A Tricky Problem-Opioid Abuse

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About This Module

Topics: Human health, epidemiology, drug abuse, opioid abuse, addiction, withdrawal, relapse, genetic vs environmental factors of substance abuse, addiction treatment, and social and emotional consequences to drug addiction

Grade levels: 9-12

Teacher Note: There are three scenarios included in the “A Tricky Situation” PBL modules. Each involves a different drug type (alcohol, cocaine, and opioids) and a slightly different scenario, but all have the same tasks. If you divide your class into multiple student teams each having a different type of drug abuse, your class will learn about issues and health effects of different drugs, but will have the same tasks. Work is equitable throughout the class teams and can be assessed with the same rubric.

You may want to assign the specific type of drug based on what type is more prevalent in your community.

Overview

Students plan carefully to present issues of opioid abuse at a school drug awareness program. They investigate the physical, social, emotional, and mental health effects of opioid abuse as well as the genetic and environmental factors that influence substance abuse.

Learning Objectives

To better understand the complex problems of alcohol abuse, students should be able to:

  • Describe the health effects of opioid abuse on organs of the body.
  • Compare and contrast genetic and environmental factors affecting drug abuse.
  • Describe issues surrounding the difficulties of talking with someone about her drug abuse.
  • Explain treatment options for substance abuse addictions.
  • Describe the social, emotional and mental health effects of opioid abuse on the user and his family and friends.
Standards

Next Generation Science Standards

Standards Aligned to PBL Modules

Scenario (with possible answers)

girl sitting slumped against a wallMeghan can’t believe it. How was this happening?  Again.  She doesn’t think she can handle it this time and she knows her parents can’t. Why is her sister doing this again? Doesn’t she see what it’s doing to her? If she doesn’t care about that, doesn’t she care about what it’s doing to your mom and dad—and you?

The Situation

Meghan’s sister, Jenny, has relapsed—again.  Jenny became addicted to opioid pain killers after a sports injury three years ago. Her injury was fairly severe. The physical therapy was painful and the doctors prescribed oxycodone, an opioid pain reliever.  Months later, after they decided that physical therapy wasn’t correcting the problem, doctors said she needed surgery to repair the injury. Her family thought that finally things were going to get better.

But, pretty soon, Jenny was complaining of worse pain, but not at the injury or surgical site. She didn’t want to get out of bed, she couldn’t go to school, and she barely walked around the house.

Her parents took Jenny to several different doctors. All of them said that she just needed to recover from the injury and surgery. They didn’t know what else it could be as tests results came back normal. And they all prescribed more pain pills. Finally, an emergency room doctor recognized the problem. Jenny was addicted to the opioid pain pills.

Meghan remembered how hard that was. They finally got an answer to Jenny’s problems, but to hear that her sister was addicted to a drug was pretty tough. She and her sister always heard how bad doing drugs could be.

Jenny went through several rehabilitation programs. They seemed to work for a while, and then Jenny would relapse—she’d get back on drugs. Sometimes, they didn’t know what she was taking. Her mom and dad did a lot of research into the problem so they could help Jenny more. They found out that some opioid abusers use other drugs as well. These street drugs have other substances added to them and could cause severe reactions, even death.

Meghan decided to make some plans. She wasn’t going to let this get her down. She had to be there for Jenny and for her parents.

She decided to participate in the drug awareness presentation at her school. She doesn’t have to hide Jenny’s problem; everybody knows about it anyway. And she’s not going to be embarrassed by it. Maybe she can help other students who have an addiction problem like Jenny, maybe she can get through to some people who may consider doing drugs just how devastating it can be, and maybe she can help other students like herself who struggle with having an addict in the family.

She knows her friends will help; they have always been there for her. Her parents think it’s a great idea. The next day she talks to the school organizers of the week-long drug awareness program that will happen at her school in a few weeks. They enthusiastically agree to Meghan’s and her friends’ participation.

Your Tasks—Part I. The Effects of Opioid Use

  • Decide on a plan that Meghan should use to talk to her sister about her problem with opioid use. Be specific with your ideas. Include your ideas with your presentation. Other students may want to find out ways to approach someone with a drug problem and may have questions or comments.
  • Make a presentation for your school assembly that provides information about the effects of opioid use on the body.
  • To be able to explain the health issues which surround opioid use as well as the social and emotional consequences to an addict’s life and to an addict’s family life.
  • Research opioid use and its related problems to prepare for your presentation. You can use any kind of presentation aid available to you, including PowerPoint. (Your teacher may have other requirements.)
  • Be prepared to answer the questions presented in this module.
  • Be prepared to answer the questions from your classmates or teacher as they play the roles of other students or teachers at the school who are interested in finding out about opioid abuse.
  • Be prepared with statistics to back up your presentation. Epidemiologists track trends, use, increases and decreases, locations, persons, age, and many other factors as they study the incidence of drug abuse. These statistics may be a powerful tool to help students and adults understand the scope of the problem.
  • Based on the results of your classroom presentation, evaluate how effective your plan was in helping students understand the challenges of helping someone who abuses drugs. What could you have done differently? What else could you do that may help?

Guiding Questions:

  1. What are the effects of opioid abuse? Explain the effects of opioids on the various body systems. Be sure to list short-term and long-term effects.

Short-term effects of opiate use include feelings of euphoria (an intense “high”), pain relief, drowsiness, sedation, lethargy, paranoia, delirium, respiratory depression, and nausea. Respiratory depression (slowed breathing) can cause inadequate blood supplies to the brain which can cause coma, permanent brain damage, and death.

Opiates cause “pinprick pupils”. Pupils become extremely small when irises (colored parts of your eye) relax. This symptom is difficult to disguise.

Opiate use slows reaction times and driving under the influence of opiates greatly increases the possibility for accidents.

Addiction can occur in less than three days.

Long-term effects of opiate use include nausea, vomiting, abdominal swelling and bloating, constipation, liver damage, brain damage, heart infections, lung infections, muscle pain and addiction.

  1. Why is it so hard for opioid abusers to quit? Why is the relapse rate so high for opioid users as compared to other types of drug abuse?

After using drugs, the brain struggles to regain the balance of dopamine highs with normal levels. You eventually cannot get high enough dopamine levels to function at low levels of normal function let alone make good decisions or quit using drugs.

The release of dopamine triggered by opiate use produces feeling of pleasure in the brain. People have intense cravings when they try to stop using opioids after becoming addicted to them. Opioids produce greater feelings of pleasure than do other drugs and cravings are stronger.

People who have used opioids for a long period of time have actually changed the way their brain works. Their brains are now more susceptible to addiction. Relapse rates for opioid users are very high.

 3. What can Meghan do to help her sister with her addiction problem? What can Meghan do to help her family?

Draft a list of actions that Meghan can do to help her sister and her parents with Jenny’s addiction problem. Be specific. List any people she might be able to contact and how she might go about getting that help.

Note: Stress that Meghan should have a parent or guardian with her when she approaches her sister. People can become sensitive and can over-react to a situation. A bad reaction by her sister could put Megan at risk.

Answers will vary, but drug treatment professionals suggest talking with the family member in a non-hostile, non-accusatory way. An argument is not going to help.

Sharing information with other family members will help you all feel more supported during a difficult time.

Meghan should find out as much as she can about drug effects, health concerns, treatment programs and support groups. She should discuss this information with her parents so they find out the best possible options. New treatment programs or support groups may have formed in their community since her sister was in rehabilitation.

Assure her sister (and her family) that relapse is not a failure. Addiction is a chronic disease and like other chronic diseases, such as diabetes or hypertension, there can be a problem with not following through with ongoing treatment. Relapse of addiction often occurs in response to drug-related behavioral cues, such as seeing people who are also using or going to places where the addict used to get drugs.

 4. What kinds of treatments are available to help someone overcome an opioid addiction?

Medications help addicts in rehabilitation programs to better deal with withdrawal symptoms and cravings.

Medications are combined with behavioral counseling in a therapy known as “Medication Assisted Treatment (MAT) which is a whole patient approach to treatment.

Research has shown that MAT decreases opioid use, opioid-related overdose deaths, and infectious disease transmission. MAT increases social functioning and helps recovering addicts stay in treatment plans.

In spite of MAT successes in some rehab programs, it is not yet widely used.

Counseling and behavioral therapies are based in both residential and hospitals. Individual counseling, cognitive-behavioral therapy (which teaches the user better coping skills and how to manage stress), motivational enhancement therapy, group counseling, and family counseling are some of the options available in rehabilitation programs.

Other options are: peer support groups, faith-based groups and educational support groups.

Part II—Genetics vs the Environment  

A model of DNA's double helix structure
A model of DNA’s double helix structure

You just heard about studies that have been done to find out if addiction is inherited or if it is more of an environmental issue—if something in your environment leads to a greater risk of addictive behaviors. It is something you have worried about all through Jenny’s struggle with substance abuse. If you knew more about this, you might be able to help Jenny and your family even more.

Guiding Questions:  

  1. Investigate the genetic and environmental links to addiction. What conclusions do you draw from your research?

Scientific studies have suggested that children who have family members who have drug addictions are more likely to try drugs and may develop a drug addiction.

But, having family members who have had an addiction problem is not a guarantee the children with either use drugs or become addicted. Studies have shown that most children of parents who abuse drugs do not develop alcoholism or addiction themselves.

 2. In this case, do you think Jenny’s drug use is inherited or has it been influenced by his environment? Why do you think that?

Answers will vary. Of course, Jenny’s direct link to opioids occurred after her injury and her prescribed opioid medications. Genetic characteristics and environment may still be an influence on her recovery.

You may want to discuss the following information with your students:

Scientific research has concluded that addictions are complex diseases that have links to both genetic and environmental factors, especially in the initial use of drugs. Family history studies, adoption statistics, and twin studies have shown that an individual’s risk is related to heredity.

The heritability differs with the type of drug abuse. It also differs with age. In early adolescence, the initial use of tobacco, alcohol, and marijuana are more related to family or social factors; genetic factors become a greater influence in young and middle adulthood.

Of course, incidence of addictive behaviors and drug abuse are dependent on the availability of the drug. Availability is great affected by culture, social policies, religion, and economic status.

Stress to your students that having a family member with an addiction problem does not mean that they will develop an addiction problem.

Part III—Risky behaviors

Meghan’s group was meeting after school to plan the last part of their presentation for the drug awareness week. Meghan hadn’t shown up yet and the group was waiting for her.

Shandra walked in with a stricken look. “Did you hear about Jenny?” Shandra asked the group.  “She apparently overdosed today. They aren’t sure exactly what all she was using. Her mom came home and found her. She called 911 right away, but they don’t know if they got to her in time yet. They gave her Narcan, but she’s in bad shape.”

 Guiding Questions:

  1. Drug use is also tied to a lot of other risky behaviors and consequences. Cite some of these behaviors and consequences and explain how other risks are associated with drug use.

Most risky behaviors are associated with the impaired judgement that results from cocaine (or any drug) use. These include:

  • social problems
  • morbidity (disease)
  • mortality (death)
  • injuries
  • pregnancy
  • contracting HIV/AIDS and other infectious diseases
  • other drug use
  • violence
  • suicide
  • car accidents
  • homicides
  • cancer
  1. Aside from the expected symptoms, what other issues surround using this drug?

Adding substances to the illegal forms of opioid drugs bought on the street. Users do not know what has been added or the strengths of the illegal drugs.

  1. What will be the some of the consequences of Jenny’s opioid abuse? If she survives the overdose, what kinds of consequences could she face to all aspects of her life now and in her future?

Jenny will have to attend rehabilitation counseling for a lengthy period of time. There is no one answer for everyone for length of time for rehabilitation. Addiction specialists consider many factors for each patient before they create a plan for treatment. These factors include how strong the addiction is, how much drug they have been using, and how long they have been addicts.

  • An average stay for inpatient rehab for varying types of drug abuse is from 30-90 days. Addicts are required to stay in a treatment facility during their rehabilitation.
  • Long-term rehabilitation can take from 3 months to a year or more.
  • Outpatient rehabilitation is a longer procedure, but can be more convenient for the patient because they do not have to reside in a facility. The patient has a variety of therapies several times per week for 10-16 weeks. Some patients require longer periods of treatment.

Jenny will also have to be diligent in attending periodic counseling sessions if she manages to stop using drugs. It is not uncommon for opioid users to relapse at least once. A relapse should be viewed as part of the recovery process and not a failure. A relapse can help a person recognize triggers that may be leading them to more drug use.

Jenny may have continued health problems from damage done to her body during her drug usage. Long-term effects may put her at a disadvantage for some opportunities she may have had otherwise. Opioid use damages vital organs of the body. Liver damage, brain damage, heart infections, lung infections can occur. Opioid use puts the user at risk for other life-threatening conditions such as HIV and hepatitis.

Even if she manages to control her drug addiction in the future, a history of drug use may put her at a disadvantage socially and professionally.

Jenny will have to be careful to avoid associations with people who may lead her back to drug use. She may have to give up friendships with people who cannot keep off drugs. (Relapses can often be traced to a “trigger”. The addict sees people who did drugs with her or places where she bought drugs and these events trigger a relapse to drug use.)

Jenny’s past drug use may prevent her from getting jobs in the future. A record of drug abuse, or worse, a criminal record related to drug abuse, could make finding a job more difficult. The Americans with Disabilities ACT (ADA) protects individuals in recovery from being discriminated in the workplace, but some employers may be hesitant to hire someone who is at risk for relapse into drug abuse.

However, it is much better for Jenny to seek treatment and show that she is in recovery than to continue to put herself and others at risk. She will do better in all aspects of her life if she can recover and stay off drugs.

Sample Rubric

 Information about constructing and implementing rubrics for problem-based learning strategies can be found in Developing Rubrics in the Teacher Professional Development section.

 

Extensions

  Call local treatment centers and support groups and ask a counselor to talk to your class about opioid addiction issues.

If you cannot find a local treatment center or support group, the U.S. Department of Health & Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) has a national helpline that provides a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish). They provide information about local treatment facilities, support groups, and community-based organizations and you can then call the local groups to contact an addiction specialist that may talk to your class.

► Invite your county or district public health officer or an epidemiologist from a local university (or both) to talk to your classes about how public health concerning drug addiction is monitored in your area.

► If you haven’t used all the scenarios for different drug types included in the A Tricky Situation module, assign student teams a second drug type. They will probably be able to move more quickly through the Tasks and Guiding Questions since they have worked through one drug type, so you will not have to use as much class time for the second scenario.

►Watch the PBS NOVA documentary “Addiction” with your class:  https://www.pbs.org/wgbh/nova/video/addiction

The documentary delves into the complex issue of drug addiction by profiling several people who became addicted to drugs. It deals specifically with opioid abuse, but some of the issues surrounding the abuse apply to any drug addiction.

The patients are diverse: a coal miner who was in a traumatic mine accident, a young student active in sports and school, a teen from a successful, caring family, and a young mother who loses her children due to her drug abuse.

Through the stories of these people, the documentary explains the mechanism of addiction, how drugs change the brain, and how those changes make continued recovery difficult. It also explains how the epidemic of drug abuse continues to grow in the United States. How did it begin? Why is it so difficult to contain? What can be done to reduce the ever-increasing trend?

A student study guide for this documentary is included in the module. A complete teacher guide with answers to questions is in the student guide are in the Teachers Pages section on the PDC site.

► If possible, display your students’ work on their drug awareness project around the school.  If you had them make a poster, do a survey, or create a fact sheet, they could be displayed in the halls, the media library, or the school cafeteria.

► Local newspapers and TV stations are always looking for community news. Contact your local newspaper and TV stations about your students’ work on drug awareness and the health effects of drug abuse. Students can be interviewed about their projects and more people will become aware of community resources and important efforts to educate students about the dangers of drug use.

► Organize a school program or parent/community night that delivers the drug awareness program in the scenario in this module. Student groups could present their research on the type of drug abuse covered in their module (each scenario in the A Tricky Problem package covers a different type of drug abuse) along with the resources, effects and consequences of drug abuse, and the approach they developed to talk to their friend or family member.

Additional Resources

Additional resources about drug abuse can be found:

at the opioid abuse scenario page at:
http://www.pandemsim.com/pdc/a-tricky-problem-opioid-abuse/

at the direct link to Internet Resources—Opioid Abuse:
http://www.pandemsim.com/pdc/internet-resources-opioid-abuse/

at the direct link to Internet Resources—Drug Abuse
http://www.pandemsim.com/pdc/internet-resources-drug-abuse/