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 happening: essential medicines started disappearing from shelves. Insulin, antibiotics, blood pressure pills, even basic painkillers-many of them became hard to find. At the same time, the illegal drug market shifted in ways that made it deadlier than ever. This isn’t just a story about supply chains. It’s about how a global crisis cracked open hidden weaknesses in how we get medicine-and how people who use drugs were left hanging in the dark.
Why Did Medications Vanish in 2020?
The first wave of drug shortages wasn’t random. It was predictable if you knew how the system worked. Over 80% of the active ingredients in U.S. medications come from just two countries: China and India. When lockdowns hit those regions in February and March 2020, factories slowed or shut down. Shipping ports clogged. Trucks couldn’t move. The result? A sudden drop in the supply of raw materials needed to make common drugs.
A study published in JAMA Network Open in October 2023 showed that from February to April 2020, 34.2% of drugs with reported supply chain issues ended up in actual shortage. That’s more than one in three. By May, things started to improve-thanks to emergency actions by the FDA, like fast-tracking inspections and pressuring manufacturers to ramp up production. But the damage was done. Patients with diabetes rationed insulin. Cancer patients waited weeks for chemo drugs. Hospitals had to switch to less effective alternatives.
It wasn’t just about big-name drugs. Even simple generics like amoxicillin, metformin, or furosemide vanished. These aren’t luxury items-they’re daily necessities. And when they disappear, people don’t just wait. They go without. Or they turn to unsafe sources.
The Illicit Drug Market Turned Deadly
While hospitals scrambled for antibiotics, the illegal drug trade was rewiring itself. Lockdowns broke up traditional distribution networks. Dealers couldn’t move product the old way. So they adapted-by making drugs stronger and cheaper. Enter fentanyl.
Fentanyl is 50 to 100 times more potent than morphine. It’s cheap to make and easy to mix into other drugs-heroin, cocaine, even fake oxycodone pills. Before the pandemic, it was already a problem. But during 2020, it exploded. The CDC reported that drug overdose deaths jumped from 77,007 in the year ending April 2020 to 97,990 by April 2021. That’s a 27% increase in just one year.
People didn’t set out to use fentanyl. They were using what they could find. A Reddit user from the r/opiates community wrote in June 2020: “The street supply got weird after lockdowns started. People were getting knocked out by doses that used to be normal. Turned out to be fentanyl-laced.” That’s not an outlier. It was the new normal. Harm reduction workers in Philadelphia reported that drug potency increased by over 40% in early 2020. Naloxone-the overdose reversal drug-was being handed out in record numbers. Boston Public Health Commission distributed 30% more naloxone kits in 2020 than in 2019.
Telehealth Helped Some, Left Others Behind
One of the few bright spots during the pandemic was the sudden expansion of telehealth for opioid use disorder treatment. Before 2020, getting buprenorphine-a life-saving medication-usually meant visiting a clinic in person. That changed fast. In February 2020, only 13% of buprenorphine prescriptions were done via telehealth. By April, that number jumped to 95%.
For people in rural areas, this was a game-changer. No more driving two hours for a weekly dose. For others, it was a lifeline. A study cited by NIDA found that Medicare beneficiaries who accessed telehealth for opioid treatment were less likely to die from overdose.
But not everyone could benefit. Older adults struggled with video calls. People without reliable internet or smartphones were left out. A 72-year-old woman in West Virginia told a local reporter, “I don’t know how to use this phone thing. My doctor says I need to talk to him online. But I can’t even get the app to open.”
At the same time, in-person support vanished. Twelve-step meetings, counseling groups, needle exchanges-all shut down or cut back. One Philadelphia program reported a 40% drop in services during lockdown. For people in recovery, those connections weren’t optional. They were survival. Without them, relapse rates climbed. And with fentanyl everywhere, relapse often meant death.
The Hidden Inequities
The pandemic didn’t create these problems. It exposed them.
Black and Indigenous communities saw the biggest spikes in overdose deaths. People without health insurance lost access to care faster. Those living in poverty had less access to testing, treatment, or even clean water to safely use drugs. The stigma around addiction didn’t disappear-it got worse. People avoided hospitals for fear of being judged or reported to police.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, put it plainly: “The pandemic highlighted issues underlying health inequities that contribute to drug use and related poor health outcomes.”
Meanwhile, the pharmaceutical industry kept its global supply chain intact-because it was profitable. No one forced companies to stockpile critical drugs. No one made them build domestic manufacturing. The system worked fine as long as things didn’t break. When they did, the costs were paid in lives.
What’s Still Broken in 2025?
Drug shortages are back to pre-pandemic levels, according to FDA data. But that doesn’t mean the system is fixed.
The same vulnerabilities still exist. Most active ingredients still come from overseas. Companies still cut costs by relying on single suppliers. The FDA still has to ask, not demand, manufacturers to increase production. And without stronger rules, another shock-whether it’s a new pandemic, a trade war, or a natural disaster-could trigger the same crisis.
As for the overdose epidemic? It’s gotten worse. In the 12 months ending December 2022, over 107,941 people died from drug overdoses in the U.S. Fentanyl is still the main driver. And while telehealth helped some, many still can’t access it. Harm reduction programs are still underfunded. And the stigma? It’s still alive.
The 2023 National Defense Authorization Act included new rules to improve drug supply chain transparency. That’s a step. But it’s not enough. We need mandatory stockpiles for critical drugs. We need domestic manufacturing capacity. We need to treat addiction like the public health crisis it is-not a moral failure.
People don’t die because they run out of pills. They die because systems fail them. And in 2025, those systems are still broken.
Erik J
December 16, 2025 AT 08:34
It’s wild how something as simple as a factory shutdown in Shanghai could ripple across the entire U.S. healthcare system. I never thought about how much of our medicine relies on overseas supply chains until I saw my dad rationing his metformin. He’s diabetic. Didn’t have a choice but to cut pills in half. That’s not healthcare-that’s survival math.
And the fact that we didn’t have domestic backups? That’s not negligence. That’s policy by design.
People talk about ‘resilience’ like it’s a buzzword. But when your life depends on a pill that’s stuck on a dock in Mumbai, resilience doesn’t matter.
I’ve been reading FDA reports since 2020. The same suppliers. The same single-source dependencies. Nothing changed. Just more PR.
Martin Spedding
December 16, 2025 AT 09:44
lol fentanyl killed more ppl than covid? lmao. so the gov’t made drugs stronger so ppl die? that’s not a market shift, that’s a hitman. 🤡
amanda s
December 17, 2025 AT 15:38
China and India are running our medicine supply? That’s why we’re weak. We let foreign nations control our health. If this was Russia or Iran doing this, we’d be bombing their ports. But nope-let’s just ‘fast-track inspections’ like it’s a traffic ticket.
Real Americans make real medicine. We need tariffs. We need factories. We need to stop being soft.
And stop pretending addiction is a ‘public health crisis.’ People choose to do drugs. They chose to die. Stop coddling them.
Telehealth? My grandma can’t Zoom. So what? She shouldn’t be on opioids in the first place. Fix the person, not the system.
Brooks Beveridge
December 18, 2025 AT 19:35
Hey, just wanted to say-you’re not alone in seeing this. I’ve worked in rural clinics for 15 years, and this isn’t new. It’s just louder now.
Before the pandemic, we were already seeing insulin shortages in the Midwest. We’d send patients to food banks for help. Not because they were poor-but because the system forgot they existed.
Telehealth saved lives, yes. But it didn’t fix the root: we treat addiction like a crime until someone dies, then we call it a ‘crisis.’
Let’s not forget the harm reduction workers who handed out naloxone in parking lots while politicians argued about ‘moral responsibility.’ They didn’t wait for permission. They showed up.
You can’t fix a broken system with press releases. You fix it with funding, dignity, and real policy. One pill at a time.
And if you’re reading this and thinking ‘it’s not my problem’-you’re wrong. The next person who can’t get their blood pressure med? Could be your mom. Your neighbor. You.
❤️ We’re all in this together.
Anu radha
December 19, 2025 AT 11:02
My brother in India, he work in pharma factory. He say many medicine make there. But when lock, no one can go work. So no medicine for America. Sad. People sick. No help. I cry when I read this.
Salome Perez
December 20, 2025 AT 09:38
What struck me most isn’t the supply chain fragility-it’s the moral inertia. We knew this was coming. Reports from 2012 warned about overreliance on foreign APIs. The GAO flagged it. The Congressional Research Service flagged it. And yet, we chose convenience over caution.
The pharmaceutical industry operates on margins, not morality. And when margins are thin, human lives become variables in a cost-benefit equation.
But here’s the quiet revolution: community pharmacies in places like rural Kentucky and West Virginia began stockpiling generics during the early lockdowns. Not because they were told to-because they saw their patients disappearing.
That’s the real story. Not the federal response. Not the headlines. It’s the pharmacist who stayed open past midnight to fill a prescription with a handwritten note: ‘I know this isn’t enough. But I’m trying.’
Let’s honor them-not just the policy wonks.
With deep respect,
Salome
Pawan Chaudhary
December 20, 2025 AT 13:43
It’s heavy, but there’s hope. People are waking up. More states are legalizing needle exchanges. More pharmacists are giving naloxone without a script. Telehealth is here to stay-even if it’s imperfect.
And honestly? The fact that we’re talking about this at all? That’s progress.
One day, we’ll look back and say, ‘We almost lost so many… but we chose to fix it.’
Let’s keep choosing that.
💙
BETH VON KAUFFMANN
December 21, 2025 AT 12:05
Let’s be precise: the 34.2% shortage rate cited in JAMA is statistically significant but not causally attributable to pandemic-induced supply disruption alone. Multivariate regression analysis controlling for pre-pandemic inventory levels, FDA inspection backlog, and pharmaceutical consolidation (per IBISWorld 2019) suggests that 68% of shortages were already in progress prior to Q1 2020. The pandemic merely accelerated latent systemic decay.
Also, ‘fentanyl explosion’ is a media construct. DEA seizure data shows fentanyl purity increased by 12% YoY-not 40%. The 40% figure conflates potency with prevalence. Misleading.
And telehealth adoption? 95% is an outlier. The median was 57%. The NIDA study had a selection bias: Medicare beneficiaries are more likely to have stable internet access. The real crisis is digital redlining.
Stop romanticizing the narrative. We need data, not anecdotes.
Donna Packard
December 22, 2025 AT 15:26
I’m just glad we’re finally talking about this. I lost my cousin last year. She was on methadone. Couldn’t get her dose because the clinic closed. She tried to get it from a friend. It was fentanyl. She didn’t know.
It’s not about politics. It’s about someone’s daughter. Someone’s sister. Someone’s mom.
Thank you for writing this.
Patrick A. Ck. Trip
December 24, 2025 AT 10:37
It's important to recognize that the systemic vulnerabilities exposed by the pandemic were not unforeseen. The 2006 FDA report on API sourcing, the 2012 GAO audit, the 2017 Senate hearings-all indicated a fragile infrastructure. The failure was not lack of awareness, but lack of political will.
Furthermore, while telehealth expanded access, the digital divide remains a critical equity issue. A 2021 Pew study found that 23% of rural Americans lack broadband access sufficient for video consultations.
Policy solutions must be structural, not reactive. Mandatory domestic stockpiles. Incentives for multi-sourcing. And crucially-decriminalization of possession for personal use.
Change is possible. But only if we stop treating symptoms and address architecture.
Sam Clark
December 26, 2025 AT 03:16
The most disturbing part isn’t the shortages or the fentanyl-it’s that we treated this like a temporary emergency, not a structural failure. We patched the hole with emergency waivers and temporary telehealth rules, but never rewired the system.
There’s a reason why hospitals still can’t guarantee insulin availability in 2025. Because we never made it a priority.
Real reform means legislating supply chain resilience. It means funding harm reduction like we fund defense. It means treating addiction like cancer-not a choice.
We can do better. We just have to choose to.
Jessica Salgado
December 27, 2025 AT 03:43
I used to work in a ER. I saw it. The woman who came in with her kid, shaking, because she couldn’t find her blood pressure meds. The guy who showed up with a needle still in his arm, asking for help but terrified to say what he’d taken. The silence in the room when the nurse said, ‘We’re out of naloxone.’
That’s not a headline. That’s Tuesday.
And then the next day, the same thing.
People say ‘the system failed.’ No. People failed the system. We let it rot. We stopped caring. We thought it was someone else’s problem.
But it’s not.
It’s yours.
It’s mine.
It’s all of ours.