“Tell me what happened that brought you in here,” the doctor says, eyeballing a thin young man consigned to a bed in the corridor of a Boston hospital’s emergency room.

He has a rare disease of his intestinal tract, the patient explains softly. The doctor leans in to hear him above the chatter of passing nurses. And he came in hoping for relief of rectal pain.

Back at the nurse’s station, the doctor shows me a warning entered in the patient’s electronic medical record: “DRUG-SEEKING BEHAVIOR,” it says. It cautions against giving him a heating pad because in the past, he has used one to elevate his temperature.

I had decided to visit the emergency room to see for myself what politicians and public health officials have called an alarming crisis – a surge in deaths caused by overdoses of heroin and prescription painkillers, which are collectively known as opioids. On Thursday, the administration of Massachusetts Governor Charlie Baker released data showing that overdose deaths from opioids increased by almost half in 2013 from the year before, to almost 20 a week.

Source: Mass. Department of Public Health (Data exclude suicides.)

A few weeks earlier, the ER I visited had treated six patients for opioid overdoses in a single Friday night shift. This is not that unusual: a federal report notes that ER visits related to misuse or abuse of opioid prescription drugs jumped 183 percent nationally between 2004 and 2011, to nearly half a million.

Source: US Substance Abuse and Mental Health Services Administration

During my evening at the ER, however, no overdose cases arrive. Patients are being treated for a stroke, a head injury suffered in a fall, shortness of breath, unexplained pelvic pain, unexplained malaise, an anxiety attack, a nose bleed. The count of patients in the waiting room, displayed prominently on screens at the nursing station, steadily ticks up, from 1 to 7.  “Welcome to the jungle,” the chief resident says when we meet.

But doctors are vigilant for patients who might be inflating pain complaints to feed an addiction to opioid medication, such as the young man in the corridor, with a stubbly patch of beard on his chin.

He drew their suspicion because his description of the location of his pain changed; when he arrived, he had told the triage nurse it was in his abdomen. But his doctor is sympathetic. The patient has suffered a litany of medical problems, and pain can be ambiguous – there’s no blood test or scan to diagnose it. She is reluctant to deny medication to someone who is actually in severe pain. Still, she recounts the story of a past patient who complained of severe pain but then walked out of the ER when a scan showed nothing wrong and doctors wouldn’t give him Dilaudid.

The doctor digs further. From the medical records and conversations with the patient, she learns he has visited four other Boston emergency departments in the previous few days. Three apparently sent him on his way without providing treatment. But a fourth performed a scan, and though it revealed no serious problem, gave him a prescription for an opioid pain reliever. That was only a few hours ago.

Next, his doctor enters his name into a state database, called the Prescription Monitoring Program. It lists all prescriptions filled by pharmacies in Massachusetts and can be used to spot patients who have a history of apparent doctor-shopping – obtaining narcotics from multiple doctors in a short period of time. In 2013, the program flagged more than 10,000 people as “individuals with activity of concern.” Nearly three-quarters of a million residents received an opioid prescription that year — 11 percent of the state’s population.

All physicians are supposed to check the list whenever they are prescribing narcotics to a patient for the first time. But only two-thirds of doctors are enrolled in the program, and even those don’t always comply, citing the time it takes.

The ER doctor has forgotten her password and searches her e-mail to find it. But in little more than a minute, the prescription data on her patient fills the computer screen:

In the past 12 months, he had obtained more than 20 prescriptions for narcotics from 10 doctors.

There is now no question he is attempting to feed an addiction.

What to do now? “You never want to blame,” the doctor says to me. “He’s just had the bad luck of having lots of illnesses.”

She pages a hospital social worker, but doesn’t hear back. She goes to see the patient, who has now been given a room in the ER. She tells him she can’t give him any medication, but offers to make him an appointment with the surgeon who operated on his intestines at another hospital. Worried he won’t keep the appointment, she calls one of the patient’s friends. There’s no answer.

He asks for a heating pad.