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Member Research and Reports

Member Research and Reports

BU: The Pain Gap

Before the opioid crisis, there was the Vioxx scandal.

When Vioxx (rofecoxib) came on the market in 1999, it was part of a new class of anti-inflammatory drugs called COX-2 inhibitors, painkillers without the gastrointestinal side effects of other non steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, making them promising for chronic pain management. But in 2004, Merck withdrew the drug amid mounting evidence that long-term Vioxx use significantly raised the risk of heart attack and stroke. According to research later published in The Lancet, Vioxx caused up to 140,000 heart attacks in the U.S., killing 38,000 people.

After the Vioxx scandal, other COX-2 inhibitors also fell out of favor, and prescriptions for high-dose NSAIDS declined across the board.

Opioids filled the gap.

That’s according to a new Boston University School of Public Health (BUSPH) study published in JAMA Network Open, the first study to suggest that this early-2000s decline in NSAID prescriptions for chronic pain contributed to the rise of opioids, and the deadly opioid epidemic still raging today.

“We see almost a mirror image, where opioid prescribing is going up at the same time that non-opioid analgesic prescribing is going down,” says lead study author Dr. Andrew Stokes, assistant professor of global health.

And the Vioxx scandal is right at the center of it, says study senior author Dr. Tuhina Neogi, professor of epidemiology at BUSPH, professor of rheumatology at the School of Medicine, and chief of rheumatology at Boston Medical Center. “We realized that the point at which increasing opioid prescriptions crossed over with the decrease in non-opioid prescriptions occurred when the cardiovascular risks of COX-2 inhibitors led to Vioxx coming off the market,” she says.

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