Horry County is best known for its beaches, its tourism economy, and the sprawl of Myrtle Beach. What gets discussed far less is this: it is one of the deadliest counties in South Carolina when it comes to drug overdose, and it has almost no addiction treatment infrastructure to address that crisis.
That gap is not a policy abstraction. For families in Conway, Myrtle Beach, North Myrtle Beach, and the surrounding communities, it means that when someone reaches the point of needing help, the options close to home are almost exclusively outpatient. primary care, the level of treatment most often needed by people with moderate to severe substance use disorders, requires leaving the county entirely.
The Numbers Behind the Need
When South Carolina saw its first statewide drop in overdose deaths in over a decade in 2023, Horry County was among the 15 counties that moved in the wrong direction, climbing from 233 deaths in 2022 to 237 in 2023. Fentanyl was responsible for roughly 53 percent of those deaths. The county's overdose rate has been among the highest in the state for years.
According to the South Carolina Department of Public Health, Horry County had the highest rate of naloxone administrations in the entire state in 2020, with 1,087 doses administered. That statistic tells its own story. Naloxone saves lives in the acute moment. It does not treat addiction.
What the Grand Strand region has is a harm reduction infrastructure working hard against a crisis that outpatient services and emergency responses alone cannot resolve.
Treatment Gaps in Rural & Suburban Counties
Horry County's situation is not unique. It reflects a documented pattern across the country. Research published in the NIH's National Library of Medicine examining barriers to opioid use disorder treatment in rural communities identified the most consistent obstacles: long distances to treatment, limited local options, lack of transportation, and communities where stigma runs deep enough that seeking inpatient care carries real social risk. The study found that distance to inpatient treatment was cited as a barrier by a meaningful portion of participants, with the combination of geography and limited local availability creating conditions where people delay or avoid care entirely.
That delay costs lives. The same body of research consistently shows that untreated substance use disorder worsens over time, and that the window between someone deciding to seek help and actually entering treatment is one of the highest-risk periods for overdose.
The Drive to Florence Is Shorter Than You Think
Florence, SC sits roughly 75 miles from Conway and about 90 miles from Myrtle Beach. That's an hour on US-501. For someone from Horry County who needs addiction treatment, a full continuum of care, or a structured step-down program after detox, that drive is not an obstacle. It's a solution.
Owl's Nest Recovery has served eastern South Carolina from its 13-acre Florence campus since 2001. For residents of Horry County, it represents the closest full-service primary treatment option in the region, one that offers the complete range of care from PHP, IOP, and sober living, all within the same program.
Research on rural treatment access published through PMC found that rural and suburban patients with long travel distances are among the least likely to receive sustained follow-up care. A program that keeps someone through the full step-down process, rather than requiring them to piece together services across multiple providers, directly addresses that risk.
What Horry County Residents Should Know Before Calling
The most important question when evaluating any treatment program is whether it can actually meet your clinical needs. Not every level of care is appropriate for every person, and the right entry point depends on the severity of use, prior treatment history, home environment, and a range of other clinical factors.
Owl's Nest conducts an individualized assessment before placing anyone in a level of care. The program also offers insurance verification upfront, which removes one of the most common practical barriers to taking the next step.
The overdose numbers in Horry County reflect a population that needs more than what's currently available locally. The hour drive to Florence is a small price for what's on the other side of it.
If you or someone you know is ready to take that step, reach out to the team at Owl's Nest. The conversation is free. Waiting is not.
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