International Overdose Awareness Day is observed on August 31 each year with the goal of preventing overdoses, combating stigma around substance use disorder and acknowledging the grief of loved ones left behind.  

From 2020 to 2021, the total number of drug overdose deaths in South Carolina increased by more than 430 individuals, from 1,734 deaths to 2,168: an increase of more than 25%. By comparison, there were only 573 drug overdose deaths in the state in 2012.  

Additionally, DHEC estimated that EMS agencies across the state responded to 13,422 overdose calls in 2021 compared to 16,449 in 2022, a 22.6 % increase. 

Illicitly Manufactured Fentanyl (IMF) and Xylazine
DHEC and the Opioid Emergency Response Team (OERT) monitor drug overdose in the state, and over the past few years there has been an increase in illicitly manufactured fentanyl (IMF). IMF, which is 50-times stronger than morphine, contributed to 1,494, or 68%, of the 2,168 fatal overdoses in 2021.  

Unfortunately, there is a new drug in the illicit market rapidly contributing to fatal overdoses. Over the past year, DHEC and OERT has seen dramatic increase in fatal overdoses involving xylazine, a veterinary tranquilizer.  

In October 2022, DHEC and the OERT issued a health alert through the SC Health Alert Network about Xylazine and the associated health effects of use. According to estimates from the DHEC Division of Biostatistics, deaths involving Xylazine have been on the rise, with a 379% increase between years 2020 and 2021.  

In April 2023, the Office of National Drug Control Policy formally designated fentanyl adulterated with Xylazine an emerging drug threat. Xylazine, also known as “tranq” or “tranq dope” on the streets, is not approved by the Food and Drug Administration for human consumption and can cause slowed heart rate, reduced breathing, lowered blood pressure and unresponsiveness, some of the same symptoms seen in an IMF overdose.  

Xylazine can increase risk of overdose and death. When taken in combination with opioids, Xylazine can prolong their effects, and it does not respond to Naloxone as it is not an opioid. Xylazine also increases the risk for skin ulcers, which can lead to skin and soft tissues infections, tissue death or amputation.  

“Changes in the drug supply are something we have to keep on our radar,” said Tramaine McMullen Opioid Grants Manager. “We have to be ready to pivot and adjust our strategies to respond accordingly. There are resources to mitigate potential harms.”  

Efforts to Prevent Overdoses
In an effort to curb opioid deaths, DHEC began distributing OD Safety Kits in health departments in each of South Carolina’s 46 counties in December 2022. Each kit contains one box of Naloxone, 5 fentanyl test strips and educational materials. DHEC Office of Pharmacy, Division of Injury and Substance Abuse Prevention and the South Carolina Department of Education also partnered to distribute naloxone to over 800 schools statewide in August 2023. 

DHEC is home to the CDC Cooperative Agreement Overdose Data-to-Action in which data-driven, evidence-based primary, secondary and tertiary prevention strategies are implemented across the state. DHEC also participates in a larger statewide, coordinated efforts through the Governor’s Opioid Emergency Response Plan, in which DHEC oversees Annex 2 Prevent and Respond. 

DHEC is also home to the state’s prescription monitoring program. South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS) is intended to improve the state’s ability to identify and stop the diversion of prescription drugs.   

The database includes all dispensing of schedule II-IV controlled substances. The data collected is used by the Bureau of Drug Control in the prevention of diversion and misuse of controlled substances through education, early intervention, and enforcement.  

Call to Action
DHEC issues a call to action for all South Carolinians:  

• Never take a prescription unless it’s from a valid pharmacy with a prescription from a medical provider, this includes pills from a friend or family member,  
• Knows the signs and symptoms of an opioid overdose, and 
• Keep naloxone in your purse or in your home first aid kit and know how to use it. You could save a life.