How COVID-19 Caused Drug Shortages and Changed Access to Medications

When the pandemic hit in early 2020, most people worried about masks, ventilators, and hospital beds. But behind the scenes, something quieter and just as dangerous was happening: drug shortages started appearing everywhere. Insulin. Blood pressure pills. Antibiotics. Even basic painkillers. Patients couldn’t get their prescriptions filled. Hospitals scrambled to find alternatives. And for people already struggling with addiction, things got even worse.

Why Did Medications Disappear From Shelves?

The problem wasn’t that drug makers stopped producing medicines. It was that the system keeping them flowing broke down. Most of the raw ingredients for pills - called active pharmaceutical ingredients - come from just two countries: China and India. When lockdowns hit those regions in early 2020, factories shut down. Shipping containers piled up at ports. Truck drivers got sick. Suddenly, the pipes that fed medicines into U.S. pharmacies started drying up.

A study published in JAMA Network Open in October 2023 found that between February and April 2020, nearly one in three drug supply reports turned into actual shortages. That’s a fivefold jump from normal levels. Critical drugs used in intensive care units - like sedatives and muscle relaxants needed for ventilated COVID patients - were among the first to vanish. Hospitals had to ration. Some patients got half-doses. Others waited days for replacements.

By May 2020, things started to improve. The FDA stepped in. They started calling manufacturers directly, fast-tracking inspections, and giving priority to drugs in short supply. Within months, most shortages returned to pre-pandemic levels. But the damage was done. People lost trust. Pharmacists saw more calls from panicked patients. And the system didn’t fix the root problem: it still relies on fragile, faraway supply chains.

The Hidden Crisis: Illicit Drugs Got More Dangerous

While prescription drugs were hard to find, illegal drugs became more deadly. With international borders closed and smuggling routes disrupted, drug cartels had to adapt. They didn’t stop making drugs - they just made them stronger. Fentanyl, a synthetic opioid 50 to 100 times more potent than heroin, started showing up everywhere. In places like Kentucky, West Virginia, and Louisiana, overdose deaths jumped more than 50% between 2019 and 2021.

People who used drugs didn’t know what they were taking anymore. A Reddit user from June 2020 described it this way: “The street supply got weird after lockdowns started. Doses that used to be fine knocked people out cold. Turns out, it was all laced with fentanyl.”

The CDC reported nearly 98,000 drug overdose deaths in the 12 months from May 2020 to April 2021 - up from 77,000 the year before. That wasn’t because more people were using drugs. It was because the drugs themselves became more lethal. And with fewer harm reduction services open - needle exchanges shut down, supervised sites closed - people were using alone, with no one to help if they overdosed.

Telehealth Helped Some, Left Others Behind

For people with opioid use disorder, the pandemic forced a sudden shift. Before 2020, getting buprenorphine or methadone meant showing up in person, often daily. But when lockdowns hit, the government allowed doctors to prescribe these medications over video calls. Within two months, telehealth prescriptions for buprenorphine jumped from 13% to 95% of all prescriptions.

That saved lives. A study cited by NIDA found that Medicare beneficiaries who got their medication through telehealth were less likely to die from an overdose. For people in rural areas, it meant no more driving two hours just to get a dose. But not everyone could benefit. Older adults struggled with Zoom. People without reliable internet couldn’t connect. Some couldn’t afford smartphones. And for those who relied on in-person counseling or peer support groups, losing those meetings was devastating. One study found behavioral healthcare visits dropped by 75% for privately insured patients in early 2020.

Harm reduction workers adapted by handing out naloxone kits at drive-throughs. In Boston, naloxone distribution increased by 30% in 2020. But these were temporary fixes. The deeper issue - lack of consistent access to care - remained.

Who Got Left Out?

The pandemic didn’t create new inequalities - it just made them worse. People of color, low-income communities, and those without stable housing were hit hardest. They were more likely to live in areas with fewer pharmacies. Less likely to have reliable internet for telehealth. More likely to be turned away from emergency care because of stigma around addiction.

One study found that fear of legal consequences or judgment kept many people from calling 911 during an overdose. Others skipped COVID tests because they didn’t trust the system. The result? More deaths, more silence, and fewer data points to guide policy.

Even the surveys meant to track drug use got messed up. The National Survey on Drug Use and Health changed its methods in 2020 because in-person interviews weren’t safe. That means we can’t be sure how much actual drug use changed - or if the rise in deaths was purely about potency.

What’s Changed Since Then?

By 2023, most prescription drug shortages had returned to normal levels. But experts warn the system is still vulnerable. The same supply chains are still in place. The same manufacturers still rely on overseas factories. The same economic pressures - low profit margins on generic drugs - still make companies hesitant to invest in backup production.

The 2023 National Defense Authorization Act included new rules requiring more transparency in drug supply chains. That’s a start. But without real incentives for manufacturers to stockpile critical drugs or build domestic capacity, another shock - whether it’s a pandemic, a war, or a natural disaster - could trigger the same chaos.

Meanwhile, overdose deaths keep climbing. The CDC recorded over 107,000 drug overdose deaths in 2022. Fentanyl is still the main driver. And while telehealth helped, it’s not a full solution. Many treatment centers still don’t have enough staff. Waiting lists are long. And for people without stable housing or transportation, even a virtual appointment isn’t enough.

What Needs to Happen Next

We need to fix two things at once: the medicine pipeline and the addiction care system.

First, we need to reduce dependence on foreign suppliers for critical drugs. That means investing in domestic manufacturing - not just for vaccines, but for everyday pills like insulin, antibiotics, and heart medications. The FDA should require manufacturers to keep at least six months of buffer stock for high-risk drugs.

Second, we need to make addiction treatment more accessible, not just during crises. That means permanently allowing telehealth for controlled substances. Expanding funding for community-based recovery programs. And removing barriers that prevent people from getting help - like requiring in-person visits or denying care based on income.

Most of all, we need to stop treating addiction as a moral failure and start treating it like the public health crisis it is. The pandemic showed us what happens when we wait for disaster to strike before acting. We can’t afford to wait for the next one.