Substance use is a serious concern in South Carolina, where fentanyl has driven a years-long rise in overdose deaths. After peaking, deaths have now fallen for two straight years. Key figures:

• 2,157 drug overdose deaths in 2023, a 6.1% decrease from 2,296 in 2022, according to the South Carolina Department of Public Health.
• 1,481 overdose deaths in 2024, a 31% decrease from 2023.
• Fentanyl was involved in 1,550 of the 2,157 deaths in 2023, roughly 72%.
• Fentanyl was involved in 914 of the 1,481 deaths in 2024.
• 2023 marked the first drop in overdose deaths in more than 10 years.
• Most of the state’s 46 counties saw a decline in overdoses from 2023 to 2024.

South Carolina’s overdose deaths climbed for more than a decade as fentanyl spread across the state. The back-to-back declines in 2023 and 2024 mark a sharp reversal, even as fentanyl remains the leading driver of fatal overdoses.

South Carolina has not expanded Medicaid under the Affordable Care Act, so Medicaid eligibility is more limited than in expansion states, though the state has added targeted coverage for some adults in need of substance use treatment. The Department of Alcohol and Other Drug Abuse Services (DAODAS) oversees the addiction treatment system. Of the 92 facilities listed below, 76 accept Medicaid.