Over the past five years, the risks associated with using drugs have changed. The chart below shows which drugs were involved in accidental overdoses over the past 11 years. Two major differences: More overdoses today involve nonpharmaceutical fentanyl, and more involve multiple drugs (most likely because so many different drugs are cut with fentanyl).

It’s the cause of almost every overdose

Non-pharmaceutical Fentanyl is the #1 cause of drug overdose deaths in Maine – by a lot. It hides in many different drugs, it acts extremely fast, and it only takes a few salt-sized grains to cause a fatal overdose. This is hard to even grasp, but fentanyl is roughly 50 times the strength of heroin, and its analog carfentanyl is 100 times as strong as fentanyl (so 5,000 times as strong as heroin). And other, stronger analogs are making their way into the drug supply all the time.

It’s in everything

Among people who use drugs, those who use heroin are more likely than others to suspect and check for fentanyl. But the truth is, fentanyl is now found in ALL street drugs, even uppers. It’s frequently found in cocaine and a variety of counterfeit pharmaceutical pills. And because it’s so inconsistently mixed, and obviously not regulated, it’s impossible to ration or predict how much you’ll get.

It’s everywhere

There are so many levels and variables to the drug supply chain that even if you trust your seller and know that they would never hurt you, you can never 100% trust everything in the supply.

That’s the bad news. The good news is that there are simple, proven steps you can take to avoid or survive an overdose.

It’s less of a threat if you take some steps

If you use drugs – any drugs – these actions will keep you safer:

  1. Start small and go slow. This will allow you to test the strength of the drug. If you are injecting, start with a little and wait 20 seconds to see how you feel. You can always take more, but you can never take less. If it feels off, consider not using it or using less.
  2.  Carry naloxone (aka Narcan). Fentanyl is an opioid, and Naloxone is the only way to reverse an opioid overdose. Even if you don’t think you’re doing an opioid, there is a strong chance it has been cut with fentanyl, so always have naloxone on hand. It could save your life if something goes wrong with ANY drug. If you overdose on Fentanyl, you will quickly become non-responsive, so you can’t use your Narcan on yourself; but if you have it on you or right nearby, someone else can revive you with it (though the window is only a few minutes, so see step 3). And in a different situation, having it on hand might allow you to save someone else.
  3. Don’t use alone. Using with someone else in-person is the best way to avoid a fatal overdose. That way, you can take turns – and if one person needs naloxone, the other person can immediately give it. If you have to be physically alone, there are still ways to give yourself that safety net. Two judgment-free anonymous options are the Never Use Alone Hotline – (800) 484-3731 – and the Brave App. They both work by matching you with a volunteer who will stay on the line with you during those first few minutes when you are taking a drug. Never Use Alone will call your local EMS if you become non-responsive, and Brave App community members will do the same, but only at your direction (if you prefer that they call another trusted person to help you, that’s what they will do).
  4. Educate others. Let your friends and family know what to do if you overdose. This is a good conversation for anyone with a substance use disorder to have with the people they are closest to, regardless of whether they are actively using. Be brave on this. The worst outcome for someone who loves you isn’t your active substance use – their worst outcome would be losing you. Make sure your loved ones know the signs of an overdose and always keep Naloxone on hand, close by – in their purse or pocket, glove compartment of the car, and/or medicine cabinet at home. And finally, share this information with other people you care about who use drugs. We have lost too many Mainers, with too much left to give, to this epidemic already.
  5. Stay informed. You can get alerts via text and email when overdoses are spiking in your area by texting SPIKE to (855) 963-5669. The SPIKE Auto Text Program issues an alert after three overdoses have occurred within 24 hours in a given county, and can alert you to when a potentially lethal batch of drugs is circulating in your community.

Need Help? You Have Options.

Everyone who uses drugs in Maine should know that their risk of overdose is higher right now than it has ever been. That said, people develop substance use disorders for many reasons, and everyone manages their situation differently. Here are some options:

If the goal is to stay alive

Harm Reduction

For some people, a moderation and harm reduction approach works – either temporarily as a bridge to recovery, or permanently as a lifestyle. Follow the steps above, and learn more tips on our safer drug use page.

If the goal is to stop active use (or greatly reduce it)

Some people use the words treatment and recovery interchangeably, but they’re different things. Think of treatment as the short-term medical intervention and recovery as the long-term psychological, social, and sometimes spiritual journey.


Drug treatments are the medical interventions that help you transition and taper down your drug use by easing the physical and mental withdrawal symptoms. Many people have successfully withdrawn from drugs through a program of Medically Assisted Treatments (MAT). MAT is available everywhere in Maine – find a local provider on our Resources page, or contact your local OPTIONS Liaison, and they’ll point you in the right direction.


Recovery is the long-term journey of controlling your substance use disorder, so that it does not control you. Many people choose a completely substance-free recovery, but that is not true for everyone. The more important goal is to recover your best life.

Everyone’s recovery journey is different, but it often involves finding your support system, building new habits and routines, pursuing physical and mental health, finding new ways to cope with aspects of life (trauma, PTSD, anxiety, etc.) that your use once “solved”; and for many people, the best part of the recovery journey is the part where you can start helping others. Maine has an incredibly large, kind, and generous community of people in recovery who can meet you where you are, show you what’s possible, and stay by your side as you find and follow your path.

To learn about recovery options near you, visit our Resources page or contact your local OPTIONS liaison.