Oftentimes, activities related to fatal overdoses within a certain county may have been initiated in an adjacent county and vice versa. Since the opioid epidemic does not recognize county lines, critical case data may be difficult to attain from neighboring agencies because of differing case management software programs and/or lack of internal tracking of overdose case data. Smaller counties may experience hurdles in uploading overdose information to stakeholder databases, such as the Overdose Detection Mapping Application Program (ODMAP) and the State Unintentional Drug Overdose Reporting System (SUDORS), because of limitations in funding and a lack of supportive personnel to enter data and detect the circumstances leading to fatal overdoses and identify opportunities to prevent future overdoses. When overdoses cross county lines, it is difficult to see critical investigative links between separate fatalities. It is also difficult to recognize individuals or groups who are at risk and in need of harm reduction outreach and lifesaving resources. To address these issues, the Charleston County, South Carolina, Coroner’s Office will soon begin a grant-funded project to adopt a multiregional approach to overdose fatality reviews (OFRs). The Charleston County Coroner’s Office will work with five neighboring county coroners’ offices to improve intercounty opioid investigation protocols and perform faster uploading of data to national stakeholder databases, thus providing more accurate regional opioid death statistics, which will be provided to local, state, and federal agencies that analyze opioid-related mortality rates. By assisting smaller, adjacent counties in their case data upload, the Charleston County OFR team anticipates an increase in the total number of fatal overdoses as refinement and capture of overdoses are recognized.