• Eriko Onishi, Tadashi Kobayashi, Eve Dexter, Miguel Marino, Tetsuhiro Maeno, and Richard A Deyo.
• From the Department of Family Medicine, Oregon Health & Science University, Portland (EO, ED, MM, RAD); the Department of General Medicine, Hirosaki University School of Medicine & Hospital, Hirosaki, Aomori Prefecture, Japan (TK); the Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland (MM, RAD); the Department of Primary Care and Medical Education, University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan (TM); and the Oregon Institute for Occupational Health Science, Oregon Health & Science University, Portland (RAD). onishi@ohsu.edu.
• J Am Board Fam Med. 2017 Mar 1; 30 (2): 248-254.

IntroductionFar fewer opioids are prescribed in Japan than in the United States.MethodsWe 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.ResultsWe 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.ConclusionsLower 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.© Copyright 2017 by the American Board of Family Medicine.

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