On a Baltimore street corner, public health workers hand out a life-saving overdose antidote to residents painfully familiar with the ravages of America’s opioid epidemic. But the training wraps up quickly; all the naloxone inhalers are claimed within 20 minutes.

With more overdoses driven by synthetic opioids like fentanyl and carfentanil — so potent it’s used as an elephant tranquilizer — naloxone remains pricy enough that Baltimore’s health department is rationing supplies, stretching a dwindling stockpile of inhalers. Last year, the city distributed more than 25,000 doses, up from about 19,000 in 2016.

“Every week, we count the doses we have left and make hard decisions about who will receive the medication and who will have to go without,” said Baltimore Health Commissioner Dr. Leana Wen, who issued the city’s innovative blanket prescription for the drug in 2015.

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