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PCPs prescribe fewer opioids in Japan than US

Japan prescribes far fewer opioids compared with the United States, particularly for acute pain, which can lead to reducing long-term use, suggesting that understanding the Japanese regulatory and cultural perspectives may be useful for U.S. physicians, according to published data.

“Systematic reviews largely agree that opioids have a greater short-term analgesic efficacy than placebo, but benefits for function and long-term pain relief are less clear,” Eriko Onishi, MD, from the department of family medicine at Oregon Health & Science University, and colleagues wrote. “If prescribers provide a large supply or simply continue to refill prescriptions, prescribing opioids for acute pain may inadvertently lead to drug dependence and long-term use.”

Because there are fewer opioids prescribed in Japan than in the United States, researchers conducted an online physician survey to compare the attitudes and perceptions regarding opioid prescribing among primary care physicians in both countries and inform physicians and patients about better pain management and prescribing practices. Surveys were sent to members of the Japan Primary Care Association (JPCA) nd members of the AAFP practicing in Oregon.

The response rates were low, with 461 responses from a pool of 4,552 JPCA members (10.1%) and 198 responses from 1,067 AAFP members (18.5%). The results showed that Japanese participants reported far less opioid prescribing compared with U.S. participants, particularly for acute pain (49.4% vs. 97%; P < .001) and chronic pain (63.7% vs. 90.9%; P < .001).

Researchers observed that the U.S. physicians were more likely to cite medical indications, standard of care and legal expectations as reasons that influenced prescribing opioids for acute pain compared with Japanese physicians. They also wrote the difference in prescribing rates between the two countries could be linked to the Asian country’s national insurance system, which will not provide coverage for a medication unless its indications are “strictly followed.” Other possible reasons that researchers cited included that in Japan, opioid use is looked at with disapproval, considered a criminal act, there are strong cultural beliefs regarding self-attention, and the burden of storing opioids in pharmacies and clinics under current law, combined with the rare use of these drugs, makes many such locations in Japan choose not to store them at all.

Onishi and colleagues also found that only 6.6% of Japanese respondents said they believed that opioids were used too frequently compared with 95.4% of U.S. respondents. Nearly half of all respondents from both Japan and the United States revealed that patient expectations and satisfaction could significantly influence prescribing. Increasing awareness of the serious adverse effects of long-term opioid therapy and educating the public about acute pain management may be important intervention strategies, the researchers wrote.

“U.S. respondents seem concerned about overprescribing opioids, whereas Japanese respondents seem more concerned about underprescribing opioids,” Onishi and colleagues wrote. “Our findings may contribute to developing more effective U.S. guidelines and policies on opioid use, especially for acute pain.” – by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.