Instructor Manual
Maisto, Drug Use and Misuse, 9th edition, ©2022,9780357375952
Chapter 10:Opiates
Purpose and Perspective of the Chapter. 1
Complete List of Chapter Activities and Assessments. 2
True or False Questions Answer Key. 5
Purpose and Perspective of the Chapter
As indicated in previous chapters, psychoactive drugs may have potential for improvingthe human condition, but also have the potential to cause destruction to individualsand society. No group of drugs captures this paradox more dramatically than the classof drugs we call opiates, which includes opium, morphine, heroin, and related compounds.Opiate drugs have been used for centuries to relieve pain and, when introducedto Europe, were hailed by physicians as a godsend. One of the first Europeanphysicians to use opium to relieve pain and suffering in his patients, Thomas Sydenham,wrote in 1680: “Among the remedies which it has pleased Almighty God to give manto relieve his sufferings, none is so universal and so efficacious as opium” (Gay & Way,1972, p. 47). Even today, opiate drugs remain the most potent painkillers available tophysicians, yet we now recognize the ability of opiates to produce severe dependence.Heroin is viewed as the prototypical dependence-producing drug, and illegal use andtraffic in heroin are major international problems. Thus, many of the general concernsregarding psychoactive drugs emerge in bold relief in a consideration of opiates. Anepidemic of dependence on opiate drugs has swept across the United States in recentyears, and opiate overdose is a major crisis today. We will first consider the early historyof opiate use and then focus on factors that led to the epidemic.
Cengage Supplements
The following product-level supplements provide additional information that may help you in preparing your course. They are available in the Instructor Resource Center.
- Educator’s Guide
- Transition Guide
- Cognero Test Banks
- PowerPoints
Learning Objectives
The following objectives are addressed in this chapter:
10-1 Discuss the historical patterns ofopiate use, including how theHarrison Narcotics Tax Act affectsopiate use in the United States
10-2 Evaluate the factors contributing tothe current opiate epidemic
10-3 Describe how opiates are absorbed,distributed, metabolized, andexcreted from the body
10-4 Explain the mechanisms of action forthe opiates
10-5 Discuss how opiates are used to treatacute and chronic pain
10-6 Compare and contrast the acute andchronic effects of opiates
10-7 Evaluate the role of physical and environmentalfactors associated withheroin dependence
Complete List ofChapter Activities and Assessments
For additional guidance refer to the Teaching Online Guide.
| Chapter Objective | PPT Slide | Activity/Assessment | Duration |
| All Objectives | PPT: #2 | Icebreaker | 5 minutes |
| 10-1 Discuss the historical patterns ofopiate use, including how theHarrison Narcotics Tax Act affectsopiate use in the United States | PPT: #4
PPT: #15–16 |
PPT, IM: Knowledge Check 1: History of the Opiates
|
5 minutes |
| 10-2 Evaluate the factors contributing tothe current opiate epidemic | PPT: #11–13
PPT: #15–16 |
PPT, IM: Knowledge Check 1: History of the Opiates
|
5 minutes |
| 10-3 Describe how opiates are absorbed,distributed, metabolized, andexcreted from the body | PPT: #17
PPT: #20–21 |
PPT, IM: Knowledge Check 2: Pharmacokinetics |
5 minutes |
| 10-4 Explain the mechanisms of action forthe opiates | PPT: #22
PPT: #24–25 |
PPT, IM: Knowledge Check 3: Mechanisms of Opiate Action |
5 minutes |
| 10-5 Discuss how opiates are used to treatacute and chronic pain | PPT: #26
PPT: #27–28 |
PPT, IM: Knowledge Check 4: Medical Use of Opiate Drugs |
5 minutes |
| 10-6 Compare and contrast the acute andchronic effects of opiates | PPT: #30
PPT: #34–35 PPT: #36
PPT: #41–42 |
PPT, IM: Knowledge Check 5: Acute Psychological and Physiological Effects of Opiates PPT, IM: Knowledge Check 6: Chronic Effects of Opiates |
5 minutes
5 minutes |
| 10-7 Evaluate the role of physical and environmentalfactors associated withheroin dependence | PPT: #36
PPT: #41–42 |
PPT, IM: Knowledge Check 6: Chronic Effects of Opiates
|
5 minutes |
Key Terms
analgesia:Pain relief produced without a loss of consciousness.
heroin:A drug produced by chemically processing morphine. It is more potent than morphine and has become the major opiate drug of harmful use.
naloxone: A short-acting opiate antagonist.
opium:The dried sap produced by the poppy plant.
What’s New in This Chapter
The following elements are improvements in this chapter from the previous edition:
- Each chapter of the ninth edition has been updated to represent findings from the latest research, as well as to reflect social and legal changes related to drugs. Among the many revisions, we present the latest survey data available at this writing on patterns of drug use in the United States and in other countries worldwide.
- Chapter 10, “Opiates,” provides extensive new coverage of the dramatic increase in use of heroin, prescription opiates, and synthetic opiates. Two new sections are included on the events that led to the opiate epidemic and the current status and impact of the epidemic. The increase in opiate overdose deaths is chronicled, and we add a new box on treating overdose with naloxone.
Chapter Outline
- History of the Opiates
- Early History
- Opiate Use in the 19th Century
- Opiate Use after the HarrisonAct
- The Making of an Epidemic
- The Opiate Epidemic
- Knowledge Check 1: History of the Opiates (10.1, PPT Slides #15–16), 5 minutes total, multiple-choice question and answer.
Question: Chronologically, what is the sequence of the discovery and release of the following drugs?
Answer: d. Opium, morphine, heroin. Opium was used thousands of years ago in ancient civilizations, became a serious dependency problem in China by the early 19th century, and became popular in the modern Western world in the 1800s. Morphine was isolated in 1803 and became widely available by the mid-1800s. Heroin was discovered in 1874 and rediscovered in 1898.
- Pharmacokinetics
- Absorption
- Distribution, Metabolism, andExcretion
- Knowledge Check 2: Pharmacokinetics (10.2, PPT Slides #20–21), 5 minutes total, multiple-choice question and answer.
Question: The opiate ________ passes through the blood-brain barrier more easily than ________; once in the brain, ________ is converted to _______.
Answer: d. heroin; morphine; heroin; morphine. Heroin is more lipid-soluble than morphine and passes through the blood-brain barrier more easily. Once in the brain, heroin is converted to morphine. Thus, heroin more effectively delivers morphine to the brain than morphine itself.
III. Mechanisms of Opiate Action
- Discovery of Endorphins
- What Do Endorphins Do?
- Knowledge Check 3: Mechanisms of Opiate Action (10.3, PPT Slides #24–25), 5 minutes total, multiple-choice question and answer.
Question: What are endorphins?
Answer: a. They are the body’s own natural pain relievers. Opiate antagonists like naloxone are not endorphins; they block endorphin receptors. Endorphins are not placebos, which are medically inactive substances given to research volunteers without their knowledge; if subjects believe these are active drugs and thus expect pain relief, they will experience it, probably through endorphin release.
- Medical Use of Opiate Drugs
- Knowledge Check 4: Medical Use of Opiate Drugs (10.4, PPT Slides #28–29), 5 minutes total, multiple-choice question and answer.
Answer: e. To relieve all of these. Various opiate drugs are used medically to relieve pain, coughs, and heroin withdrawal symptoms, and in maintenance programs to aid ongoing abstinence from heroin use.
- Acute Psychological andPhysiological Effects of Opiates
- Knowledge Check 5: Acute Psychological and Physiological Effects of Opiates (10.5, PPT Slides #34–35), 5 minutes total, multiple-choice question and answer.
Question: Which of the following is a common acute physiological effect of opiate drugs?
Answer: d. Respiratory depression or failure. Opiates cause respiratory depression. When a high dose of heroin is fatal, the immediate cause is usually respiratory failure. Reduced sex drive, impotence, and impairment in social interactions and cognitive functions are all common acute psychological effects of opiate drugs.
- Chronic Effects of Opiates
- Tolerance
- Withdrawal and Dependence
- Knowledge Check 6: Chronic Effects of Opiates (10.6, PPT Slides #41–42), 5 minutes total, multiple-choice question and answer.
Question: Researchers have found that when morphine or heroin was always available, a human and a rhesus monkey did which of the following?
Answer: b. Both increased the dose gradually over time. Neither the human nor the rhesus monkey increased the dose almost immediately or quickly. The similar patterns of self-administration between the human and the monkey illustrate the generality of the emergence of tolerance to the rewarding consequences of opiate drugs.
d.Summary
True or False Questions Answer Key
- Opium comes from the plant Cannabis sativa.
FALSE.Opium comes from the poppy plant Papaversomniferum.
- Morphine is one of the active ingredients inopium.
TRUE.Morphine and codeine are chemicals directlyderived from opium.
- Heroin was first made illegal by the 1965 DrugAbuse Control Amendment.
FALSE.All opiates were brought under legal controlby the 1914 Harrison Narcotics Tax Act.
- As of December 2020, not more than 100,000Americans have died from opiate overdose ordependence.
FALSE.Data from the Centers for Disease Control andPrevention indicate that over 400,000 Americanshave died from opiate overdose or dependenceas of December 2020.
- Fentanyl and its analog compounds are lesspotent than pure heroin.
FALSE.Fentanyl and fentanyl analogs range from tento hundreds of times more potent than pureheroin. Thus, the risk of overdose is greater.
- The opiates are among the most powerful analgesicdrugs.
TRUE.The principal medical use for opiates is torelieve pain.
- Heroin enhances sexual desire and activity.
FALSE.Heroin inhibits sexual arousal.
- Heroin dependence is a factor of physicalwithdrawal symptoms, lifestyle, and socialenvironment.
TRUE.Heroin dependence is complex. Factors ofphysical withdrawal symptoms, lifestyle, and
social environment all interact to influencethe development and maintenance of heroin
dependence.
- Heroin withdrawal is much like alcoholwithdrawal.
FALSE.Opiate withdrawal does not include deliriumtremens but rather is characterized by flu andcold symptoms.
- Veterans of the Vietnam War had a high rate ofheroin dependence and were unable to kick thehabit when they returned to the United States.
FALSE.Most veterans were able to quit using heroinwhen they returned to their homeenvironment.
- The effects of opiates are synergistic with thoseof alcohol.
TRUE.Alcohol and other depressant drugs act synergisticallywith heroin and other opiates, andthese combinations are often fatal.
- The expression “cold turkey” comes from the“goose bumps” seen in those suffering from heroinwithdrawal.
TRUE.The resemblance is thought to be the basis forthat expression.
Discussion Questions
You can assign these questions several ways:in a discussion forum in your LMS, as whole-class discussions in person,or as a partner or group activityin class.
- Discussion: The Opiate Epidemic(p. 270,1, PPT Slide#12)Duration 15 minutes.
- An essential paradox inherent in opiates is that they are the most effective known painkillers, yet they are also highly addictive.
- What are some ways that doctors can manage their patients’ pain more effectively, with fewer or no harmful sideeffects?
- Answer: Answers will vary. Some students may recall the text’s discussion of physicians’ historical caution in prescribing opiates and say that they should return to those practices, stop overprescribing them, and only allow their short-term use to relieve severe, acute pain. Some students may recommend that researchers work harder to seek alternatives for pain relief that are not addictive. If no studentsbring these up, remind them of: Research findings of differences in mechanism of action between therapeutic opioids and endorphins, which could inform designing novel, nonaddictive therapeutics, on p. 273; the new (2016) CDC guidelines cited on p. 276; and the Contemporary Issue Box 10.3 on p. 276 about partial opiate agonists like buprenorphine as one safer alternative. Some students may also bring up existing alternative methods of pain relief, such as acupuncture; reinforce this by citing the text’s inclusion of acupuncture in the discussion of endorphins on p. 274.
- What are some events cited in your text that represent government attempts to address the growing opiate epidemic, and some parallel events that represent a continuing epidemic despite those attempts?
- Answer: In 2001, the Drug Enforcement Administration (DEA) pressured Purdue Pharma to discontinue the highest dose of OxyContin; however, widespread misuse of this drug did not stop, and even the Joint Commission on the Accreditation of Health Care Organizations (JCAHO) encouraged prescribing opiates (using teaching materials, some developed by Purdue Pharma), suggesting that concerns about addiction and death risks were exaggerated. Also, several U.S. state governments filed lawsuits, and in 2007, Purdue Pharma was fined and paid $634 million for misrepresenting OxyContin’s misuse liability; however, in 2008, deaths from drug overdoses, mostly of opiates, exceeded auto accidents as the United States’ leading cause of death.
Appendix
Generic Rubrics
Providing students with rubrics helps them understand expectations and components of assignments. Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.
Customize these rubric templates as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.
Standard Discussion Rubric
| Criteria | Meets Requirements | Needs Improvement | Incomplete |
| Participation | Submits or participates in discussion by the posted deadlines. Follows all assignment. Instructions for initial post and responses.
5 points |
Does not participate or submit discussion by the posted deadlines. Does not follow instructions for initial post and responses.
3 points |
Does not participate in discussion.
0 points
|
| Contribution Quality | Comments stay on task. Comments add value to discussion topic. Comments motivate other students to respond.
20 points |
Comments may not stay on task. Comments may not add value to discussion topic. Comments may not motivate other students to respond.
10 points |
Does not participate in discussion.
0 points |
| Etiquette | Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.
5 points |
Does not always maintain appropriate language. Offers criticism in an offensive manner. Provides only negative feedback.
3 points |
Does not participate in discussion.
0 points |
