For those on the front lines of the fight against opioid overdoses, mounting deaths are a reminder of an insidious problem that communities across South Carolina grapple with daily.
While the Palmetto State has not seen as many deaths as states like West Virginia, Ohio and Pennsylvania — the three deadliest in the nation — deaths related to these drugs in South Carolina have steadily increased since 2013, worrying medical professionals, law enforcement and treatment officials.
Those concerns led to the creation of a statewide Opioid Emergency Response Team in late 2017. The team released its first report Thursday detailing its efforts during the past year.
From 2014 to 2017, South Carolina saw a 47 percent increase in opioid deaths, according to statistics from the S.C. Department of Health and Environmental Control. In 2017, Charleston County took Horry County's place as the deadliest in the state for opioid overdoses, according to the statistics.
While 2018 numbers weren't available statewide, Charleston County Coroner Rae Wooten said the last year was "very busy" with about 90 opioid overdose deaths in her county alone.
For those involved in statewide efforts to curb opioid abuse and addiction, the emergency response team has brought together experts and invited collaboration in a way that hasn't been seen before. That teamwork, they say, is key to winning the fight.
"The collaboration that has gone into creating and updating South Carolina’s Opioid Emergency Response Plan is a tremendous example of what team South Carolina can do when we work together," Gov. Henry McMaster said in a statement Thursday.
The team's plan, developed in June 2018, focuses on four areas: education and communication; response; treatment; and law enforcement.
The team's first year, however, has been spent mostly on developing their plan and determining a course of action. Its leaders warn against expecting monumental changes right away.
"I think the results of these effort are yet to come," said State Law Enforcement Division Chief Mark Keel, co-chairman of the team. "There’s a lot that's been accomplished, but we can’t stop where we’re at. Many of those (initiatives) are just getting under way."
A key component that could take years to be fully-implemented is data collection and sharing, Keel said.
Collecting data within hours of an overdose will allow state officials to coordinate an appropriate response, said Sara Goldsby, director of S.C. Department of Alcohol and Other Drug Abuse Services, who co-chairs the opioid task force with Keel.
"That data and surveillance are important because prevention is so important," she said.
The group's data team is also involved in public awareness campaigns through the website www.justplainkillers.com. The site features South Carolina's first comprehensive data dashboard where the public can find information from a local to statewide level.
Caitlin Kratz, opioid treatment program director at the Charleston Center, said anything aimed at increasing public awareness and encouraging conversations around addiction is welcome. The center, while not part of the response team, follows the team's guidance.
For decades, addiction was stigmatized. But in recent years, it has begun to be recognized as a chronic disease, Kratz said.
"My biggest thing is that addiction’s not a dirty word," she said. "People that suffer from addiction are just like us. Everybody knows somebody that's impacted. Just having the conversation is important."
Decreasing the stigma around opioids could help even more people seek life-saving treatment that is increasingly important in the face of stronger synthetic opioids appearing in the illicit drug trade, Kratz said.
"The average person that comes in to our services will report at least one or two overdoses," Kratz said. "It truly is a life or death situation."
Since 2007, the Palmetto State has seen a 165 percent increase in people seeking treatment for opioid addiction at state-funded facilities, according to the report. Administrations of naloxone, a medication that can reverse the effects of an opioid overdose, by emergency medical services personnel rose by 110 percent from 2013 to 2018.
As of this January, 7,920 law enforcement officers from 190 departments around South Carolina have been trained on how to use naloxone, the report said. These trained officers have successfully reversed 619 overdoses, saving 554 lives.
In 2018, the Charleston Center saw significant increases in users of fentanyl, which is 100 times stronger than morphine, and carfentanil, which is 100 times stronger than fentanyl, she said.
According to Keel, SLED's lab saw a 29 percent increase in opioid cases between 2016 and 2018, and a 432 percent increase in positive tests for fentanyl.
During the coming year, the team — which is comprised of members from 24 organizations — plans to step up efforts to expand access to medicine-based treatments for addiction and to set up drug courts and alternatives to incarceration for those facing certain drug-related charges.
As they prepare for the year ahead, the team's leaders say they're confident the project's success will become more tangible as more communities, agencies and personnel come on board.
"It’s been unbelievable," Goldsby said. "The coordination, the collaboration, the emphasis, the acknowledgement of the issue — it’s truly been an all hands on deck effort."