SC overdose deaths decline, but counterfeit pills keep teens at risk
Editor’s note: This article will be Part 1 of a series on the overdose epidemic.
South Carolina is seeing its first meaningful drop in overdose deaths in years and a steeper decline than the nation overall.
Provisional data from the Centers for Disease Control and Prevention estimates 1,475 deaths in 2024, down from 2,157 in 2023 – a 33% decrease and the largest single-year drop in state history.
Nationally, deaths fell 27%, from 110,037 to 80,391.
Experts credit wider naloxone access, faster EMS response, increased awareness of counterfeit pills, and law enforcement pressure on fentanyl networks. Naloxone, now common in schools and community settings, reverses opioid overdoses and has reduced lethality even as drug use remains high. Still, overdoses remain the leading cause of death for Americans ages 18-44, underscoring the volatility of today’s drug supply.
Fentanyl continues to drive most deaths and is often mixed, unknowingly to users, with methamphetamine, cocaine, or sedatives such as xylazine, which naloxone cannot reverse. Toxicology trends show a rise in polysubstance use, increasing the risk of fatal outcomes.
The U.S. Drug Enforcement Administration has recently warned about several emerging threats:
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Xylazine, a veterinary sedative found in fentanyl mixtures, is not reversed by naloxone and can leave a person dangerously sedated.
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Nitazenes, extremely potent synthetic opioids, can be reversed but often require multiple naloxone doses.
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Medetomidine, another veterinary sedative, is also non-responsive to naloxone and causes profound sedation.
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Bromazolam, a powerful illicit benzodiazepine common in counterfeit Xanax, is frequently mixed with fentanyl. Naloxone treats only the opioid component, leaving deep sedation and respiratory depression.
These substances increasingly appear in counterfeit pills that look identical to legitimate medications, especially fake Xanax, Adderall, and oxycodone.
Counterfeit Xanax has become particularly popular among teenagers, young adults, and people self-medicating anxiety or sleep problems. DEA reporting shows these pills rarely contain alprazolam, the benzodiazepine active ingredient in Xanax. Instead, they often contain fentanyl, bromazolam, or other dangerous additives. Because they are visually convincing and widely used in social settings, they are a major driver of unexpected overdoses among occasional or first-time users.
To help families understand these risks, the DEA continues to promote its “One Pill Can Kill” and fentanyl awareness campaigns, emphasizing that counterfeit pills sold on social media or shared among peers are now a leading cause of youth overdoses.
Even with declining deaths, one illicit pill can be lethal. While naloxone can reverse fentanyl and nitazenes, though multiple doses may be needed, it cannot reverse xylazine, medetomidine, or bromazolam. Warning signs of overdose include slowed or stopped breathing, blue lips or fingertips, unresponsiveness, or unusual sedation, each requiringimmediate emergency care. Open conversations about stress, peer pressure, and substance use remain one of the strongest protective factors for teens.
According to Director Robert Murphy, who leads the Atlanta–Carolinas High Intensity Drug Trafficking Area program, “While increased access to naloxone and strong law enforcement efforts are helping save lives, the safest choice for teenagers is simple: never take a pill that was not prescribed specifically to you by a trusted medical professional. One counterfeit pill can be deadly."
Murphy adds, "Education and prevention are essential to ensure this downward trend continues. The drugs of the future are becoming cheaper, more accessible, and more lethal, which makes early prevention and awareness more important than ever.”
Doug Treasurer is a longtime Daniel Island resident and an analyst with the Atlanta-Carolinas HIDTA. Before joining HIDTA, he served a full career as a special agent with the Drug Enforcement Administration.