Real Tri-County SC DPH data on Charleston County opioid overdose deaths, naloxone use, and how it compares to Berkeley, Dorchester, and the state.
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Charleston County's age-adjusted drug overdose death rate has run above both neighboring Tri-County counties and the South Carolina state average for years, according to the South Carolina Department of Public Health's (SC DPH) own Tri-County behavioral health data. This is a data-driven look at what the numbers actually say about Charleston, Berkeley, and Dorchester counties — not national averages, but the local Lowcountry picture.
Key Takeaways on Charleston County Overdose Data
- Charleston County's naloxone administration rate (3.3 per 1,000 population) is higher than Berkeley (1.8), Dorchester (1.1), and the South Carolina average (2.7), per SC DPH's Tri-County behavioral health report.
- In 2022, Charleston County had the 16th-highest drug overdose death rate of South Carolina's 46 counties; Charleston also had the 13th-highest naloxone administration rate statewide that year.
- Charleston County's age-adjusted overdose death rate climbed from 21.5 per 100,000 in 2015 to 46.0 per 100,000 in 2020, per SC DPH Vital Statistics data, before the statewide trend began reversing.
- South Carolina recorded 1,481 drug overdose deaths statewide in 2024, a 31.3% decrease from 2,157 in 2023 — the second consecutive annual decline — with fentanyl involved in 914 of those 2024 deaths, per SC DPH.
- Charleston County launched a public real-time Opioid Dashboard in early 2025, reporting 124 opioid-involved deaths in Charleston County in 2024.
How Does Charleston County's Overdose Rate Compare to Berkeley and Dorchester?
SC DPH's Tri-County behavioral health data (drawn from SC DHEC Vital Statistics, the SC Prescription Drug Monitoring Program, SC EMS, and SC DHHS) tracks Berkeley, Charleston, and Dorchester counties side by side. Charleston's age-adjusted drug overdose death rate rose from 21.5 per 100,000 in 2015 to 46.0 per 100,000 in 2020 — consistently at or above the statewide rate across that period, and higher than both Berkeley (which moved from 16.2 to 30.4 per 100,000) and Dorchester (5.3 to 22.3 per 100,000) over the same years. In 2022, Charleston County ranked 16th of 46 counties statewide for drug overdose death rate.
Naloxone administration data tells a related story: Charleston County's EMS naloxone administration rate was 3.3 per 1,000 population, well above Berkeley (1.8), Dorchester (1.1), and the state rate (2.7). Because naloxone administrations track opioid-involved overdose events — including non-fatal ones responded to by EMS — a higher rate here reflects both a heavier overdose burden and more consistent EMS naloxone deployment in the county.
Opioid Use Disorder and Prescription Trends Across the Tri-County
Opioid use disorder (OUD) rates in the Tri-County area, per SC DHHS 2022 data, ran close to the statewide average of 2.9 per 1,000 for females: Charleston (2.5), Dorchester (2.5), and Berkeley (2.3) all trailed the state slightly among women, while male rates were roughly even across all three counties (1.0–1.1 per 1,000). Opioid prescriptions dispensed have fallen across the board — Charleston's rate dropped from 790.8 per 1,000 population in 2018 to 550.9 in 2022, tracking the statewide decline from 803.2 to 594.2 over the same period. A falling prescription rate alongside a still-elevated overdose death rate is consistent with what SC DPH and national data both point to: illicit fentanyl, not prescription opioids, now drives the overdose burden.
What Changed Between 2023 and 2024
Statewide, South Carolina overdose deaths fell from 2,157 in 2023 to 1,481 in 2024 — a 31.3% decline and the second consecutive year of improvement. Fentanyl was still involved in 914 of the 1,481 deaths (about 62%) in 2024, confirming it remains the primary driver even as total deaths fall. SC DPH Director Dr. Brannon Traxler has noted that most of the state's 46 counties saw overdose numbers decline between 2023 and 2024, with five counties (Aiken, Colleton, Georgetown, Jasper, and Spartanburg) posting drops of 50% or more. County-level 2024 figures specific to Charleston were not published in the statewide summary report at the time of writing.
Charleston County's New Real-Time Opioid Dashboard
In early 2025, Charleston County Government launched a public-facing Opioid Dashboard, funded through the South Carolina Opioid Recovery Fund (opioid litigation settlement dollars). The dashboard pulls data directly from the Charleston Center, Charleston County EMS, the Charleston County Sheriff's Office, and the Charleston County Coroner's Office, and reports 124 opioid-involved deaths in Charleston County in 2024 along with monthly naloxone kit distribution figures. This is the first county-run, continuously updated overdose data source for Charleston, rather than a periodic state report — worth checking directly for the most current local numbers as they update.
Why This Matters for Getting Help
A high naloxone administration rate combined with a still-elevated overdose death rate points to a Tri-County area where overdose events are frequent enough that EMS response has become routine — and where the gap between surviving an overdose and getting into structured treatment is where people fall through. Reversal with naloxone is not treatment. Programs across the continuum — from medical detox through residential care and medication-assisted treatment for opioid use disorder — exist specifically to close that gap. Lantana Recovery's Charleston, SC location serves the Tri-County area directly.
Key Takeaways on Charleston County Overdose Data
See the summary box above for the core figures from this report.
FAQ: Charleston County Overdose Trends
Is Charleston County's overdose rate higher than the South Carolina average?
Are overdose deaths in South Carolina going up or down?
What drug is most involved in Charleston-area overdose deaths?
Where can I find current Charleston County overdose data?
Bottom Line
Charleston County has consistently carried a heavier opioid overdose burden than Berkeley and Dorchester counties, and above the South Carolina state average, even as statewide deaths have fallen two years running. Fentanyl, not prescription opioids, remains the dominant factor. For Charleston-area families, the practical takeaway is that a naloxone reversal is a moment to act on, not an isolated event — structured treatment options exist locally through the full continuum of care, from detox through outpatient support.
Sources
- SC DPH — Behavioral Health: Berkeley, Charleston, and Dorchester Counties Drug Use (Tri-County report)https://dph.sc.gov/sites/scdph/files/2025-04/DW_Drug_Use_2024_Tri-County.pdf
- ABC News 4 — South Carolina overdose deaths drop for second year, down 31% in 2024 (SC DPH report)https://abcnews4.com/news/local/south-carolina-overdose-deaths-drop-for-second-year-down-31-in-2024-scdph-report-opioid-overdose-safety-kit-south-carolina-department-of-public-health-fentanyl
- Spectrum News — Charleston County unveils Opioid overdose dashboardhttps://spectrumlocalnews.com/sc/south-carolina/news/2025/01/30/south-carolina-news-charleston-opioid-dashboard
Reviewed by
Warren PhillipsCo-Founder, LMSW · Editorial Reviewer
Warren Phillips is a Co-Founder of Lantana Recovery and a Licensed Master Social Worker (LMSW) specializing in substance abuse and mental health treatment. He previously worked in various capacities at Turnbridge Addiction Treatment and Clearpoint Recovery Center before co-founding Lantana Recovery. Warren's clinical approach draws on a strengths-based perspective, Twelve Step philosophies, Cognitive Behavioral Therapy, and Motivational Interviewing. He brings both personal and professional experience to his work — as a person in long-term recovery from alcohol and illicit substances, he has used that experience to help shape Lantana's treatment programming. Warren grew up in Memphis, TN and St. Louis, MO, attended college in Mississippi, and lived in California and Connecticut before relocating to Charleston. He now lives in Mount Pleasant with his wife, Angela, and their two young children, Hall and Sam.
Written by the Lantana Recovery Editorial Team and reviewed for clinical accuracy before publication.
