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 unfolding: drug shortages. Essential medicines - from antibiotics to insulin to blood pressure pills - started disappearing from shelves. At the same time, illegal drug supplies became more dangerous as fentanyl crept into street drugs. For patients, this wasn’t just an inconvenience. It was life-or-death.

Why Did Medications Vanish Overnight?

The global supply chain for pharmaceuticals was already fragile. Most active ingredients for common drugs came from just two countries: China and India. When lockdowns hit those regions in early 2020, factories slowed or shut down. Shipping ports clogged. Workers got sick. The result? A sudden, massive drop in the production of raw materials needed to make medicines.

A study published in JAMA Network Open found that between February and April 2020, nearly one-third of all reported drug supply issues turned into actual shortages. That’s a fivefold increase compared to pre-pandemic levels. Drugs like propofol (used in ICU sedation), heparin (a blood thinner), and even simple antibiotics like amoxicillin became hard to find. Hospitals rationed doses. Pharmacies limited refills. Patients with chronic conditions had to switch medications - sometimes with risky side effects.

The good news? After May 2020, things started to stabilize. The FDA stepped in, pushing manufacturers to report shortages earlier and fast-tracking inspections. By mid-year, the rate of new shortages dropped back to near-normal levels. But the damage was done. Many of these disruptions exposed deep flaws in how the world makes and moves medicine.

Illicit Drugs Got Deadlier

While prescription drugs vanished, illegal drug markets didn’t collapse - they got more dangerous. With borders closed and traditional supply routes cut, drug cartels turned to cheaper, more potent substances. Fentanyl, a synthetic opioid 50 to 100 times stronger than morphine, became the go-to filler. It’s cheap to produce and easy to mix into heroin, cocaine, or even fake pills made to look like oxycodone.

The numbers are chilling. From May 2020 to April 2021, over 97,000 Americans died from drug overdoses - a 31% jump from the year before. In states like West Virginia and Kentucky, overdose deaths rose by more than 50%. People who used drugs weren’t using more - they were just getting poisoned by what they bought. One Reddit user in the r/opiates community wrote in June 2020: "I took a dose that used to be fine and passed out for hours. Turned out it was laced with fentanyl. I got lucky. My friend didn’t." Harm reduction programs tried to respond. Needle exchanges in cities like Philadelphia and Boston started handing out naloxone - the overdose-reversal drug - at double the rate. Drive-through testing and take-home kits became common. But these efforts couldn’t keep up with the scale of the problem.

Telehealth Helped - But Left People Behind

On the treatment side, the pandemic forced a massive shift to telehealth. For people with opioid use disorder, that meant doctors could prescribe buprenorphine over video calls instead of requiring in-person visits. Before the pandemic, only about 13% of these prescriptions were done remotely. By April 2020, that number jumped to 95%.

That change saved lives. A study cited by the National Institute on Drug Abuse found that Medicare beneficiaries who accessed telehealth for addiction treatment were less likely to die from an overdose. For people in rural areas, it meant no more driving hours to see a specialist. For those with mobility issues or childcare responsibilities, it removed major barriers.

But not everyone benefited. Older adults struggled with technology. People without reliable internet or smartphones couldn’t join virtual therapy sessions. Rural clinics lacked the staff to manage the new systems. And while telehealth expanded access to medication, it didn’t replace the human connection that recovery often needs. Group meetings, peer support, and in-person counseling dropped by 75% in the first few months of lockdowns. Many people slipped through the cracks.

A pill turning into a skull, representing fentanyl-laced drugs and the overdose crisis.

Who Got Hit Hardest?

The pandemic didn’t affect everyone equally. Low-income communities, people of color, and those without health insurance faced the worst outcomes. In places with fewer pharmacies, drug shortages lasted longer. In neighborhoods with high overdose rates, fentanyl-laced drugs spread faster.

People with mental health conditions were especially vulnerable. With therapy canceled and support groups shut down, many turned to drugs to cope. The CDC found that emergency room visits for drug overdoses spiked in the summer of 2020 - right when isolation and anxiety peaked.

Even the data was messy. The National Survey on Drug Use and Health changed its methods in 2020 to accommodate lockdowns, making it hard to compare results with previous years. That meant public health officials were flying blind in some areas, trying to respond to a crisis they couldn’t fully measure.

What’s Still Broken?

Yes, drug shortages returned to pre-pandemic levels after mid-2020. But that doesn’t mean the system is fixed. The same vulnerabilities still exist. Most generic drugs are made overseas. Manufacturers have little incentive to keep extra stock on hand - it’s cheaper to produce just-in-time. One supply chain hiccup - a power outage, a labor strike, a natural disaster - can still trigger a nationwide shortage.

The overdose crisis, meanwhile, has only gotten worse. In 2022, over 107,000 Americans died from drug overdoses - the highest number ever recorded. Fentanyl is now the leading cause of death for adults between 18 and 45 in the U.S. The problem isn’t just availability - it’s safety. People need clean, reliable access to treatment, not just more pills.

Split scene of telehealth call versus empty pharmacy, showing unequal access to care.

What’s Being Done - and What’s Not

Some progress has been made. The 2023 National Defense Authorization Act included new rules requiring drugmakers to report potential shortages earlier. The FDA now monitors supply chains more closely. States have expanded access to naloxone and allowed more flexible prescribing for addiction treatment.

But long-term solutions are still missing. There’s no national plan to bring drug manufacturing back home. No major investment in building buffer stocks of critical medicines. And while telehealth is still allowed, many insurance plans have rolled back coverage, forcing patients back into clinics they can’t reach.

The truth? We didn’t fix the system. We patched it. And patches don’t hold up under pressure.

What This Means for You

If you take medication regularly, don’t wait for a crisis to act. Keep a 30-day supply on hand if possible. Talk to your pharmacist about alternatives if your usual drug is unavailable. Ask your doctor about generic versions - they’re often just as effective and more stable in supply.

If you or someone you know uses drugs, know the risks. Fentanyl can be in anything. Use test strips - they’re free in many places. Carry naloxone. Reach out to local harm reduction centers. You don’t have to go through this alone.

The pandemic showed us how thin the line is between access and absence when it comes to medicine. It’s not just about having a pill - it’s about having a system that works when things fall apart. We’ve seen how fragile that system is. Now we have to decide: do we fix it, or wait for the next crisis?