These questions are based on the feature article Fatal fix.

1. What is the main idea of the article?

Possible student response: Opioids restrict breathing and can impact body functions in other harmful ways. The number of opioid-related deaths in the United States has increased from 1999 until 2016.

2. What are opioids?

Possible student response: Opioids are a category of drugs that can relieve pain and provide pleasure. They include prescription opioids such as morphine and fentanyl, and heroin.

3. What is the most life-threatening effect of opioids?

Possible student response: Opioids slow a person’s breathing rate and depth, making it so the body cannot get enough fresh oxygen or eliminate enough carbon dioxide.

4. How do opioids affect the brain stem?

Possible student response: Regions of the brain stem, called the medulla and the pons, control the depth and rate of breathing. Those regions contain large numbers of opioid receptors, docking stations on the surface of cells to which opioids attach. When opioids bind to the receptors, cells’ behavior changes in ways that can decrease breathing depth and rate.

5. How do opioids affect voluntary breathing?

Possible student response: Other areas of the brain control voluntary breathing, such as consciously deciding to take a deep breath, for example. But opioid receptors cover those areas too, so the drugs may work directly on those brain areas to suppress breathing.

6. What is the carotid body and how do opioids affect it?

Possible student response: The carotid body is a cluster of cells in the neck that senses levels of dissolved carbon dioxide in the blood. If CO2 levels rise, the cells send signals to the brain to increase breathing. Opioids suppress the carotid body’s CO2 warning system by dampening the sensors.

7. How do opioids affect lung fluid?

Possible student response: Opioids appear to increase fluid in the lungs and the rest of the respiratory tract, although currently it is not known exactly how the drugs do that. The accumulated fluid interferes with gas transfer from the air to the lung tissue and makes breathing more difficult.

8. How can large doses of opioids affect chest muscles?

Possible student response: Opioids such as fentanyl can paralyze the diaphragm and other chest muscles that work in conjunction with the lungs.

9. What non-lethal but still potentially harmful physiological effects do opioids have?

Possible student response: Opioids can suppress the throat’s gag reflex, decrease blood pressure or trigger an abnormal heart rhythm. The drugs can also dilate blood vessels in the arms and legs, shrink the pupils to pinpoints and slow digestion.

10. How does Narcan work?

Possible student response: Opioids bind to empty opioid receptors on some cell surfaces, altering the cells’ behavior and causing problems such as difficulty breathing. The drug nalaxone, often sold as Narcan, is an opioid antidote. Naloxone thwarts opioids by binding to empty opioid receptors so opioids can’t gain access. Usually injected or inhaled, naloxone begins working within minutes and can reverse overdoses.

11. What information does the graph “Deadly direction” convey? Explain the overall trend and give numerical data to support your trend statement.

Possible student response: The graph plots the number of U.S. opioid overdose deaths per year from 1999 to 2016. Total deaths from all opioids are shown in red, and deaths attributed to various categories of opioids are shown in other colors. The total number of opioid-related deaths has been rising from year to year, with deaths attributed to specific types of opioids, such as fentanyl and other synthetic opioids, increasing more rapidly than others. Overall, the combined number of deaths from all opioids increased more than five-fold during this time, from roughly 8,000 deaths in 1999 to roughly 42,000 deaths in 2016.

12. What questions do you still have after reading the article?

Possible student response: What is the natural role of opioid receptors in the human body? What biochemical means could be used to prevent or reverse opioid addiction? What behavioral or other non-biochemical means could be used to prevent or reverse opioid addiction?

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