When the pandemic hit, people didn’t just worry about masks and ventilators. A quieter crisis was unfolding: drug shortages. Essential medications vanished from pharmacy shelves. At the same time, the illegal drug supply turned deadly. Two systems - one legal, one underground - both broke down, but in ways that hurt people in very different ways.
Medications Disappeared Overnight
In early 2020, hospitals ran out of sedatives needed to put COVID-19 patients on ventilators. Insulin, antibiotics, and blood pressure pills became hard to find. It wasn’t just one drug. It was dozens. A study published in JAMA Network Open found that from February to April 2020, nearly one in three drug supply reports turned into actual shortages. That’s more than four times the normal rate.
Why? Most of the world’s active drug ingredients come from just two countries: China and India. When lockdowns hit, factories slowed or shut down. Shipping containers piled up at ports. A single broken link in that chain meant a whole class of medicines vanished. Generic drugs - the cheap, everyday ones - were hit hardest. Why? Because companies make tiny profits on them. When costs rose, many just stopped making them.
Patients didn’t wait. Some rationed their insulin. Others switched to untested alternatives. One nurse in Ohio told me her diabetic patient started using expired insulin because the pharmacy couldn’t restock. That’s not a rare story. It was the new normal.
The Illicit Market Got More Dangerous
While hospitals scrambled for medicine, the street drug market was collapsing - and getting deadlier.
Before the pandemic, heroin and cocaine flowed through established networks. When borders closed and transport routes were cut, suppliers turned to fentanyl. It’s cheap, powerful, and easy to ship in powder form. Suddenly, street drugs that used to be 10% fentanyl became 70% or more. People who had used heroin for years didn’t know what they were taking. One Reddit user in June 2020 wrote: “I took my usual dose. Passed out for two hours. My friend had to call 911. Turns out it was pure fentanyl.”
The numbers don’t lie. From May 2020 to April 2021, over 97,000 Americans died from drug overdoses - a 31% jump from the year before. In West Virginia, overdose deaths jumped more than 50%. In Louisiana, they nearly doubled. These weren’t random spikes. They were direct results of a poisoned supply.
Help Got Harder to Find
For people trying to get off drugs, the pandemic made recovery nearly impossible. Treatment centers closed. Support groups moved online. But not everyone had Wi-Fi, a smartphone, or the tech skills to join a Zoom meeting.
Older adults, rural residents, and people without stable housing were left behind. A study from the National Institute on Drug Abuse found that in-person behavioral therapy visits dropped by 75% in spring 2020. Meanwhile, telehealth prescriptions for buprenorphine - a medication that helps manage opioid addiction - shot up from 13% to 95% of all prescriptions in just two months. That sounds like progress. But for many, it wasn’t enough.
One woman in rural Kentucky told a reporter she drove 90 miles each way for methadone before the pandemic. When clinics cut hours, she couldn’t afford the gas. She started using fentanyl-laced pills instead. “I didn’t want to,” she said. “But I couldn’t wait three days for my dose.”
The FDA Tried to Fix It - But the System Was Already Broken
The U.S. Food and Drug Administration scrambled to respond. They fast-tracked inspections. Asked manufacturers to ramp up production. Pushed for more transparency. By May 2020, shortages began to ease. But that didn’t mean the problem was solved.
The fix was temporary. The root causes? Still there. The U.S. still relies on foreign factories for 80% of its active ingredients. Companies still make generic drugs in the cheapest country, not the most reliable one. And there’s no backup plan when things go wrong.
The 2023 National Defense Authorization Act finally included a provision to track drug supply chains better. That’s a start. But without real investment in domestic manufacturing or incentives for companies to keep making low-profit drugs, the next crisis is just a delay away.
What’s Still Broken Today
Drug shortages are back to pre-pandemic levels - but overdose deaths aren’t. In 2022, over 107,000 people died from drug overdoses in the U.S. That’s higher than ever. Why? Because the drug supply is still full of fentanyl. Because treatment access is still unequal. Because stigma still keeps people from calling for help.
Even now, harm reduction groups are stretched thin. Needle exchanges in Philadelphia saw a 40% drop in services during lockdowns. In Boston, naloxone distribution went up 30% - but so did demand. One worker told me: “We’re handing out more life-saving kits than ever. But we’re handing them out to more people who need them.”
Telehealth helped some. But it didn’t fix everything. People still need counselors. Still need community. Still need to sit in a room with others who get it. When those connections vanish, relapse follows.
What Needs to Change
Here’s what works:
- Build domestic manufacturing capacity for critical drugs - not just for profit, but for safety.
- Make it financially viable for companies to produce low-margin generics.
- Expand access to naloxone and fentanyl test strips in every pharmacy and community center.
- Keep telehealth options for medication-assisted treatment - but pair them with in-person support where possible.
- End the criminalization of drug use. Fear keeps people from seeking help. Compassion saves lives.
The pandemic didn’t create these problems. It exposed them. And if we don’t act now, the next crisis won’t be a surprise. It’ll be predictable. And preventable.
Why did drug shortages happen during the pandemic?
Drug shortages happened because the global supply chain for pharmaceutical ingredients - mostly from China and India - broke down during lockdowns. Factories shut down, shipping slowed, and companies stopped making low-profit generic drugs because they couldn’t cover rising costs. The U.S. has no real backup system, so when one link failed, entire classes of medications vanished.
Did the pandemic make illegal drugs more dangerous?
Yes. With traditional drug supply routes disrupted, dealers turned to fentanyl - a cheap, powerful synthetic opioid that’s easy to ship in small amounts. Many street drugs became laced with it, often at levels 10 to 100 times stronger than users expected. This led to a massive spike in overdose deaths, especially in states like West Virginia and Kentucky.
How did telehealth help people with addiction during the pandemic?
Telehealth allowed doctors to prescribe buprenorphine and methadone remotely, which kept people in treatment when clinics closed. Prescriptions via telehealth jumped from 13% to 95% in just two months. For people in rural areas or without transportation, this was life-saving. But it didn’t replace the human connection of in-person counseling, which many still needed.
Are drug shortages still happening today?
The number of reported shortages has returned to pre-pandemic levels, but the system hasn’t changed. The same vulnerabilities remain: reliance on foreign manufacturing, no incentives to produce low-profit drugs, and no emergency stockpiles. Experts warn the next disruption - whether from a new pandemic, war, or climate event - could cause another wave of shortages.
Why are overdose deaths still rising after the pandemic?
Because the drug supply is still laced with fentanyl, and access to treatment remains unequal. Many people lost their support networks during lockdowns and never regained them. Stigma, poverty, and lack of insurance still block care. Even with more naloxone available, people keep dying because the root causes - isolation, trauma, and economic despair - haven’t been addressed.
What You Can Do
If you or someone you know is struggling with medication access or substance use, reach out. Talk to your pharmacist about alternatives. Learn where to get free naloxone. Support local harm reduction groups. And push for policy changes - because this isn’t just about drugs. It’s about who gets care, and who gets left behind.