Selling painkillers in Japan used to be like pulling teeth. That was until baby boomers discovered how analgesics could take the sting from arthritis, diabetic nerve damage and the ravages of cancer.
Now demand is taking off and drugmakers are introducing new products to a market where per-capita opioid consumption is the fourth-lowest in the developed world. Sales of drugs prescribed for chronic pain in Japan will jump 62 percent to ¥188 billion ($1.7 billion) in the seven years through 2024, Fuji Keizai Co., a Tokyo-based market research firm, said in a report in November.
Unlike the U.S., where President Donald Trump declared the opioid epidemic a national emergency, Japan has had an aversion to narcotics because of restrictive laws and the stigma of addiction. But chronic-pain sufferers are demanding relief, and authorities are doing more to help them, especially since workers aren’t economically productive when they are agonized by aches. A 2015 study estimated chronic pain costs Japan about ¥1.95 trillion annually.
“People suffering from pain these days are less tolerant of it compared with the older generation,” said Tsutomu Suzuki, emeritus professor of addiction research at Hoshi University in Tokyo. “Some of the newer products are opioids, but they aren’t categorized as narcotics, which makes people feel more relaxed about using them.”
Prime Minister Shinzo Abe committed to improving chronic-pain treatment as part of his economic growth plan announced in June last year. That led the health ministry this year to fund specially designated clinics and hospitals focused on managing patients in chronic pain.
Shionogi & Co., which sells OxyContin in Japan, filed an application for the drug to be used for chronic pain in November following a request from a health ministry panel, and antidepressant Cymbalta was approved as a treatment for chronic back pain in March last year. The Osaka-based company bought rights to sell Methapain, or methadone, from Teikoku Seiyaku Co. in February and won approval for Symproic to treat opioid-induced constipation in March.
“Most doctors in Japan feel strongly about keeping opioid usage to a minimum because they believe patients may not be able to quit taking them once they have been on them long-term,” said Masashi Katsumata, senior director of Shionogi’s pain management business. “That’s why the risk of abuse and addiction is much lower than in the U.S., and that’s an ideal situation.”
Daiichi Sankyo Co. began selling a generic version of OxyContin in March and won approval to sell the cancer painkillers Narurapid and Narusus in Japan in June following a government-funded program to support patients. Daiichi Sankyo, which also sells fentanyl, has a potential treatment for diabetic nerve damage, with its drug mirogabalin in late-stage patient studies, the Tokyo-based company said in July.
Pfizer Inc.’s Lyrica won approval as a treatment for pain after shingles and peripheral neuropathic, or nerve damage, pain in 2010. In 2012, regulators allowed it to be sold as a treatment for pain associated with a disorder called fibromyalgia, and as a treatment for neuropathic pain the following year. That helped it become the fifth-bestselling medicine in Japan in the year that ended in March, according to QuintilesIMS, a marketing research firm.
Endo International PLC’s local partner, Nihon Shinyaku Co., began selling Tramal, or tramadol, for cancer-related pain in 2010. It was approved for chronic pain in 2013, the same year that Johnson & Johnson’s Janssen Pharmaceuticals unit was given approval to sell Tramset, tramadol combined with acetaminophen, for noncancer pain and post-surgical toothache.
It’s all adding up to less anguish for sufferers of chronic pain, more than half of whom receive no treatment, according to a 2015 study funded by New York-based Pfizer.
Part of the problem is that pain isn’t well understood by doctors, according to Kazuro Wakazono, who runs a patient group called Goodbye Pain.
“Medical professionals tell them their pain is imagined or is being used as an excuse to get out of doing rehabilitation,” said Wakazono, whose wife suffered from paralysis and pain after a car accident injured her spinal cord 15 years ago, leaving her to search for 18 months for appropriate care. “They are told to put up with it, which leaves them in despair.”
Still, newer treatments such as Lyrica and tramadol are giving doctors and patients greater confidence about using painkillers that aren’t subject to strict narcotics controls, said Hoshi University’s Suzuki, who is also a member of the World Health Organization’s expert committee on drug dependence.
While opioid drugs have been widely used for noncancer pain in the U.S. since at least the mid-1990s, in Japan drugs like OxyContin were made available in 2003 and only for cancer-related pain. Japan approved tramadol in 2010, 15 years after it was introduced in the U.S., and hasn’t allowed combination opioid drugs like Percocet and Vicodin.
When the health ministry asked drugmakers to develop modern versions of morphine in response to WHO cancer-care guidelines in 1984, none of the country’s pharmaceutical companies authorized to manufacture narcotics accepted the request.
Kotaro Shiono, Shionogi’s former chairman, saw a pressing social problem, and agreed to obtain the rights to develop Mundipharma’s MS Contin, which was introduced in Japan in 1989, followed by OxyContin in 2003.
Shionogi had to educate doctors and nurses about MS Contin to resolve misunderstandings, and it took the company 14 years to achieve peak sales of about $100 million, said Katsumata. The company is part of a group of health-care companies in Japan promoting public awareness about palliative care, he said.
Sales of OxyContin fell 3 percent to ¥9.7 billion in the year to March, and Katsumata is cautious about it sales prospects because of doctors’ concerns that long-term use may lead to dependence problems.
Still, he points to a large, unmet need for pain relief, with many cancer patients reporting dissatisfaction with current levels of palliative care.