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South Carolina Honors College

One Clinical Word

by Mylah Mathis

Heroin is bad; that’s not exactly a hot take. Somewhere between the images of strung-out junkies with needles in their arms and decades of “Just Say No” adverts it’s been decided that “shooting up” is disturbingly euphemistic. After all, heroin isn't just heroin. It's dope, smack, horse, skag. It’s prostitutes on Figueroa Street and muttering ex-cons on Skid Row. It's the neighborhood in the bad part of town that looks more like the muse for a demolition crew than a place to live. It’s dirty in the kind of way that is intimately understood and universally reviled.  

PR problems aside, heroin can be summed up in one clinical word: opioid. Although the term has been steadily creeping into South Carolina vernacular, it’s not nearly as titillating as its syringe-studded headliner. Respectable over-the-counter opioids like Vicodin and Methadone evade public scorn while heroin, the redheaded stepchild, is left holding the gun. For all our selective pearl-clutching, though, the opioid problem shows few signs of abating. Like some macabre family reunion, opioids brandishing Rx seals and physician signatures have allied with their illegal counterparts to catapult South Carolina’s growing epidemic.  

The Centers for Disease Control and Prevention reported that 1,325 South Carolinians died from general opioid overdoses in in 2020, up 59 percent from the previous year. Covid-19, with its cruel résumé of financial instability and social upheaval, is much to blame for this uptick. Unsure of whether they could afford their next meal and isolated from family and friends, many sought comfort in the ill-fated kaleidoscope of -ins, -ones, and -nyls – of course, this comfort wasn’t hard to find in a state that writes five million opioid prescriptions per year at a rate 14 percent higher than the national average. In a deadly cocktail of chronic pain and looming uncertainty, highly addictive opiates became the malignant tumor growing in our state’s underbelly.  

Although this could have been an opportunity for South Carolina to show its stripes in the fight against mental illness and substance abuse, our behavioral health care system, ranked 43rd in the nation, was woefully unprepared. Psychiatric professionals are scarce enough in metropolitan areas, and with fewer still in less-populated regions, rural communities are even more deeply scarred. These poor, often forgotten populations were and still are left to endure the crippling lows of untreated anxiety, depression, and schizophrenia. With the shabby bones of our mental health infrastructure laid out in unmistakable clarity, low-income groups traded the fluorescent lights of pharmaceutical opiates for the sketchy street corners of heroin, illegal fentanyl, and a host more.  

Although we pay the price for our negligence in toe tags and obituaries, punitive institutions continue to fail the living. Basic sensibility tells us sobriety and jail time go together about as well as Clemson and Carolina, with PEW Research Center reporting 77 percent of drug offenders recidivate within five years of their initial charge. Our state legislature, however, continues to allow for the routine imprisonment of opioid victims. When these individuals inevitably recommit, they are met with longer sentences and even heftier fines. By slapping the label of “criminal” on populations so clearly in need of help, we auction off our own humanity in exchange for six-by-eight feet of brick and thousands more jumpsuits. If our beloved Palmetto State were in the business of compassion, it’d be nearly bankrupt.  

While the forecast for South Carolina’s future may seem bleak, opportunities for preventative and restorative measures are still viable. The expansion of peer support networks and counseling resources would aid in dismantling the constraints of opioid stigma. Through further investment in prescription drug monitoring programs, health care providers can identify and curb misuse in its early stages. For individuals already in the throes of addiction, increased distribution of the overdose-reversing medication Naloxone to first responders, police, and community members would be a life-saving contribution. By taking steps towards improving the state’s 911 Good Samaritan Law, we can ensure overdose victims and bystanders receive full criminal immunity for illicit opioid possession.  

Addiction, whether born of halfway houses or hospitals, is a battle worth fighting. The ills of opioid abuse are not an indictment of those caught in its unforgiving jaws; rather, they are a mesh to a broader, statewide sickness. Through negligence and continued criminalization, we poison our most vulnerable with the same unnerving potency as any numbered pill or tar-filled syringe. To better our state means to better our fundamental understanding of what it is to be kind, and in doing so, create a South Carolina that reaches its full potential. 

Works Cited 

Code of Laws - Title 44 - Chapter 53 - Poisons, Drugs, And Other Controlled Substances,

“Drug Overdose Mortality by State.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 Mar. 2022, 
 “Opioid Data.” Just Plain Killers - SC DAODAS, 11 Aug. 2022,

“Opioid Emergency Response Plan.” Opioid Emergency Response Plan - South Carolina Emergency Management Division,

“Opioid Use Disorder.” Yale Medicine, Yale Medicine, 23 Mar. 2022, use disorder is consequences caused by their use.  

Vestal, Christine. “Helping Drug-Addicted Inmates Break the Cycle.” The Pew Charitable Trusts, The Pew Charitable Trusts, 13 Jan. 2016,  

“When Addiction and Mental Illness Collide.” National Institutes of Health, U.S. Department of Health and Human Services, 

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