Fatal overdose rates surge as opioid-involved deaths rise across SC

Last month, the South Carolina Department of Health and Environmental Control (DHEC) published its annual report detailing the number of overdose deaths that occurred in the state during 2021. Regrettably, mirroring the national upward trajectory, overdose deaths in the Palmetto State continued to rise at an alarming rate. 
In 2021, South Carolina reported 2,168 in total overdose deaths, from all drug categories, a jump of 25% from the 1,734 that occurred in 2020. Horry County had the most overdose deaths with 272, followed closely by Greenville County with 270. Charleston County accounted for 201 of the state’s recorded total overdose fatalities, third highest in the state, while Berkeley County tallied at 70. Since 2017, South Carolina has seen an approximate 116% increase in overdose deaths, which then totaled 1,001 for the year.  
Nationally, in 2021, there were approximately 107,000 overdose deaths. According to the Center of Disease Control and Prevention, overdose death remains “a leading cause of injury-related death in the United States.” By comparison, approximately 58,000 U.S. soldiers died during the entire Vietnam War. The national overdose death figure also beat yearly records for nationwide fatalities caused by car accidents, gun violence, and the HIV/AIDS epidemic. It also exceeded deaths caused by both prostate and breast cancer in 2021, approximately 34,130 and 44,000, respectively. The 2021 national number is analogous to what would be observed were a commercial airliner to crash every day of the year, or three 9/11 tragedies happening each and every month. The overdose numbers are staggering.     
As illustrated in the DHEC report, a single overdose fatality often involves multiple types of drugs, and each was accounted for separately in the data corresponding to an individual death. 
Of the 2,168 total overdose deaths for the state, roughly 1,733 (80%), involved opioids of all types, including natural, semi-synthetic and synthetic forms of the drug. Of those, 1,494 (86%), the vast majority, involved fentanyl, a synthetic opioid that is roughly 50 times stronger than heroin and 100 times more powerful than morphine.
Director Dan Salter oversees the Atlanta-Carolinas High Intensity Drug Trafficking Area (HIDTA) program, which provides assistance to federal, state, local and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the United States. Prior to joining HIDTA, Director Salter served as the Special Agent in Charge of the U.S. Drug Enforcement Administration (DEA) Atlanta Division, which includes South Carolina. While he has witnessed different drug scourges throughout his long career in narcotics enforcement, Salter calls the current prevalence of illicit fentanyl in our society an unprecedented and extremely worrisome “game changer.”  
According to the DEA, Mexico and China are the primary source countries for fentanyl and fentanyl-laced substances trafficked into the United States. Because of its cheap way to make their product more potent, drug cartels and trafficking organizations are mixing the fentanyl with other drugs, including heroin, methamphetamine, cocaine, and pressed pills that masquerade as legitimate prescription opioids. The last category being the most problematic, which has led the DEA to initiate the “One Pill Can Kill” nationwide awareness campaign. DEA reports that, in 2022, six out of every 10 pills that were seized and tested by the agency’s laboratories contained a potentially lethal dose of fentanyl, which was up from the four in ten reported for 2021. The influx of rainbow-colored fentanyl-laced pills is particularly concerning, as those pills resemble candy and can be alluring to younger individuals. Marijuana and THC products have also been reported to contain the fentanyl poison.  
“We are seeing all types of drugs adulterated with fentanyl,” Salter said. “It is a killer drug that demands a collective ‘all-hands-on-deck’ approach to combat its devastating effects in our communities. If not, unfortunately, we will long for the days when we only had 107,000 Americans die in a single year from drug overdoses.”
In 2021, the highest number of opioid involved deaths in South Carolina was in the age group of 35-44, with 459 total deaths. Closely behind was the age group of 25-34, with 457 total opioid-involved deaths. For the ages less than 25, there were 140 overdose fatalities.
While total overdoses from all drug categories crossed demographic lines, white males accounted for 55% of opioid-involved deaths.
For every fatal overdose, countless other nonfatal overdoses also occur. Naloxone is an antidote medicine used to reverse and counter the effects of opioids in an overdose event. According to the South Carolina Department of Alcohol and Other Drug Abuse Services, there were 9,455 Naloxone administrations in 2020 by EMS, an approximate 92% increase from the 4,933 in 2015. Of all 46 counties in the state, Charleston ranked third highest in 2020, with 905 EMS administrations of Naloxone, while Berkeley County came in 10th with 316.
This Naloxone data does not reflect private administrations of the antidote not administered by EMS or law enforcement.
Comprehensive and accurate drug mortality data remains critical to formulating pragmatic strategies to battle this continuing public health emergency, and, while the numbers remain troubling, is becoming more precise with each passing year. Government and community
coalitions are using this improved data to navigate successful campaigns against the overdose epidemic.
Chief Luther Reynolds of the Charleston Police Department (CPD) is a key and founding member of the Addiction Crisis Task Force (ACT Force), a local coalition of public health and public safety entities that work collectively to reduce the number of overdose deaths in Charleston County. The ACT Force promotes the cross-discipline sharing of information, resources and expertise to bridge the communication gap that traditionally existed between the individual organizations that deal with the opioid crisis. “We all must work together with a sense of urgency and purpose,” said Reynolds. “If we save just one life, it is all worth it.”
Despite the state’s 25% increase in total overdose deaths for 2021, Charleston County reported only having a 2% rise in drug fatalities for the year, going from 197 in 2020 to 201 in 2021. Berkeley County observed roughly a 45% increase, jumping from 48 to 70 for the same timeframe.    
Aside from promoting and fostering the collective approach to addressing all parts of the overdose crisis equation, Chief Reynolds also recognizes the vital importance of drug prevention efforts, especially with our youth. According to the U.S. Department of Health and
Human Services National Institute on Drug Abuse, early intervention to prevent, or delay, first use lessens a person’s chances of suffering from substance use disorder later in life. As Chief Reynolds so clearly stated, “Education and awareness is absolutely critical to reducing the number of overdoses and saving lives.”
With a grant award from the U.S. Department of Justice, Chief Reynolds and his staff at CPD recently rolled out a program to help stem the overdose crisis under the Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP). Among other goals, COSSAP aims to reduce the impact of opioids in a community, including the reduction in the number of overdose fatalities. The program included the hiring of a project coordinator who will work closely with the community.  
Doug Treasurer, Esq., is a Daniel Island resident and counterdrug intelligence analyst with HIDTA. Prior to serving with HIDTA, Treasurer had a full career as a special agent with the DEA. 
2021 Opioid Involved Deaths in SC by Race and Gender 
· White Male: 55% 
· White Female: 27% 
· Black and other male: 14% 
· Black and other female: 4%
*According to South Carolina Department of Health and Environmental Control

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