South Carolina Overdose Deaths Drop 31% in 2024, Marking Second Consecutive Year of Decline

For the second consecutive year, South Carolina has recorded a significant reduction in drug overdose mortality, with the state's Department of Public Health reporting 1,481 fatal overdoses in 2024—a 31.3% decline from the 2,157 deaths documented in 2023. The figures, released Wednesday in the agency's annual Drug Overdose Deaths Report, suggest that coordinated public health interventions are beginning to bend the mortality curve even as the illicit drug supply remains dominated by potent synthetic opioids.

"The continued decrease in overdose deaths in South Carolina is a testament to the comprehensive approach public health partners have taken to address the opioid epidemic here in our state," said Dr. Brannon Traxler, the department's acting director. "As we celebrate our progress, we do so humbly, acknowledging that too many people are still dying. Even one death is too many."

Geographic Patterns of Progress

The improvement spans much of South Carolina's geography. Of the state's 46 counties, most recorded fewer overdose deaths in 2024 than the previous year. The most dramatic reductions occurred in Aiken, Colleton, Georgetown, Jasper, and Spartanburg counties, each reporting decreases of 50% or more in overall drug overdose fatalities.

These localized successes suggest that interventions scaled differently across urban and rural settings can achieve measurable results. Spartanburg County, in the state's Upstate region, has invested heavily in peer recovery support services and medication-assisted treatment access points. Georgetown County, along the coast, has expanded harm reduction programming through community health centers.

Yet the data also reveals persistent vulnerability. Fentanyl, the synthetic opioid that has driven the nationwide surge in overdose deaths since 2015, remained the primary contributor to fatalities in South Carolina. The drug was involved in 914 of the state's 1,481 overdose deaths last year—roughly 62% of all cases. This proportion underscores a sobering reality: while overall mortality has declined, the drug supply has not become less dangerous. Rather, more people are surviving encounters with fentanyl, likely due to expanded naloxone distribution and improved response protocols.

The Role of Harm Reduction Infrastructure

South Carolina's progress arrives amid broader national trends. The Centers for Disease Control and Prevention has documented a 14% decline in overdose deaths nationwide for 2025, marking the third consecutive year of improvement after the pandemic-era surge that peaked in 2022. Multiple states—including Oregon, North Carolina, New York, and Alabama—have reported reductions exceeding 28%.

What distinguishes South Carolina's approach is its emphasis on low-barrier harm reduction tools distributed through established public health infrastructure. The Department of Public Health maintains a network of Opioid Overdose Safety Kits available at health departments statewide. Each kit contains two doses of naloxone, five fentanyl test strips, five xylazine test strips, educational materials, and guidance on recognizing overdose symptoms.

"Carrying naloxone is an act of care, giving people the power to act in a moment when every second matters," said Sara Goldsby, director of the S.C. Department of Behavioral Health and Developmental Disabilities' Office of Substance Use Services. "It's easy to use and can mean the difference between life and death."

The safety kits are provided without cost, and recipients are not required to answer questions or provide identification. This no-barrier approach removes the stigma and bureaucratic friction that often deter people from accessing potentially life-saving resources.

Sustaining Momentum Amid Evolving Threats

Public health officials caution that the downward trend, while encouraging, remains fragile. The illicit drug supply continues to evolve, with xylazine—a veterinary sedative known as "tranq"—increasingly detected alongside fentanyl. Xylazine complicates overdose response because it does not respond to naloxone, requiring additional medical intervention for affected individuals.

South Carolina's test strip distribution, included in the safety kits, allows drug users to detect the presence of fentanyl and xylazine before consumption. This knowledge enables behavioral modifications—using smaller amounts, ensuring naloxone is available, or avoiding use altogether—that reduce fatal outcomes.

The state has also benefited from substantial opioid settlement funding. Attorney General Alan Wilson announced in May that South Carolina had secured $256 million for its Opioid Recovery Fund through litigation against pharmaceutical distributors, manufacturers, and pharmacy chains. This funding, separate from the state's $72.8 million share of the Purdue Pharma settlement, supports treatment expansion, prevention education, and recovery infrastructure.

Connecting People to Care

Beyond immediate harm reduction, South Carolina has worked to strengthen pathways from crisis to treatment. The Department of Behavioral Health and Developmental Disabilities operates embracerecoverysc.com, a resource hub connecting individuals with substance use disorders to services across the state. The website provides information on treatment providers, recovery support groups, and harm reduction resources searchable by location.

For those seeking immediate assistance, the state's behavioral health services portal at bhdd.sc.gov offers guidance on accessing care, including medication-assisted treatment for opioid use disorder. The combination of readily available naloxone, test strips, and treatment referral resources represents a comprehensive approach that addresses different stages of substance use—from active use through recovery.

Looking Forward

As South Carolina enters 2026 with two consecutive years of declining overdose deaths, public health leaders emphasize that sustained progress requires continued investment and vigilance. The 31% reduction, while significant, still leaves the state with nearly 1,500 preventable deaths annually—far above pre-pandemic baseline levels.

Dr. Traxler's statement captures the dual reality: celebration of progress tempered by recognition of ongoing tragedy. The challenge for South Carolina, as for other states experiencing similar improvements, is to maintain the harm reduction infrastructure and treatment access that have contributed to declining mortality while adapting to an ever-changing illicit drug supply.

The state's experience suggests that even in the face of fentanyl's lethality, well-implemented public health interventions can save lives. Whether that progress can be sustained—and eventually accelerated—will depend on continued commitment to evidence-based approaches and the resources to support them.