How COVID-19 Caused Drug Shortages and Increased Overdose Risks

When the pandemic hit in early 2020, most people worried about masks, ventilators, and hospital beds. But behind the scenes, something quieter but just as dangerous was unfolding: drug shortages. Essential medications-antibiotics, insulin, blood pressure pills, even anesthetics used in emergency rooms-started disappearing from pharmacy shelves. At the same time, the illegal drug supply became more deadly. People who used drugs were getting substances laced with fentanyl, often without knowing it. The pandemic didn’t just change how we lived-it broke the systems that keep us alive.

Why Did Medications Disappear?

The global supply chain for pharmaceuticals was already stretched thin before COVID-19. Most of the active ingredients in common drugs came from just two countries: China and India. When lockdowns hit those regions in early 2020, factories shut down. Shipping slowed. Workers got sick. Suddenly, the raw materials needed to make even basic medications couldn’t get to the U.S.

A study published in JAMA Network Open in October 2023 found that from February to April 2020, nearly one in three drug supply reports turned into actual shortages. That’s a fivefold jump from normal levels. Critical drugs like propofol (used in surgeries), heparin (a blood thinner), and even antibiotics like azithromycin became hard to find. Hospitals rationed doses. Patients delayed treatments. Some people with diabetes had to stretch their insulin supplies, risking dangerous spikes in blood sugar.

It wasn’t random. The shortages hit generic drugs hardest-medications that cost pennies but are used by millions. Why? Because manufacturers make almost no profit on them. When costs rise or demand shifts, they stop making them. The pandemic exposed a system built on cheap labor and thin margins, not resilience.

What Changed After May 2020?

By May 2020, things started to improve. Not because the world got better, but because the FDA stepped in. They started calling drugmakers directly, pushing them to fix bottlenecks. They fast-tracked inspections. They gave companies more flexibility to switch suppliers. These weren’t flashy policy changes-they were practical fixes. And they worked. By mid-2020, the rate of drug shortages dropped back to pre-pandemic levels.

But here’s the catch: the system didn’t get stronger. It just got back to where it was before. The same vulnerabilities are still there. One factory shutdown. One port delay. One labor strike. And the same drugs could vanish again. Experts warn that without long-term reforms-like building domestic manufacturing capacity or requiring companies to report supply risks early-we’re just delaying the next crisis.

The Hidden Crisis: Illicit Drugs Got Deadlier

While hospitals struggled to get morphine, the illegal drug market was doing something terrifying: getting more lethal. With borders closed and traditional smuggling routes disrupted, drug cartels started cutting their products with fentanyl-a synthetic opioid 50 to 100 times stronger than morphine. It’s cheap. It’s easy to smuggle. And it’s deadly.

The CDC reported that drug overdose deaths jumped from 77,000 in 2019 to nearly 98,000 in 2020. By 2022, that number hit over 107,000. In states like West Virginia, Kentucky, and Vermont, overdose deaths rose more than 50% in just one year. People weren’t using more drugs-they were just getting poisoned by what they were using.

One Reddit user described it simply: “The street supply got weird after lockdowns started. Doses that used to be fine knocked people out cold. Turns out, it was fentanyl.” That wasn’t an isolated story. Harm reduction workers in cities like Philadelphia and Boston saw a spike in overdoses linked to fake pills made to look like oxycodone or Xanax. They were just fentanyl.

Why Couldn’t People Get Help?

At the same time, the support systems for people with addiction collapsed. Therapy centers closed. Needle exchanges shut down. 12-step meetings moved online-except many people didn’t have internet, phones, or privacy to join.

A 2020 survey found that 67% of addiction treatment centers had their services disrupted. Behavioral healthcare visits dropped by 75% among people with private insurance. Older adults, rural residents, and low-income communities were hit hardest. Telehealth became a lifeline for some-but only if you had a smartphone, stable Wi-Fi, and someone who could help you set it up.

The government did try to help. They allowed doctors to prescribe buprenorphine (a medication for opioid addiction) over the phone. They let patients take home more methadone. These changes saved lives. But they didn’t reach everyone. Many people still couldn’t access care. And for those who did, the emotional support-hugging a counselor, sitting in a group circle, feeling less alone-was gone.

Who Got Left Behind?

The pandemic didn’t create new problems. It exposed old ones. People with addiction were already stigmatized. They were already ignored. When the crisis hit, they were less likely to get tested for COVID. Less likely to get emergency care. More likely to die alone.

A study from the National Institute on Drug Abuse found that fear of legal consequences kept many from seeking help. If you’re using drugs and you feel sick, do you call 911? What if you’re afraid of being arrested? What if you’ve been told your life doesn’t matter?

The data doesn’t lie: overdose deaths rose fastest in places with the least healthcare access. In rural counties, where clinics are miles away and pharmacies are few, the death rate climbed faster than in cities. In communities of color, where systemic neglect has long been the norm, the pandemic made things worse.

What’s Being Done Now?

Some progress has been made. The 2023 National Defense Authorization Act included new rules to improve transparency in drug supply chains. Companies now have to report potential shortages earlier. The FDA is keeping a closer eye on foreign suppliers. Harm reduction groups have expanded drive-through naloxone distribution. In Boston, they handed out 30% more overdose-reversal kits in 2020 than in 2019.

But these are bandaids. The real fix requires changing how we value health. We need to invest in domestic manufacturing of essential drugs. We need to treat addiction as a medical issue, not a crime. We need to make sure telehealth works for everyone-not just the tech-savvy.

The pandemic showed us that drug availability isn’t just about chemistry and logistics. It’s about policy. It’s about equity. It’s about who gets to live.

What You Can Do

If you or someone you know relies on prescription medication, keep a 30-day supply on hand. Talk to your pharmacist about alternatives if your drug runs out. If you’re concerned about a loved one using drugs, learn how to use naloxone. It’s free in many places. It’s easy to use. It can save a life.

Support organizations that provide harm reduction services. Push your lawmakers to fund addiction treatment and drug supply resilience. Don’t assume the system will fix itself. It didn’t before. It won’t now-unless we make it.