Eriko Onishi, MD, Tadashi Kobayashi, MD, PhD, Eve Dexter, MS, Miguel Marino, PhD, Tetsuhiro Maeno, MD, PhD, and Richard A. Deyo, MD, MPH

Introduction: Far fewer opioids are prescribed in Japan than in the United States. Methods: We conducted an online physician survey assessing attitudes and perceptions that might influence prescribing. A Japanese version was distributed to members of the Japan Primary Care Association and an English version to members of the American Academy of Family Physicians practicing in Oregon.

Results: We received 461 Japanese responses and 198 from the United States, though overall response rates were low (Japan: 10.1%, United States: 18.5%). Japanese respondents reported far less opioid prescribing than US respondents, especially for acute pain (acute pain: 49.4% vs 97.0%; chronic pain: 63.7% vs 90.9%; P < .001 for both). Almost half of respondents from both countries indicated that patient expectations and satisfaction were important factors that influence prescribing. US respondents were significantly more likely to identify medical indication and legal expectation as reasons to prescribe opioids for acute pain. Most US respondents (95.4%) thought opioids were used too often, versus 6.6% of Japanese respondents.

Conclusions: Lower opioid use was reported in Japan, especially for acute pain, which may help minimize long-term use. Patient expectations and satisfaction seem to influence opioid prescribing in both countries. The United States could learn from Japanese regulatory and cultural perspectives. ( J Am Board Fam Med 2017;30:248 –254.)


One of the benefits of having been in practice a few decades is being able to look at how it was vs. how it is now.  We collectively prescribe crazy amounts of opiates, often patient-demanded/driven now compared to then.  We have MUCH stronger agents available for oral use now than we had then, thanks largely to Purdue pharmaceuticals and slick marketing as reviewed by Sam Quinones in his book “Dreamland”.  In medicine we often use a patient for a “before and after” study of various forms of treatment & care in which the patient serves as their own control in the experiment.  This tactic is also the beauty of primary care, being a single provider long-term for a patient allows you to get to know and understand the patient better.  In this case, the “patient” is overall medical care for our US population over the past few decades.  It ain’t pretty!  We need to collectively get ourselves closer to the “Ozzy & Harriet” days of the ’50’s and away from the insanity the world is currently sinking into.  We need a sociocultural shift, substance abuse is only a part of the problem that brought us down, but recovery, including medication-assisted treatment (MAT) is essential to getting us back to where we should be as a culture.

Dr. Raymond Oenbrink