The number of fatal opioid overdoses in the state’s two largest cities doubled from March to April, according to a report released Wednesday by American Medical Response Ambulance Service (AMR).

The data was released the same day the U.S. Centers for Disease Control and Prevention reported more than 107,600 Americans died from drug overdoses in 2021, the highest annual death toll on record.

Preliminary data show that there were 14 likely opioid related deaths between Manchester and Nashua in April, pending verification from the Office of the N.H. Chief Medical Examiner.

“That is double last month’s fatality number and one of the highest monthly fatality numbers we have seen in some time,” AMR Regional Director Chris Stawasz said in a statement.

There were 71 suspected opioid overdoses in Nashua and Manchester in April. AMR medics responded to 57 suspected opioid OD’s in Manchester and 14 in Nashua.

Of the 14 suspected opioid OD’s in Nashua in April, half of them appear to have been fatal, the report shows.

The CDC’s National Center for Health Statistics figures released Wednesday show a record 107,622 drug overdose deaths in 2021, a 14.9% increase from the 93,655 overdose deaths reported in 2020.

Prescription painkillers and heroin may have fueled the country’s overdose epidemic over the last decade, but the synthetic opioid fentanyl is behind the majority of overdose deaths these days, officials report.

Overdose deaths from fentanyl rose from 57,834 in 2020 to 71,238 last year, the CDC reports.

Illicit fentanyl is behind the surge of overdose deaths, officials said.

“We continue to see and hear reports from patients that they believed they were not specifically using opioids and were surprised that they overdosed on an opioid,” Stawasz said in an email. “This is suggestive of following a national trend of fentanyl now being found in numerous types of illicit street drugs such as cocaine and marijuana.”

Nationally, stimulants like methamphetamine were found in 32,856 overdose deaths and cocaine in 24,538 deaths, officials report. Experts say the illicitly manufactured fentanyl gets mixed with cocaine, methamphetamine and counterfeit prescription opioids, then is sold on the street.

“AMR medics also continue to see victims simultaneously using both stimulants, such as methamphetamine or cocaine, along with opioids — sometimes on purpose and sometimes unwittingly,” Stawasz said. “These cases are particularly challenging to deal with for first responders as they often pose a significant risk of unpredictable patient behavior.”

According to AMR, of the 297 suspected opiate overdoses medics have responded to in Manchester and Nashua year to date, 69% involved males and 31% females.

Of those, medics were encountering a person for the first time in 52% of the calls, while 48% involved repeat patients.

Thirty-five percent of the calls involved individuals reported being homeless, and 34% reported they live in Manchester.

In 2021, AMR medics responded to 855 suspected opioid overdoses in Nashua and Manchester, 38% more than in 2020. The 855 overdoses represent the highest number since 2018.