When the pandemic hit in early 2020, most people worried about masks, ventilators, and hospital beds. But behind the scenes, something just as dangerous was happening: drug shortages began spreading across the U.S. and the world. It wasn’t just about hand sanitizer or face shields-people couldn’t get their blood pressure pills, insulin, antibiotics, or even pain medications. And while hospitals scrambled to keep critical care drugs in stock, another crisis was brewing in the shadows: illegal drug markets became deadlier than ever.
Why Did Essential Medications Vanish?
The problem wasn’t that drug companies stopped making medicines. It was that the machines, factories, and shipping routes that made those medicines broke down. Most of the active ingredients in pills-like the stuff that makes antibiotics work-come from just two countries: China and India. When lockdowns hit there in early 2020, factories shut down. Trucks didn’t move. Ports sat empty. By February to April 2020, nearly one in three drug supply reports showed signs of a real shortage. That’s more than four times the normal rate. Some drugs disappeared completely. Insulin, which millions of diabetics rely on daily, became harder to find. Antibiotics used to treat pneumonia and sepsis ran low. Even basic IV fluids, the kind given in emergency rooms, were rationed. Hospitals had to make tough choices: which patients got the medicine, and which didn’t. By May 2020, things started to improve. The FDA stepped in. They started calling manufacturers directly, fast-tracking inspections, and pushing for more transparency. They didn’t fix everything-but they stopped the worst of the bleeding. After May, the number of new shortage reports dropped back to near pre-pandemic levels. But the damage was done. Many patients had already gone weeks without their meds. Some switched to less effective alternatives. Others skipped doses. A lot of people never got back on track.The Hidden Crisis: Illicit Drugs Got More Dangerous
While hospitals dealt with shortages of legal drugs, the underground drug market was falling apart in a different way. When lockdowns hit, traditional drug distributors couldn’t move product the way they used to. Cartels and dealers lost their usual routes. So they adapted. And they didn’t adapt safely. Fentanyl, a synthetic opioid 50 to 100 times stronger than morphine, started showing up everywhere. It was cheaper to produce and easier to smuggle in tiny amounts. Dealers began mixing it into heroin, cocaine, and even fake prescription pills sold as oxycodone or Xanax. People didn’t know what they were taking. One Reddit user from June 2020 wrote: “The street supply got weird after lockdowns started-people were getting knocked out by doses that used to be normal. Turned out to be fentanyl-laced.” The results were deadly. From May 2019 to April 2020, there were 77,007 drug overdose deaths in the U.S. The next year? 97,990. That’s a 31% jump in just 12 months. By the end of 2022, overdose deaths hit over 107,000. States like West Virginia, Kentucky, and Vermont saw increases of more than 50%. This wasn’t just a spike-it was a collapse.
Help Got Harder to Reach
For people trying to get help with addiction, the pandemic made everything harder. In-person support groups like Narcotics Anonymous shut down. Needle exchange programs cut hours. Counseling centers closed. One harm reduction program in Philadelphia reported a 40% drop in services during the first lockdown. Meanwhile, stigma kept many from calling 911-even if they overdosed-because they feared police involvement or judgment. But there was one bright spot: telehealth. For the first time, doctors could prescribe buprenorphine (a medication for opioid use disorder) over video calls. Before the pandemic, only 13% of these prescriptions were done remotely. By April 2020, that number jumped to 95%. For people in rural areas or without reliable transportation, this was life-changing. Medicare data showed telehealth visits for substance use disorders went from less than 1% to 40% in just a few months. Still, not everyone could use it. Older adults struggled with apps and Zoom. People without high-speed internet or a smartphone were left out. One patient in rural Arizona told a nurse: “I got my buprenorphine through telehealth, but I had to drive 40 miles to get Wi-Fi just to log in.”Who Got Left Behind?
The pandemic didn’t create new inequalities-it just made them worse. People with low income, people of color, and those living in rural areas faced the worst of both crises. They were more likely to have chronic conditions that made them vulnerable to COVID-19. They were less likely to have insurance or access to telehealth. And they were more likely to live in areas where illegal drugs were more heavily adulterated. A study from the National Institute on Drug Abuse found that Black and Hispanic communities saw the largest increases in overdose deaths. At the same time, these communities had fewer treatment centers, fewer mental health providers, and less access to naloxone-the drug that can reverse an opioid overdose. Harm reduction groups tried to fill the gaps. In Boston, they handed out 30% more naloxone kits in 2020 than in 2019. In some cities, they set up drive-through services so people could get clean needles or medication without entering a building. But these efforts were patchwork. They depended on donations, volunteers, and emergency funding. They couldn’t replace a real, sustained public health system.
What’s Changed Since Then?
Today, most prescription drug shortages have returned to normal levels. The FDA still monitors supply chains closely. The 2023 National Defense Authorization Act included new rules to make drug manufacturing more transparent-forcing companies to report potential shortages earlier. That’s a step forward. But the overdose crisis? It hasn’t slowed down. Fentanyl is still everywhere. More people are dying from synthetic opioids than ever before. And while telehealth is still widely used, many of the emergency rules that made it possible are being rolled back. Some states now require in-person visits again before prescribing buprenorphine. That’s a step backward for people who rely on remote care. The pandemic exposed a truth we’ve ignored for years: our drug supply is fragile. Our addiction treatment system is underfunded. And when a crisis hits, the people who need help the most are the ones who lose it first.What You Can Do
If you or someone you know depends on regular medication, keep a 30-day supply on hand if possible. Talk to your pharmacist about backup options if your usual drug runs out. Don’t wait until you’re out to ask questions. If you’re concerned about someone using drugs, learn how to use naloxone. It’s free in many places. Carry it. Know the signs of an overdose. Don’t assume someone’s “just sleeping.” And if you’re in recovery, reach out-even if it’s just a text. Isolation is one of the biggest triggers for relapse. Online support groups still exist. Hotlines are still open. You’re not alone. The pandemic didn’t cause drug shortages or overdose deaths. It just ripped away the bandage hiding a wound that’s been there for decades. Now that we’ve seen it, we can’t look away.Why did drug shortages happen during the pandemic?
Drug shortages happened because the global supply chain for pharmaceutical ingredients broke down. Most active ingredients in medicines come from factories in China and India. When lockdowns hit in early 2020, those factories shut down, shipping slowed, and transportation networks stalled. This caused immediate disruptions in the production and delivery of essential medications like insulin, antibiotics, and IV fluids. The problem peaked between February and April 2020, with supply chain issues affecting nearly one in three drugs reported to be at risk.
Did drug shortages get better after 2020?
Yes, most prescription drug shortages improved after May 2020. The FDA took direct action by increasing communication with manufacturers, fast-tracking inspections, and prioritizing critical drugs. By mid-2020, the rate of new shortage reports dropped back to near pre-pandemic levels. However, the underlying vulnerabilities-like overreliance on foreign manufacturing and lack of inventory buffers-remain. Experts warn that without policy changes, future disruptions are likely.
How did the pandemic affect illegal drug markets?
The pandemic disrupted traditional drug distribution networks, causing dealers to turn to more potent and dangerous substances like fentanyl. Fentanyl is cheaper to produce, easier to smuggle, and can be mixed into other drugs without changing appearance. This led to a sharp rise in overdose deaths. From May 2019 to April 2020, there were 77,007 overdose deaths in the U.S. The next year, that number jumped to 97,990-a 31% increase. Many people didn’t know they were taking fentanyl until it was too late.
Why did overdose deaths keep rising even after drug shortages improved?
Even as prescription drug supplies stabilized, the illicit drug market became more dangerous. Fentanyl contamination spread widely, and people who used drugs lost access to in-person support systems like recovery groups, counseling, and harm reduction services. Isolation, stress, and economic hardship made relapse more likely. At the same time, stigma prevented many from seeking help. These factors combined to keep overdose deaths climbing through 2021 and beyond.
Did telehealth help people with addiction during the pandemic?
Yes, telehealth made a big difference for many. Before the pandemic, only 13% of buprenorphine prescriptions were done remotely. By April 2020, that number jumped to 95%. For people in rural areas or without transportation, this meant access to life-saving treatment. However, not everyone could benefit. Older adults, low-income individuals, and those without reliable internet or smartphones struggled to use virtual services. As emergency rules expire, some states are requiring in-person visits again, which could block access for those who need it most.
What’s being done to prevent future drug shortages?
The 2023 National Defense Authorization Act included new requirements for drug manufacturers to report potential supply issues earlier. The FDA continues to monitor critical drug supplies more closely. Experts are also pushing for more domestic production of key ingredients and better inventory management. But these are long-term fixes. Without addressing the economic pressures that make cheap overseas manufacturing more profitable, future shortages remain a real risk.
