OBJECTIVES: Although opioids play a central role in the treatment, and palliation of many medical conditions, there is a large and growing problem of abuse nationally and in South Carolina particularly. According to the 2009 National Survey on Drug Use and Health, more than 5 million Americans abused prescription opioid painkillers in January 2011. Reports show an increase in cases of doctor shopping, prescription forgery, illicit prescribing and dispensing, and other diversion activities. We determine patterns of opioid prescribing in South Carolina through an epidemiologic analysis and geo-spatial mapping of South Carolina prescription data for 2010-2011. METHODS: Using de-identified data from the South Carolina Reporting and Identification Prescription Tracking System (SCRIPTS), we conducted a state-wide epidemiological analysis of patient and prescriber opioid prescribing patterns including distributions of number of prescriptions, number of prescribers and of pharmacies used by each patient. Additionally, we conducted County- and Zip Code-level analyses of opioid prescribing patterns. RESULTS: Prescriber deciles were created representing 10% groupings of prescribers based on controlled substances (CS) II – IV prescription volume. The top 10% of SC prescribers wrote more than 60% (N=2,158,574) of the total CS II – IV prescriptions in 2010, and  58% of total opioid prescriptions. The top pharmacy decile dispensed about 44% of total prescriptions and about 37% of opioid prescriptions. Five Zip Codes had the highest percent of opioid prescriptions out of total prescriptions (Charleston, Richland, Greenville, Barnwell and Aiken). In 2010 counties with the highest percent of prescriptions (>61%) were Greenville, Richland, Barnwell and Charleston, whereas in 2011 the counties with the highest percent of prescriptions were Greenville, Chester, Richland and Charleston. CONCLUSIONS: Our findings indicate a relatively small percentage of providers, concentrated in a few counties, account for most opioid prescriptions.  This group represents a potential target for physician education and engagement in handling pain management and appropriate use of opioids.