The high-profile arrest of former Toyota Motor Corp. executive Julie Hamp last month over importing oxycodone might fuel prejudice in Japan against the narcotic painkillers and other strong pain-relieving drugs, experts fear.
Hamp, the automaker’s first female managing officer, was released by police without charge July 8 after spending 20 days in detention. She was arrested June 18 on suspicion of violating Japan’s drug laws after she reportedly had her father in the U.S. ship her 57 tablets of the powerful prescription drug hidden in jewelry boxes.
It is illegal to import oxycodone into Japan without a prescription and prior permission from Japan’s health ministry.
Hamp told investigators that she had the pills shipped to treat her knee pain, and that she was unaware she was breaking the law or importing narcotics, according to media reports.
The domestic news coverage of the arrest, especially on TV, however, highlighted only the negative side of the drug, with virtually no mention of the important role it plays among cancer patients in Japan, said Takeshi Hirohashi, a doctor and palliative care specialist at Tokyo’s Eiju General Hospital.
“One of my cancer patients said she was shocked by the way the drug was mentioned in the media,” Hirohashi said, adding he heard from another doctor that a separate patient asked not to have the drug prescribed. “The news has spread the image among the public that oxycodone itself is a ‘bad’ drug.
“For cancer patients, it’s an important drug to maintain their quality of living, and it’s not only for patients in terminal stages,” he said, noting he is worried patients who really need oxycodone might get scared or feel guilty about using it.
“It is only recently that Japan started embracing the idea that palliative care — and pain relief — need to start right after a cancer diagnosis, while many people here are still under the belief they need to put up with the pain.”
Hirohashi said the danger of oxycodone addiction is “nearly zero” for people who suffer from pain as the drug works differently in the brain for people with and without pain.
Oxycodone is categorized by the World Health Organization as a “strong” opioid, or medication containing narcotics.
Doctors in Japan need a special license to prescribe strong opioids, which also includes the drug morphine.
The use of oxycodone in Japan, meanwhile, is approved only for cancer-induced pain and it cannot be used to treat other conditions. Shionogi & Co., which manufacturers tablet and powder formulations of oxycodone in Japan, is currently conducting a clinical trial to have it approved for chronic pain not related to cancer.
Oncologists find the drug useful because it comes in various doses and doctors can start prescribing it from small amounts, Hirohashi said.
But due in part to cultural inhibitions about relying on opioids in Japan, the use of oxycodone here has long been extremely limited.
According to a recent report on opioids, compiled by the Pain & Policy Studies Group at the University of Wisconsin-Madison, the annual per capita consumption of oxycodone in Japan was 3.63 mg in 2012, ranking 32nd among the 71 countries surveyed.
By contrast, the U.S. topped the list in oxycodone consumption, at 243.79 mg, followed by Canada at 140.62 mg, Australia at 85.27 mg and Denmark at 47.70 mg. The global average was 13.5 mg.
The use of medical morphine is also rare in Japan, according to the same report, with doctors administering 3.2 mg on average per person, half the global average of 6.3 mg as of 2012. Austria is the biggest consumer of medical morphine, with per capita consumption of 199.2 mg, followed by 100.8 mg in Canada, 81.9 mg in Denmark and 78.6 mg in the U.S.
“The use of opioids in Japan is extremely small compared to that of advanced countries in the West,” Mutsuko Ohnishi, a Boston-based physician and former researcher at Harvard University, wrote in a recent article for online journal Blogos. “In other words, Japan is significantly behind, legally and across the health care system, when it comes to pain management.”
Finding the right balance is key, as abuse of prescription opioids has become a serious concern in the U.S. Statistics from the National Institute on Drug Abuse show the number of prescriptions for opioid painkillers in the U.S. has skyrocketed from 7,600 in 1991 to 207 million in 2013.
According to NIDA, 16 million Americans aged 12 or older have used oxycodone for purposes other than pain control. Of those, 70 percent obtained the drug through friends, family and people other than doctors.
Oxycodone, a semisynthetic opioid synthesized from thebaine, an alkaloid found in the opium poppy, can bring euphoric effects similar to those of amphetamines, especially when crushed and snorted.
Given the situation in the U.S., Ohnishi cast doubt on Hamp’s reported claim that she didn’t know oxycodone was a narcotic. “I think she knows that oxycodone is a narcotic and that it is hard to have it prescribed in Japan,” she said by email. “The chemical components of oxycodone and their nonmedical use are widely reported in the U.S., so most Americans know they are effective as a painkiller and also have risks of abuse.”
Ohnishi echoed Hirohashi’s view that Hamp’s case will further lead to public misconceptions in Japan that medical opioids are dangerous and that using them could lead to arrest and criminal charges. As Japan ponders a wider use of oxycodone, it needs to step up education on the drug, Ohnishi said.
“It would be necessary to monitor doses among individual patients and educate (the public) on its appropriate use,” she said.
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