Charleston County Coroner Bobbi Jo O’Neal | Photo by Joey Izzo
Charleston County Coroner Bobbi Jo O’Neal sits down to document yet another death as a drug overdose. She’s sad and angry, again. But her feelings motivate her to think of ways to help combat the fentanyl crisis. This has become part of her grieving process.
“We’re losing so many people to something that’s preventable,” O’Neal said. “It’s a really scary time out there. I don’t think people know what they’re using or what’s in it which is why I don’t think the death rate will be going down.”
While O’Neal believes overdoses are preventable, she also recognizes the issue is overwhelming. She said Narcan, a nasal spray that can reverse opioid overdoses, is not always used when it could be. Even more disheartening, there is a stigma around mental health problems and substance use disorders.
Summertime is also when drug overdoses tend to increase, O’Neal said. People are outside more and willing to try new things. They are also using drugs as a coping mechanism and may be getting drugs they don’t know are mixed with fentanyl, she said.
“When I first started at the coroner’s office back in 1996, we usually saw drug overdoses from a drug of one kind,” O’Neal said. “Now, we never see one drug alone. Currently, we’re seeing an uptick in fentanyl mixed with methamphetamine.”
Anytime her office suspects someone may have died from a substance, they screen the victim for a positive or negative result and send that information to law enforcement and the Charleston Center, which is a substance use treatment center.
Beyond investigating deaths and overdoses, the coroner’s office recently became a certified Narcan distributor. Now, it is working with other agencies to combat fentanyl and opioid overdoses before they even happen.
“If we’re on the scene of death and we suspect that it’s opioid-involved, we’re leaving Narcan behind for survivors in the hopes that they can save someone from becoming one of our statistics.”
Narcan, an opioid antidote, is available at the coroner’s office | Photo by Joey Izzo
The numbers behind the crisis
So far this year, there have been 40 confirmed deaths involving fentanyl in Charleston County, according to O’Neal. Only six of the drug deaths this year didn’t involve fentanyl.
It only takes about two milligrams of fentanyl — the equivalent of 10 to 15 grains of table salt — to kill a person. For some people, 2 milligrams is deadly. For others, it’s not. It depends on a person’s body size, tolerance and past usage. If they have built up a tolerance, the lethal level can be higher, O’Neal said.
Pharmaceutical fentanyl is classified as an opioid and prescribed to treat severe pain. The drug is about 100 times more potent than morphine and 50 times more potent than heroin. The top five controlled substances distributed in South Carolina last year included Adderall, Vicodin, Ultram, Xanax and Ambien. Fentanyl prescriptions in South Carolina have been decreasing, according to the S.C. Department of Health and Environmental Control (DHEC). But that doesn’t mean it’s any less deadly.
In an effort to address opioid abuse in Charleston, DHEC started a prescription monitoring program. Its website dashboard includes fentanyl in the total number of opioid prescriptions but doesn’t have specific data on fentanyl-related deaths because most are from illegal street drugs, the department said.
“Our agency wanted to make overdose data more publicly accessible because we think it will help a lot of treatment providers and local communities who are trying to respond to the drug crisis we have in our state,” said Casey White, the public information officer at DHEC.
The department said it hoped its data could be used by public health professionals, politicians and researchers to drive policy decisions and develop new programs to address the misuse of fentanyl and other drugs. DHEC decided to make the dashboard public to keep South Carolina residents informed and engaged in the prevalent drug issues happening in their communities.
Local efforts to save lives
Before deputies from the Charleston County Sheriff’s Office head out on a shift, they check their duty belts for Narcan.
Charleston deputies on the road and in the Sheriff Al Cannon Detention Center used Narcan more than two dozen times last year, the sheriff’s office said. While U.S. overdose death rates have dropped for the first time in five years, Charleston is still being affected by the ongoing fentanyl crisis.
“Fentanyl use doesn’t discriminate and is often being laced with other drugs,” said Alexis Douglas, a spokesperson at the sheriff’s office. “If you’re getting drugs off the streets, they are most likely laced with another substance, possibly fentanyl. The opioid epidemic is an issue that needs to be taken seriously across the entirety of the Lowcountry.”
The county sheriff’s office was approved as a community distributor of Narcan in February to provide direct service to people who are at risk of an opioid overdose. The agency is also part of the Charleston County Addiction Crisis Task (ACT) Force, along with other law enforcement agencies, community groups, medical professionals and treatment providers.
The group meets every other month to review overdose cases and determine how best to provide information to survivors and their families. A smaller ACT subcommittee meets weekly.
The Sheriff’s Office also has applied for funding from the South Carolina Opioid Recovery Fund Board (SCORF) to add an opioid outreach specialist to its team. Officials said they hoped the position would help with overdose follow-ups in the community and the detention center.
O’Neal describes how a new machine acquired by the county will help officials know in a matter of minutes whether a death is related to an overdose | Photo by Joey Izzo
The first Narcan vending machine in South Carolina was installed in the Sheriff Al Cannon Detention Center during the summer of 2022. Last year, 1,006 boxes of Narcan were taken from the vending machine. The machine is free and currently holds 54 boxes stocked by the Charleston Center.
“The Charleston Center is taking a collaborative approach on tackling the opioid and fentanyl crisis, said Chanda Funcell, the director of the Charleston Center. “With support from federal, state and SCORF funding, we are able to get Narcan, fentanyl test strips, xylazine test strips and literature out to the community.”
For people struggling with opioid use disorders, the Charleston Center offers several programs and resources. It has opioid treatment services that offer medication management and counseling services. The center also offers in-patient withdrawal management and transitional care for people.
“Through a comprehensive approach that includes prevention, harm reduction, treatment and recovery components, we work with other agencies to ultimately save lives,” Funcell said.
If you or someone you know is struggling with substance use disorder, you can call the Charleston Center helpline at (843) 722-0100.
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