It's a Monday night in a Baltimore emergency room. An unkempt, middle-aged man is complaining of wrist pain. “I came in a week ago,” he says. “I broke my right wrist.” Records indicate it was actually two days ago. Now his left wrist hurts too, he complains, and he's out of pain meds. In 48 hours, he has evidently consumed his entire prescription of 30 Oxycodone.

Behind him, more Baltimoreans are in pain. “It's my knee,” claims the next man. “It's been hurting for years, but it's been worse the last few months.” An obese woman has arrived following a motor vehicle accident. “Well, actually, the car was parked,” she explains. “Another car bumped into my car in the parking lot.” She says her neck pain is a 14 out of 10. Another patient has a chronic back injury. He's out of meds, and he can't wait until Friday, when his refill is due. These are considered “emergencies.”

The waiting room is full tonight. People fidget in their chairs. Some sleep. Most wear blank expressions. They've done this before. Some know the providers by name. “A true addict will wait as long as it takes to get a prescription,” remarks a doctor. Some of tonight's patients will wait 14 hours to be seen by a provider. This is not exceptional. Last year, investigative journalists at ProPublica measured the average time, for each state, that patients spent in the E.R. before being sent home. Despite its world-class facilities, no state had longer wait times than Maryland.

Although the amount and severity of actual pain afflicting Americans has remained unchanged over the years, the amount of opioids prescribed and sold in the U.S. has quadrupled since 1999. Here, we are exceptional: With only 5 percent of the world's population, we are consuming over 80 percent of the world's painkillers.

Last week, the CDC released long-awaited federal prescription guidelines — guidance the medical community would have benefited from well over a decade ago. The non-binding recommendations discourage doctors from prescribing painkillers for chronic conditions such as backaches, neck pain and migraines.

Prescription of opioids had been traditionally limited to cancer pain and comfort measures, but in the mid-'90s drug companies began marketing these pills as the solution to a new plethora of ailments. In their efforts to expand the market, producers understated and willfully ignored the powerfully addictive properties of their drugs. The promotion of OxyContin by Purdue Pharma was the most aggressive marketing of a schedule II drug ever undertaken by a pharmaceutical company. The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, achieved a place on Forbes' 2015 list of America's wealthiest families. The Sacklers — the richest newcomers to the list — are worth an estimated $14 billion.

By now, the damage of opioid over-prescription is indisputable. The largely hidden plague of heroin in America has surpassed the crack epidemic in size and scope, and it's largely driven by the explosion in opioid prescriptions: Once a patient is hooked, he or she often turns to the street drug, which can be easier and less expensive to acquire. Nationwide, heroin deaths have more than tripled since 2010. According to the federal government, heroin addiction rates in Baltimore are the highest of any major city in the country, with the number of users estimated to range from 19,000 to 60,000 plus.

Back at the Baltimore emergency room, the staff works to medically clear a 39-year-old Baltimore native for detox. You could tell that she was once a beautiful young woman. Today, she appears weathered, exhausted, and deeply depressed. Heroin has taken over her life. Overdoses can be serious and complicated affairs, and they are only getting more common. Spurred by prescription opioids, the Drug Enforcement Administration reported last year that drug overdoses overtook auto accidents nationwide for the first time in 2013, and are now the leading cause of death for Americans aged 44 and younger.

It's hard to find any individuals or institutions that aren't paying a price for this epidemic, in one form or another. Families have been torn apart. Thousands lose their lives every year. Taxpayers are footing the bill for federal and state treatment funds. And as any staff member will point out, patients with legitimate medical emergencies are suffering every day from the congestion in the E.R.

Emily Narciso is a physician's assistant in Baltimore. Connor Narciso (connornarciso@gmail.com) is a freelance writer in Baltimore.