South Carolina recorded 2,157 overdose deaths in 2023. That was considered progress. It was the first decline the state had seen since 2012. The relief was real, but so was this: in 15 counties, the numbers went up, not down. And across the Pee Dee region and along the Grand Strand, the crisis looks nothing like a trend line beginning to flatten.
At Owl's Nest Recovery, we're not removed from these numbers. We're located inside them.
Florence, Darlington, and Horry counties sit at different points on the overdose map.
According to the South Carolina Department of Public Health's 2023 Drug Overdose Death Report, Florence County recorded 71 overdose deaths in 2023, down from 82 the prior year. That 13.4 percent decline reflects real effort from treatment providers, community organizations, and first responders working across the county. Fentanyl was involved in 42.3 percent of those deaths, with 52 people killed by a drug that often arrives without warning and leaves no margin for error.
Darlington County saw the steepest percentage drop in the region, from 27 deaths in 2022 to 20 in 2023, a 25.9 percent decline. That's meaningful. It's also 20 people dead in a county of roughly 60,000 residents.
Horry County moved in the opposite direction. Deaths climbed from 233 to 237, with fentanyl involved in approximately 53 percent of fatalities. Cocaine, increasingly laced with fentanyl, accounted for another 20 percent. Horry County is the most populous county in eastern South Carolina. It is also, by total overdose count, one of the deadliest in the state.
The shift to a fentanyl-dominated drug supply is not just a statistic. It restructures the risk calculus for everyone who uses drugs, including people who have no idea fentanyl is present in what they're taking. NIDA's research on fentanyl documents how synthetic opioids now contaminate not just heroin but cocaine, methamphetamine, and counterfeit prescription pills, dramatically expanding the population at risk beyond people who seek out opioids specifically.
In rural and suburban counties like those across the Pee Dee, that dynamic is compounded by limited harm reduction infrastructure, longer distances to treatment, and communities where stigma still quietly prevents people from asking for help before a crisis becomes a fatality. Research funded through the NIH's HEAL Initiative on substance use care in rural communities identifies financial constraints, limited clinical resources, transportation gaps, and stigma as the overlapping barriers that keep rural residents from accessing the care that exists. In many parts of the Pee Dee, that care is hard to reach even when it's known to exist.
A crisis driven by fentanyl contamination, geographic isolation, and treatment access gaps does not resolve through outpatient counseling alone. It requires a full range of care options, placed as close to the communities in need as the infrastructure allows, staffed by people who understand the specific pressures of the region.
Owl's Nest Recovery operates in Florence specifically because Florence sits at the center of this region's need. The program offers PHP, IOP, drug and alcohol treatment, and sober living within a single continuum of care, and has done so since 2001. For residents of Darlington County, that's roughly 30 minutes. For Horry County, it's an hour. For all of them, it's a full-service option that doesn't require crossing a state line or navigating an out-of-network provider in a different region entirely.
The data on this region's overdose burden is public and updated regularly. We read it. We think the communities represented in those numbers deserve a treatment program that does.
If you or someone you know is ready to take the next step, the team at Owl's Nest is here.