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In the pandemic, thousands of South Carolinians are overdosing on fentanyl-laced pills: A snapshot from Barnwell and Rock Hill

People are buying what they believe to be prescription opioid pills to cope with the pandemic. Sometimes they're getting them. Sometimes they're very much not.
Hal Gatewood
People are buying what they believe to be prescription opioid pills to cope with the pandemic. Sometimes they're getting them. Sometimes they're very much not.

In April of 2019, 473 South Carolinians overdosed on opioids. A year later, at the onset of the coronavirus pandemic’s lockdowns and restrictions on social gatherings, that number leapt to 712.

And one month after that, in May of 2020, the number of statewide overdoses hit 915. They’ve not been below 700 since at least last spring, reaching as high as 957 in July.

These numbers come from the South Carolina Department of Health and Environmental Control’s Bureau of Emergency Medical Services and Trauma.

“Data indicates that opioid overdoses have increased in South Carolina since the beginning of the COVID-19 pandemic,” DHEC states on its opioid epidemic webpage, “likely due to increased anxiety, social isolation and depression.”

Substance abuse counselors like Pam Rush concur. Rush is the director of Axis 1 Center of Barnwell County, its substance abuse treatment and prevention agency. She says that when the pandemic struck and face-to-face services closed, clients who had been coming in for treatment were left to find comfort with each other, which proved dangerous immediately.

Axis 1 reopened within weeks because Rush says it was just too problematic to leave the doors closed. But not everyone made it back in.

In a small, rural community like Barnwell County – where even the largest cities of Barnwell, Blackville, and Williston are too small to warrant population estimates from the U.S. Census Bureau – Rush says drug users know each other intimately.

Critically, the sellers and dealers know them too.

More critically, what buyers are buying has changed. A few years ago, the largest problem communities faced when the word “opioid” came up was the abundance of prescription pills left over in people’s homes that found their way onto the street.

Today, while that’s still a problem, a wave of arrests for overprescribing opioids and tighter reins on how many pills go home with patients has deeply cut into the number of prescription pills in circulation. You’d think that would be a good thing, but in the absence of the real thing, Rush says the market is being overrun with “homemade” pills containing fentanyl.

These designer pills are a witch’s brew of powders and chemicals pressed by simple contraptions on tabletops, often with brand names and batch numbers convincingly etched right into the pills. They can look so much like the real thing that you might have to analyze them in a lab to know for sure what you’ve got.

“Because it takes such a small amount to cause death,” Rush says, “it’s the fentanyl that really causes the overdose.”

Fentanyl is a legitimate prescription opioid. But it’s problematic in the illicit drug trade because it takes as little as 2 milligrams to be lethal, according to Oxford Treatment Center in Mississippi. That’s about the size and weight of half a mosquito.

A small mosquito.

So when someone is making knockoff pills in a pill press, miscalculating the amount of something like fentanyl can trigger a severe overdose.

Moreover, says Danielle Russell, director of Keystone Substance Abuse Services of York County, opioid users whom she’s been seeing (especially since the beginning of the pandemic) are taking a cocktail of pills.

This, plus fentanyl, is making saving overdose patients increasingly troublesome. Naloxone sprays like Narcan are typically effective at rousing someone who’s taken too much of an opioid, but these sprays are less effective where too much fentanyl is in the body; they’re even less so when there are other drugs, some prescription, some pure (like heroin), and some an amalgam of who-knows-what.

For rural counties like Barnwell or its neighbor, Union, which led the state in overdoses per 1,000 residents in the summer, fentanyl is taking a heavy toll.

But across the state in York County, Keystone’s treatment director, Cathy Caruthers, says her agency is increasingly worried about fentanyl use among high school students. She says Keystone has counselors in the Rock Hill School District who are reporting the presence of fentanyl-laced pressed pills. She calls the situation “alarming.”

Lindsay Machak, the school district’s director of communications, says that while the district is keeping a close watch and is working with agencies like Keystone, it is not seeing anything too concerning yet.

Machak says the district touts a strong anti-drug message that leverages peer-to-peer pressure to live a drug-free life. Red Ribbon Week, one of the district’s most concentrated efforts at fostering a drug-free state of mind in students, kicks off next week.

October is National Youth Substance Use Prevention Month.

Peer-to-peer pressure is also leveraged by treatment agencies like Axis 1, where Rush says clients who fell away during the pandemic have suffered the worst of not having in-person, in-treatment friends to help keep them on the straight and narrow.

She says some clients don’t come in for treatment, for fear of (or are using as an excuse) the pandemic. Agencies have adopted some telehealth sessions, but those are not proving as effective as in-person groups.

Russell says funding issues centering on the size of tele-group sessions have hampered their effectiveness. Rush says that in rural (and poor) counties like Barnwell, access to the internet can be limited, keeping many from being able to get help when they try to reach out for it.

If you or someone you know needs counseling for any kind of substance use or addiction issues, the South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS) is available HERE or by calling 803-896-5555.

You can also contact the Substance Abuse and Mental Health Services Administration (SAMHSA) HERE or by calling 1-800-662-4357 (HELP), 24/7/365.

Scott Morgan is the Upstate multimedia reporter for South Carolina Public Radio, based in Rock Hill. He cut his teeth as a newspaper reporter and editor in New Jersey before finding a home in public radio in Texas. Scott joined South Carolina Public Radio in March of 2019. His work has appeared in numerous national and regional publications as well as on NPR and MSNBC. He's won numerous state, regional, and national awards for his work including a national Edward R. Murrow.