How COVID-19 Disrupted Drug Availability and Created Lasting Shortages

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 medications-from antibiotics to insulin to blood pressure pills-started disappearing from pharmacy shelves. At the same time, the illegal drug market became deadlier than ever. Two crises. One pandemic.

Drug shortages spiked in the first months of the pandemic

From February to April 2020, nearly one in three reports of supply chain problems led to actual drug shortages. That’s more than four times higher than before the pandemic. The most affected drugs were the ones hospitals relied on daily: sedatives for ICU patients, antibiotics for infections, and even basic medications like saline solutions. Many of these drugs are made from active ingredients sourced overseas, mostly from China and India. When factories shut down or shipping slowed, the ripple effect hit U.S. pharmacies fast.

By May 2020, things started to improve. The FDA stepped in-pushing manufacturers to report shortages earlier, speeding up inspections, and temporarily allowing alternative suppliers. By summer, the number of new shortages dropped back to pre-pandemic levels. But that doesn’t mean the problem went away. It just went underground.

Some drugs never fully came back

Even after the initial surge faded, certain medications stayed hard to find. Generic drugs, which are cheaper and make up most of the market, were hit hardest. Why? Because manufacturers had little profit incentive to keep large stockpiles. If a drug sells for pennies per pill, companies won’t risk storing extra inventory. During the pandemic, that risk became reality. One hospital pharmacist in Ohio told me they went three weeks without a single vial of midazolam-a key sedative for emergency intubations. They had to switch to alternatives that weren’t as effective.

Insulin shortages also lingered. People with diabetes were forced to ration doses or skip injections. A 2021 survey found that 1 in 5 U.S. adults with diabetes reported cutting back on insulin because they couldn’t afford or find enough. That’s not a supply issue-it’s a systemic failure.

The illegal drug market turned deadly

While prescription drugs vanished, street drugs became more dangerous. With border closures and lockdowns, traditional drug routes were cut off. Traffickers didn’t stop selling-they just made their products stronger and cheaper. Fentanyl, a synthetic opioid 50 to 100 times more powerful than heroin, started showing up in everything: counterfeit pills sold as oxycodone, cocaine, even methamphetamine.

Overdose deaths didn’t just rise-they exploded. From May 2020 to April 2021, nearly 98,000 people died of drug overdoses in the U.S. That’s a 31% jump from the year before. In states like West Virginia and Kentucky, deaths climbed over 50%. People weren’t using more drugs-they were just getting poisoned by what they thought was the same thing they’d always used.

People who use drugs were left without support

Lockdowns didn’t just cut off drug supplies-they cut off lifelines. Needle exchanges shut down. Support groups moved online. Methadone clinics reduced hours. For people in recovery, these services weren’t optional-they were survival tools.

A study from the National Institute on Drug Abuse found that in-person behavioral health visits dropped by 75% in the spring of 2020. Meanwhile, telehealth for addiction treatment jumped from less than 1% of visits to over 40%. That sounds good, until you realize many people didn’t have reliable internet, a smartphone, or privacy to talk on video. Older adults, rural residents, and those without stable housing were left behind.

One man in rural Kentucky told a reporter he hadn’t seen his counselor in six months. He’d been getting his buprenorphine through telehealth, but the app kept crashing. He didn’t know how to call for help. He relapsed. He overdosed. He survived.

Telehealth helped-but it wasn’t enough

The government did make some smart moves. For the first time, doctors could prescribe buprenorphine over the phone without an in-person visit. Take-home doses of methadone were extended from two weeks to a month for stable patients. These changes saved lives.

But access wasn’t equal. In cities with good Wi-Fi and clinics, telehealth worked well. In places like Appalachia or the Mississippi Delta, many people still had to drive hours for a single dose. And for those without phones or transportation, nothing changed.

What’s still broken today

The pandemic exposed how fragile our drug supply system really is. We still rely on overseas factories for 80% of our active ingredients. We still let manufacturers decide whether to make cheap, life-saving drugs based on profit margins. And we still treat addiction as a criminal issue instead of a health one.

The FDA has improved its tracking of shortages, and Congress passed a law in 2023 requiring more transparency in drug manufacturing. But those are Band-Aids. The real fix? Build domestic capacity. Pay manufacturers fairly to keep stockpiles. And treat addiction like any other chronic illness-with consistent access to medication and care.

Today, drug overdose deaths are still above 100,000 per year. Generic drug shortages still happen. People still die because a pill they thought was safe was laced with fentanyl. The pandemic didn’t create these problems-it just ripped off the cover and showed us how deep the rot goes.

What you can do

If you’re on a medication that keeps disappearing:

• Ask your pharmacist to notify you when it’s back in stock
• Keep a 30-day supply on hand if possible
• Talk to your doctor about alternatives-some generics work just as well
• Join patient advocacy groups like the American Society of Health-System Pharmacists-they push for policy changes

If you or someone you know uses drugs:

• Always test for fentanyl with a test strip (they’re free at many harm reduction centers)
• Carry naloxone-it can reverse an opioid overdose
• Reach out to local organizations: needle exchanges, mobile clinics, and peer support groups are still operating

The pandemic taught us that drug availability isn’t just about supply chains. It’s about who gets care, who gets ignored, and who pays the price when systems fail.