Fatal drug overdoses in 2022 topped 700 people, according to a new report from the Maine Office of the Attorney General, with fentanyl appearing in the majority of cases — more than 500 of them.

“Because fentanyl is so potent and so toxic and very unpredictable in the illicit drug supply,” it is often the primary cause of death in most fatal overdoses, Rebecca Taylor, the deputy director of research and evaluation for the Office of Behavioral Health, said Friday at a seminar on the report.

“Some people in the drug community refer to it as the ‘instant death,’” Taylor said.

“One minute you are conscious and the next minute you are unconscious and not breathing,” she said.

The total number of fatal overdoses in 2022, some of which are considered suspicious while the toxicology reports are finalized, represents a nearly 14% increase over 2021.

Fatal overdoses last year broke records well before the year’s end.

“Worsened by the growing presence of deadly fentanyl, the scourge of addiction continues to reach into every corner of our state — rural and urban — robbing us of our friends, family and loved ones and harming our communities, our people, and our future,” Gov. Janet Mills said in a statement Thursday.

“It’s a very high number. It’s not a number we’re happy with,” Gordon Smith, the state director of opioid response, said at Friday’s seminar. “But we very much have to think about the 9,394 individuals who survived their overdose in 2022,” and how to connect those individuals with services, he said.

The number of nonfatal overdoses does not directly translate to the number of people who overdosed in 2022, Smith said. There are likely some people who overdosed more than once during the calendar year.

The total in the AG’s report are “absolutely lower than the actual numbers,” because some overdoses are reversed in private and are not reported to the state, Smith said.

Taylor said that nearly four out of every five people who die of an overdose in Maine have at least three substances in their system. Increasingly, fentanyl is combined with illicitly manufactured stimulants, mainly cocaine and methamphetamine.

About a quarter of confirmed fatal overdoses last year involved fentanyl in combination with cocaine. About the same proportion involved fentanyl in combination with methamphetamine. A portion of those deaths likely involved all three drugs.

Although fentanyl appears in the majority of deaths, because so often there are multiple drugs in a person’s system that could have contributed to their death, there is “no smoking gun,” said Dr. Marcella Sorg, a forensic anthropologist and the director of the University of Maine’s Rural Drug and Alcohol Research Program.

That said, there are still several concerning features of the current drug supply.

Both the nonpharmaceutical opioid tramadol and the animal tranquilizer xylazine showed up in toxicology reports for the first time in 2021.

Xylazine is a sedative but not an opioid, meaning that it is unresponsive to the opioid overdose reversing drug naloxone.

A person may ingest fentanyl contaminated with xylazine, “and may have a bad-on-bad reaction where their breathing is also lowered by the sedative and not be able to be revived because they are still under the effects of the xylazine,” Taylor said.

“It’s a bad-on-bad situation,” she said.

Using drugs in isolation makes the effects of fentanyl even more dangerous, Taylor said. About 80% of all people who died of an overdose were using drugs in isolation.

“Because it is so fast-acting, these individuals can be dead within minutes and not be found by loved ones until much later, when it’s too late,” Taylor said.

Many people may not even know that they are ingesting fentanyl due to the pervasiveness of it in the illicit drug supply. Fentanyl is often cut into other illicitly manufactured drugs and sold on the streets, often unknown to the person buying the drugs or even the person selling them.

The “pervasive belief” of the past that a person who dies of an overdose was on a downward spiral is “no longer true because of the lethality of fentanyl,” Taylor said.

“It means that far and away, individuals who may not be longtime drug users can still experience a fatal overdose,” she said.