Opioid vs. Non-Opioid Painkillers: What Are the Differences?

Opioid vs. Non-Opioid Painkillers: What Are the Differences?

There’s nothing more effective at managing acute patient pain than opioids. But, did you know that 91 Americans die everyday from opioid overdose according to the Centers for Disease Control and Prevention? This alarming statistic has forced the medical community to take a serious look at America’s growing addiction to habit-forming pain relievers and to start recommending non-opioid alternatives. Here’s a quick break down of what you need to know about the key differences between these two types of pain management.

Analgesic Effect

The main difference between opioids and non-opioids is in the way they produce their analgesic or pain-relieving effects. Opioids reduce patient pain by working on special pain receptors in the nervous system, mostly focused in the brain and spinal cord. Non-opioids, however, work more directly on injured body tissues. While opioids reduce the brain's awareness of pain, non-opioids affect some of the chemical changes that normally take place wherever body tissues are injured or damaged. These chemical changes at the site of the injury typically result in inflammation and increased pain sensitivity.

Other Key Differences

Controlled vs. Uncontrolled Substance: Opioids are Schedule II/III controlled substances, which means they have high potential for abuse and can lead to severe psychological or physical dependence. Non-opioids, like over-the-counter acetaminophen, are non-habit forming and do not require a prescription.

Ceiling Effect: Unlike opioids, non-opioids are subject to the ceiling effect, which means an increase in the dose does not increase the pain relieving benefits. But, it does increase side effects.

Anti-Inflammatory: With the exception of acetaminophen, all non-opioid medications are anti-inflammatory.

Adverse Side Effects: The most common adverse side effects associated with opioid use include sedation, respiratory depression, and constipation. For non-opioid use, side effects can include gastric irritation, bleeding problems, and renal toxicity.

Now that you know the key differences between opioid and non-opioid painkillers, it's important to know how to respond should you encounter a non-responsive victim who you suspect has overdosed on an opioid painkiller.

Current guidelines recommend performing CPR for two minutes then administering 2 mg of intranasal naloxone or 0.4 mg of intramuscular naloxone. Because naloxone competes with opioid drugs at the opioid receptors, it reverses the effects of opioid drugs. However, it has a short half-life in the body, which may require multiple administrations.  

To review the complete Opioid Overdose Algorithm, check your ACLS Provider Manual. You can purchase the manual here or receive it as part of your tuition when you register for ACLS certification.