Japanese taboo regarding the use of strong painkillers is the key difference in athletic injury care when compared with other countries. Many wrestlers with chronic joint injuries would face a life struggling with a delicate balance between managing pain and avoiding addiction. The United States’ well publicized opioid epidemic serves as a cautionary tale in how readily available and easily prescribed narcotics can lead to serious long term battles with addiction. This may be why some foreign wrestlers are seeking care in their home countries. It is notoriously difficult to obtain a prescription for the medicine and strict penalties hinder the importation of these medicines.

This is a very serious issue for athletes, even those in high school and even middle school. With athletics comes injury and often, surgery. When an athlete reaches the professional ranks, they often have numerous procedures under their belt to go along with any trophies earned along the way. A distant relative of Tachiai had a long, successful professional career in one of America’s four major sports. He continues to battle with his own addiction to opioids, a result of treatment for a score of injuries and resulting surgeries.

Two years ago, the Tachiai blog flew to Japan to visit relatives for a few weeks, just as news of the Julie Hamp scandal broke. Mrs. Hamp was just named as one of Toyota’s executives and as a female, her ascension brought wide news coverage. However, that coverage paled in comparison to the coverage of her fall when she was caught importing opioids hidden in jewelry boxes.

On the flight to Narita, my wife turned white as a sheet as she watched the news on the in-flight entertainment system. In our luggage was a bottle of opioids, prescribed to yours truly shortly before our travels because of another bout with kidney stones. Bringing these medicines into the country illegally carries very stiff penalties: up to 10 years in prison and $250,000 in fines. For Mrs. Hamp, it cost her a job, her reputation, and several weeks in detention while her case played out.

My wife was terrified when we landed in Japan. I joked that, “at least we’re not in Taiwan, the airports there have big signs pronouncing in bold letters that you risk the death penalty for bringing drugs into that country.” She didn’t find me funny. It was also very interesting to see how her friends reacted when they heard her tell the story. The taboo is certainly real.

In the US, however, it is quite easy for doctors to turn to the morphine genie. When another pebble pops loose from one of my kidneys and begins to meander down to my bladder (the last one looked more like a shard of glass than a “stone”) holy crap that hurts. When I make it to the Emergency Room, I am inevitably treated with a morphine drip, a quick MRI scan to see where it is and how big, then I’m sent home with a prescription for opioids. Thankfully none of mine have been large enough to remove surgically. Perhaps that should be “unfortunately,” though, as it means I must let them find their way out, naturally.

My kidney woes crop up every couple of years so thankfully I don’t have to dance with the devil in the medicine cabinet because I don’t keep it around. I know it’s dangerous to have that stuff, especially with the kids around, so I rely on those IV drips at the hospital when I get the pain, which isn’t often. But athletes face this kind of treatment on a continual basis, particularly with chronic joint or muscle issues. If Terunofuji, Kotoshogiku, Aminishiki, and Osunaarashi were athletes in the United States, they would certainly be provided opioids on an almost continual basis. As a result, they would be in prime danger for opioid addiction. I believe this aversion to opioid treatment leads to many of the ongoing injury issues we witness basho after basho.

This is conjecture, but I believe the NSK feels that if the rules were loosened for rikishi, this would not only lead to addiction among wrestlers, it would bring yakuza back into the sport. With the door opened for sumo wrestlers to be routinely treated with opioid pain killers, inevitably some of those pills would trickle out of the stables and into the general population as athletes supplement their income.

Is a few days pain worth a couple of hundred dollars? This isn’t fantasy. This tradeoff is happening here in the US every day and my dad’s cousin is an example. And if the pills and pain can be traded, is it necessary to begin with? To me, this is where the danger of socialized medicine makes itself known, unnecessary tests and unnecessary treatment – including OTC and prescription medication – become rife when someone else is paying. It’s already an issue for deep-pocketed insurance companies and it becomes a bigger one for deep pocketed sovereign governments. (Ask the NHS.)

The first time I had a kidney stone, I was lucky enough to be at home. When the doctor handed me the oxycodone prescription, my dad (also a physician) reached over and plucked it out of my hands, ripped it up, and threw it away. “You won’t be needing that.” My dad’s a smart dude. I didn’t need it. I passed the stone later that day and it would be two years before my next stone. The risk of addiction and abuse is high, and so is the temptation to make a few bucks in the black market. Who’s to say a sekitori won’t start cutting his pills in half so he can trade the other half away?

According to the Japan Times, Americans consume 243.79mg of oxycodone per capita. Japanese consume the drug at the miniscule rate of 3.63mg per capita. Much of that treatment goes to cancer patients. But this article claims that even among cancer patients, there is a strong taboo when it comes to the use of opioids while in the US it is standard “palliative care” for terminal diseases.

(Note: I also wonder if this plays into the low birth rate as Japanese women do not seem to have the same access for epidurals…but I digress.)