Chapter 33 Quiz: The Opioid Crisis
Multiple Choice
1. OxyContin was introduced by Purdue Pharma in:
a) 1986 b) 1996 c) 2001 d) 2006
2. Purdue Pharma's claim that OxyContin had a low addiction rate — "less than one percent" — was based on:
a) A comprehensive ten-year clinical trial b) A brief letter published in the New England Journal of Medicine about hospitalized patients receiving opioids for acute pain c) Data from the FDA's post-market surveillance program d) Research conducted by independent academic scientists
3. Which of the following best explains why Appalachia was specifically targeted by Purdue Pharma's marketing campaign?
a) Appalachian physicians prescribed fewer opioids than the national average b) Appalachian communities had high rates of chronic pain from industrial injuries, limited specialist access, and workers' compensation coverage that would pay for prescriptions c) Appalachia had the most advanced addiction treatment infrastructure in the country d) Federal law required pharmaceutical companies to market exclusively in rural areas
4. The "three waves" of the opioid crisis are, in order:
a) Heroin, fentanyl, prescription opioids b) Fentanyl, prescription opioids, heroin c) Prescription opioids, heroin, fentanyl d) Prescription opioids, methamphetamine, heroin
5. The transition from prescription opioid abuse to heroin use was driven primarily by:
a) A cultural preference for heroin over pills b) Heroin being legalized in several states c) Reduced supply and increased cost of prescription opioids due to reformulation and monitoring programs, while physical dependency remained d) The closure of all pharmacies in Appalachian counties
6. Fentanyl is approximately how many times more potent than morphine?
a) 5-10 times b) 15-25 times c) 50-100 times d) 500-1,000 times
7. The "deaths of despair" framework, developed by Anne Case and Angus Deaton, identifies three categories of rising mortality:
a) Cancer, heart disease, and stroke b) Drug overdoses, suicide, and alcohol-related liver disease c) Mining accidents, black lung, and work-related injuries d) Homicide, automobile accidents, and infectious disease
8. Medication-Assisted Treatment (MAT) for opioid use disorder typically uses which of the following medications?
a) Aspirin and ibuprofen b) Buprenorphine, methadone, or naltrexone c) Antibiotics and antivirals d) Antidepressants and benzodiazepines
9. Naloxone (Narcan) works by:
a) Curing opioid addiction permanently b) Creating a long-term aversion to opioid use c) Rapidly reversing the effects of an opioid overdose by blocking opioid receptors d) Providing a mild euphoria that substitutes for opioid effects
10. The chapter argues that the opioid crisis is best understood as:
a) An isolated event caused solely by Purdue Pharma b) A natural disaster that no one could have predicted or prevented c) The latest chapter in a centuries-long history of Appalachian health disparities created by extraction, underinvestment, and neglect d) A problem caused entirely by individual moral failure
Short Answer
11. Explain what a "pill mill" is and why pill mills flourished in rural Appalachia during the prescription opioid wave.
12. The chapter identifies the "rural treatment gap" as a major barrier to addressing the opioid crisis. What specific factors create this gap in Appalachian communities?
13. What is neonatal abstinence syndrome (NAS), and why did it increase sharply during the opioid crisis?
14. The chapter argues that criminalization "failed" as a response to the opioid crisis. Identify two specific reasons why criminalizing addiction did not reduce the crisis and may have worsened it.
Essay
15. Chapter 33 draws a deliberate parallel between the coal industry's extraction of mineral wealth and the pharmaceutical industry's extraction of profit from chronic pain, arguing that "both extracting profit from Appalachian bodies while leaving communities with the costs." In a 500-750 word essay, evaluate this parallel. Address: (a) the specific ways in which the two industries' relationships with Appalachian communities were similar, (b) the ways in which they were different, and (c) what this parallel reveals about the structural patterns that have shaped Appalachian history. Draw on evidence from both Chapter 32 (coal's collapse) and Chapter 33 (the opioid crisis).