3% Oxford 9 (2%) 7 (2%) 4% Penobscot 53 (14%) 48 (15%) 11%          Bangor 28 (7%) 27 (8%) 2% Piscataquis 3 (1%) 3 (1%) 1% Sagadahoc 8 (2%) 8 (3%) 3% Somerset 16 (4%) 11 (3%) 4% Waldo 3 (1%) 3 (1%) 3% Washington 10 (3%) 9 (3%) 2% York 57 (15%) 51 (16%) 15%         Biddeford 16 (4%) 15 (5%) 2%         Sanford 8 (2%) 8 (3%) 2%          4 • Involvement of specific drug categories:  Table 3. Frequency of specific drug categories, 2019 Specific drug or drug category causing the death (alone or in combination with other drugs and/or alcohol) Number of Deaths Percent of 380 drug deaths Number of deaths caused by more than one drug 322 85% Any pharmaceutical drug  246 68% Any opioid (pharmaceutical or non-pharmaceutical) 318 84% Naloxone present in the toxicology report*  110 29% Any illicitly manufactured drug (includes heroin/morphine, non-pharmaceutical fentanyl, fentanyl analogs, other illicitly-manufactured opioids, cocaine, methamphetamine, and MDMA)   301   79% Any non-pharmaceutical opioid drugs (heroin/morphine, fentanyl, fentanyl analogs, U-47700, mitragynine).   268  71% Heroin/morphine and/or fentanyl or fentanyl analogs 268 71% Fentanyl and/or fentanyl analogs (known pharmaceutical fentanyl removed) 259 68% Heroin/morphine (known pharmaceutical morphine removed) 61 16% Any pharmaceutical opioid (highest frequency opioids itemized below)      Buprenorphine (8 decedents had current prescription)      Methadone (1 decedent had current prescription-tablets)      Oxycodone (9 decedents had current prescription) 96 32 25 21 25% 8% 7% 6% Any benzodiazepine 84 22% Cocaine 110 29% Methamphetamine 47 12% *Excludes cases with buprenorphine in toxicology.   Pharmaceutical Opioid Deaths  • This category includes deaths caused by opioids that are manufactured by legitimate pharmaceutical companies and available by prescription (Figure 5).  Most deaths (78%) in this category involve drugs that were not currently prescribed to the decedent.  There were 96 overdoses due to pharmaceutical opioids, alone or in combination with other drugs and alcohol.  Of that total, 21 (22%) had a current prescription for the opioid that caused death, dispensed to them within 30 days of death.  There were an additional 7 individuals who had a current prescription for a pharmaceutical opioid, but who died due to a non-pharmaceutical opioid, and their prescription drug was not actually involved in the death.  • Of the 96 deaths due to pharmaceutical opioids, half (48, 50%) also had a non-pharmaceutical opioid listed as a cause.  Of the 21 that died due to a drug for which they had a current prescription 8 (38%) also had a non-pharmaceutical listed as a cause of their death.  • The most common pharmaceutical opioids listed as a cause of death are buprenorphine (32, 33% of the pharmaceutical opioid deaths), methadone (25, 26%), and oxycodone (21, 22%). See Figure 6.  Of the 32 decedents with buprenorphine listed, 8 had a current prescription. Of those 25 who died due to methadone, 1 had a current prescription.  Of those 21 who died due to oxycodone, 9 had a current prescription.       5 Non-pharmaceutical (“Illicit”) Fentanyl and/or Fentanyl Analog Deaths  • This category includes deaths caused by non-pharmaceutical (illicitly manufactured) fentanyl or fentanyl analogs. We removed all cases that involved known pharmaceutical fentanyl from these totals. There were 259 overdoses due to non-pharmaceutical fentanyl and/or fentanyl analogs in 2019. This is a 19% increase from 217 deaths in 2018. There were 52 (20%) of the fentanyl and/or analog deaths combined with heroin (see Figure 7), 74 (29%) combined with alcohol, and 88 (34%) combined with cocaine.  • Involvement of co-intoxicant drugs in non-pharmaceutical fentanyl deaths:  Table 4.  Frequency of co-intoxicant drugs involved in fentanyl deaths, 2019   Specific co-intoxicants in addition to fentanyl and/or fentanyl analogs identified as a cause of death    Number Percent of Fentanyl/Fentanyl Analog Deaths N=259 FENTANYL and FENTANYL ANALOG COMBINATIONS   • Fentanyl (with or without fentanyl analogs) 255 99% • Fentanyl analogs (with or without fentanyl) 69 27% • Both non-pharmaceutical fentanyl and at least one fentanyl analog  65  25% CO-INTOXICANTS IDENTIFIED IN FENTANYL and/or FENTANYL ANALOG DEATHS   • One or more drugs (or alcohol) in addition to fentanyl and/or fentanyl analogs   219  85% • One or more pharmaceutical opioids in addition to fentanyl and/or fentanyl analogs  41  16% • Heroin/morphine in addition to fentanyl and/or fentanyl analogs  52  20% • Alcohol in addition to fentanyl and/or fentanyl analogs 74 29% • One or more benzodiazepines in addition to fentanyl and/or fentanyl analogs  45  17% • Cocaine in addition to fentanyl and/or fentanyl analogs 88 34% • Methamphetamine in addition to fentanyl and/or fentanyl analogs  34  13%  • Fentanyl analogs identified:  Table 5.  Frequency of fentanyl analogs identified as a cause of death in 2019   Fentanyl Analog Identified (Some cases had more than one analog.)  Total Number of Cases* Percent of Fentanyl Analog-Involved Deaths N=69 4-ANPP fentanyl 2 3% Acetyl fentanyl 58 84% Carfentanil 3 4% Furanyl fentanyl 1 1% Parafluoroisobutyryl fentanyl 6 9% Valeryl fentanyl 6 9%  6 Heroin/Morphine Deaths   • Heroin/morphine deaths include any death in which the cause of death identifies “heroin” or “morphine.”  We have removed all cases involving known pharmaceutical morphine, so the heroin/morphine deaths are all probable heroin overdoses. In 2019 there were 61 deaths due to (non-pharmaceutical) heroin/morphine alone or in combination with other drugs.  This is a 16% decrease from the 73 heroin/morphine deaths identified in 2018. o 42 (69%) are male and 19 (31%) are female. o Average age of heroin/morphine deaths is 41 (age range 19-71).  • Involvement of co-intoxicant drugs in heroin/morphine deaths:  Table 6. Frequency of co-intoxicant drugs involved in heroin/morphine deaths, 2019   Specific co-intoxicants in addition to heroin/morphine identified on the death certificate as a cause of death    Number Percent of Heroin/Morphine Deaths N=61 One or more drugs (or alcohol) in addition to heroin/morphine   61  100% At least one pharmaceutical opioid in addition to heroin/morphine  17  28% Non-pharmaceutical fentanyl and/or at least one fentanyl analog in addition to heroin/morphine  52  85% Alcohol in addition to heroin/morphine 18 30% At least one benzodiazepine in addition to heroin/morphine 14 23% Cocaine in addition to heroin/morphine 22 36% Methamphetamine in addition to heroin/morphine 11 18%   Deaths Involving the Stimulants Cocaine and Methamphetamine  • Deaths involving cocaine have been rising since 2014 (see Figure 7).  In 2013 there were 10 cocaine deaths.  By 2014 the number had more than doubled to 24. The total has been rising steadily, and reached 110 in 2019, which is 29% of all drug deaths, compared to 90 (25%) of drug deaths in 2018.  Most (88, 80%) of cocaine deaths list at least one non-pharmaceutical opioid as a co-intoxicant; 19 (17%) of cocaine deaths list at least one pharmaceutical opioid as a co-intoxicant.  Cocaine is a co-intoxicant in 34% of fentanyl deaths and 36% of heroin deaths.  • Deaths due to methamphetamine totaled 47, an 81% increase from 26 in 2018. As shown in Figure 7, these totals began rising in 2016.  Most (36, 77%) of methamphetamine deaths list at least one non-pharmaceutical opioid as a co-intoxicant; 10 (21%) of methamphetamine deaths list at least one pharmaceutical opioid as a co-intoxicant.  Methamphetamine is a co-intoxicant in 13% of fentanyl deaths and 18% of heroin deaths.    7  Figure 2.  Number of drug-induced deaths in Maine, with subtotals for deaths caused by any pharmaceutical drugs and for deaths caused by any illicit (non-pharmaceutical) drugs.  Most deaths are caused by more than one drug.  Pharmaceutical and illicit drugs may be combined to cause death.  Note: 2017 total was revised from 418 to 417 subsequent to the release of the 2017 report.    Figure 3.  Number of deaths caused by cocaine and by methamphetamine, alone or in combination with other drugs  345466 6090165153 162176 167154 164179167155 163176208272376417354380304760 5174149129141 139 134 136155 163 160142 140 147173 1832312531982468 18 13 1531 3547 5061 59 4930 22 19 1940 46911662593052573011997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019TOTAL DRUG DEATHS, COMPARING THE TOTALS FOR DEATHS CAUSED BY ANY PHARMACEUTICAL AND NON-PHARMACEUTICAL (ILLICIT) DRUGSTotal Pharmaceutical Illicit2010 2011 2012 2013 2014 2015 2016 2017 2018 2019Cocaine 11 14 13 10 24 35 60 91 90 110Methamphetamine 0 0 1 0 1 3 7 16 26 47020406080100120NUMBER OF DEATHS DUE TO COCAINE AND METHAMPHETAMINE 8  Figure 1. Comparison of the number deaths due to pharmaceutical versus non-pharmaceutical opioids, alone or in combination with other drugs and/or alcohol.   Figure 5.  Number of deaths caused by key pharmaceutical opioids, alone or in combination with other drugs. Note that these fentanyl cases are pharmaceutical fentanyl.  2010 2011 2012 2013 2014 2015 2016 2017 2018 2019Total 167 155 163 176 208 272 376 417 354 380Pharm Opioid 123 108 103 107 111 112 123 124 78 96Non-Pharm Opioid 8 7 28 40 78 157 243 281 231 268050100150200250300350400450NUMBER OF DEATHS DUE TO PHARMACEUTICAL VERSUS NON-PHARMACEUTICAL OPIOIDS2010 2011 2012 2013 2014 2015 2016 2017 2018 2019Oxycodone 47 35 45 34 42 37 46 53 29 21Methadone 51 43 32 38 30 38 41 31 19 25Buprenorphine 5 3 5 7 7 9 12 22 14 32Hydrocodone 17 17 10 10 18 17 18 9 12 4(Pharm.) Fentanyl 10 16 10 9 10 6 3 3 2 2(Pharm.) Morphine 17 13 8 10 7 4 7 3 2 40102030405060NUMBER OF DEATHS DUE TO KEY PHARMACEUTICAL OPIOIDS 9  Figure 6. Total drug deaths with subtotals for the number of deaths due to heroin/morphine and non-pharmaceutical fentanyl and/or its analogs.  Although separate totals are provided for heroin/morphine and fentanyl/fentanyl analog fatalities, many deaths include both drug categories.     Figure 7.  Total deaths due to heroin/morphine (“HM”) with non-pharmaceutical fentanyl (non-pharm Fent”) and/or its analogs, alone or in combination with each other. 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019Buprenorphine and Nonpharm.Fent. 0 0 0 0 0 1 3 5 13 4 18Buprenorphine without Nonpham.Fent. 2 5 3 5 7 6 6 7 9 10 1405101520253035NUMBER OF DEATHS DUE TO BUPRENORPHINE, COMBINED OR NOT COMBINED WITH NON-PHARMACEUTICAL FENTANYL AND/OR FENTANYL ANALOGS2010 2011 2012 2013 2014 2015 2016 2017 2018 2019Non-pharm Fent, without Heroin 0 0 0 0 21 50 119 193 157 207HM, without Non-pharm Fent 8 7 28 39 46 70 45 34 13 9HM and Non-pharm Fent 0 0 0 1 11 37 75 54 60 52050100150200250300NUMBER OF DEATHS DUE TO HEROIN/MORPHINE (HM) ALONE OR IN COMBINATION WITH NON-PHARMACEUTICAL FENTANYL AND/OR ITS ANALOGS

Maine Drug Death Report for 2019

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Maine Drug Death Report for 2019

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