Florence, South Carolina – Renee McCall keeps her brother’s last voicemail because she is afraid of forgetting the sound of him sober. It is only 18 seconds. He says he is coming by Sunday. He says he is tired, but good tired. He says he loves her. Then the recording ends, and Renee is back in her kitchen outside Conway, where the chair beside the window has been empty for three years.
Her brother died after using cocaine that, the family was told, contained fentanyl.
“He wasn’t trying to die,” Renee said. “That’s what people need to understand. He thought he knew what he was taking. He didn’t.”
That is the cruel shape of South Carolina’s overdose crisis. The numbers are finally moving in a better direction. The grief is not. The South Carolina Department of Public Health reported 2,157 drug overdose deaths in 2023, down 6.1% from 2,296 in 2022, the state’s first decline in more than a decade. Federal data show another sharp drop in 2024, when South Carolina recorded 1,467 overdose deaths, an age-adjusted rate of 27.5 deaths per 100,000 people.
Nationally, the decline continued into 2025. CDC provisional estimates put U.S. overdose deaths at 69,973 in 2025, down nearly 14% from 81,313 in 2024. Opioid-involved deaths fell from an estimated 55,296 to 44,564.
But the data does not support a simple political claim that overdose deaths only went down after Donald Trump returned to office in January 2025. The decline began earlier. South Carolina’s first drop came in 2023. The national total fell substantially in 2024. The 2025 numbers extended a trend already underway, rather than starting it. For Renee, that distinction matters because the crisis is too large for slogans.
“If fewer people are dying, thank God,” she said. “But don’t turn my brother into somebody’s talking point.”
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Fentanyl changed the risk
South Carolina’s 2023 improvement did not mean fentanyl loosened its hold. A state opioid emergency plan said South Carolina reported 1,704 opioid-involved overdose deaths in 2023, including 1,550 involving fentanyl. That means fentanyl was connected to most opioid deaths and roughly seven in 10 overdose deaths overall.
Fentanyl is dangerous because the margin is small. It can appear in heroin, counterfeit pills, cocaine, methamphetamine and other drugs. People may not know they are exposed until they stop breathing.
That uncertainty has changed family life. Renee’s teenage son knows where the naloxone is. Her church keeps overdose reversal kits near the first-aid supplies. At family gatherings, people talk quietly about cousins, neighbors and classmates in the same careful voice they once reserved for cancer.
“That’s how normal it got,” Renee said. “We know where Narcan is the way we know where the fire extinguisher is.”
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The decline was not equal everywhere
The statewide trend hides local pain. In Horry County, where Renee lives, overdose deaths rose slightly from 233 in 2022 to 237 in 2023, even as the state total fell. County officials said 196 of those deaths involved opioids, and DPH identified Horry as one of 15 counties where deaths increased.
In the Pee Dee, the burden varied. Florence County recorded 71 overdose deaths in 2023, down from 82 the year before, while Darlington County fell from 27 to 20. Those are improvements. They are also 91 deaths across two counties in one year.
In the Upstate, Greenville County saw 215 overdose deaths in 2023, down from 287 in 2022, the largest numerical drop reported in the state that year. The Midlands still felt the crisis through emergency rooms, law enforcement calls, families caring for children after a parent’s death and county jails dealing with addiction.
That is why a falling statewide line can feel confusing. It can be true that deaths are down and true that a community still feels overwhelmed.
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First responders see what the public does not
An overdose death is often counted once, in an annual report. First responders count the crisis differently.
They count the same apartment complex. The same motel. The same gas station bathroom. The same person revived twice and then seen again. They count the family members screaming in the yard, the child in the next room, the officer waiting with a coroner, the paramedic who goes home quiet.
Law enforcement agencies also face the supply side: fentanyl trafficking, counterfeit pills, drugs mixed by people who are not chemists and users who may also be victims. Prosecutors often say they are trying to separate people who need treatment from people selling lethal products. Families often want both mercy and accountability. Renee understands that conflict.
“I wanted somebody punished,” she said. “Then I met other mothers whose sons were using and selling to survive their own addiction. It stopped being simple.”
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Treatment access remains the hard part
Overdose prevention has expanded. Naloxone is more available. Public warnings are louder. Some courts, jails and community groups have built recovery programs. But treatment is still uneven, especially outside major cities.
The South Carolina Opioid Treatment Dashboard tracks opioid use disorder diagnosis, treatment and retention by county and region, showing a system where getting into care is only the first step. Staying in care can be harder when people lack transportation, stable housing, insurance, child care or a nearby provider.
Medication treatment, counseling, recovery housing, peer support and crisis stabilization all matter. But in rural counties, a person may have to travel far or wait long. In small communities, stigma can keep people quiet until the risk becomes fatal. Renee’s brother tried treatment twice. Once he left because he said he was ready. Once he left because he could not keep the job and the appointments together.
“He needed more than a brochure,” Renee said. “He needed somebody to catch him when he slipped.”
The next phase cannot be complacency
The decline in overdose deaths is real and important. It may reflect many forces: wider naloxone access, changes in drug supply, more public awareness, expanded treatment, local outreach and fewer people using alone. CDC also warns that provisional data can change as death records are finalized.
South Carolina should celebrate fewer deaths. It should not mistake fewer for few.
The state still lost 1,467 people in 2024. That is more than four people a day. The provisional national decline in 2025 does not erase the risk of new synthetic drugs, fentanyl mixed with stimulants, treatment gaps or families already damaged by years of loss. Renee still plays the voicemail sometimes. Not often. Enough to remember the voice, not enough to get trapped in it.
On the counter below the cabinet, she keeps naloxone beside the batteries and spare keys.
“That’s what hope looks like now,” she said. “You keep the medicine close. You keep answering the phone. You keep people alive long enough for tomorrow.”
In South Carolina, the overdose curve may finally be bending. The work is making sure it keeps bending toward life.
