Substance abuse is a critical problem facing the State of Maine, as well as local government and the communities served. Rates of substance abuse are increasing dramatically which is reflected in emergency medical care encounters, substance abuse treatment admissions, drug-related arrests, and drug-related deaths. The Office of Chief Medical Examiner in Maine received funding from the Maine Justice Assistance Council to review and analyze medical examiner data concerning drug-related deaths. The goal of the Maine Drug-Related Mortality Patterns project was to provide an immediate, comprehensive review and analysis of the drug-induced and drug-related deaths in the State of Maine from 1997 to 2002. The data were compared with published national data on drug deaths and data from the 2000 U.S. Census. The study includes all medical examiner cases in which a drug or toxic substance caused the death. The annual rate of drug deaths in Maine has been rising rapidly, particularly in the last year with opiate drugs and heroin being the most prevalent. The pattern of toxicology findings in decedents is an indicator of the supply of drugs, legally prescribed, illicit, or diverted. The population at risk for mortality and morbidity from drug abuse is widespread, but most persons dying from drugs are middle-aged and representative of the general population. Further research is recommended on the medical history of decedents as it involves emergency medical encounters and patterns of prescription availability. This would benefit decisionmakers involved in treatment, law enforcement, and the legislative process, as well as benefiting those at-risk. Tables, references, and appendices