Phenylbutazone — or "Bute" for short — was introduced into veterinary medicine in the 1950’s and by 1959 had been approved for use in racing by the State of Colorado.  Many believe that this was the beginning of the era of "permissible controlled substances" in the horse racing industry. Probably one of the most famous cases of the use of "bute" in horse racing was the disqualification of Dancer’s Image in the 1968 Kentucky Derby. Post-race urinalysis revealed trace amounts of Bute but, while at the time legal at some tracks, Churchill had yet to adopt this rule. Shortly thereafter it was legalized in most states and was well established in racing jurisdictions by the mid to late 70’s.
Many claim that Bute, currently one of the most common drugs used in horse racing, is akin to aspirin. Classified as therapeutic there are many misconceptions about this hypothesis, primarily from the standpoint that it allows injured horses to continue training and running. Anti-inflammatory drugs do not cure musculoskeletal problems although they do provide control of inflammation which helps to decrease further damage while controlling the discomfort to the horse during painful episodes.
"Phenylbutazone seemed a miracle drug when the stuff began entering the bloodstreams of racehorses in the 1960s. I was collecting the post-race urine that concentrated the metabolites of that drug during the ’60s, and as a teenager I became acutely aware of drugs and racehorses.
What a soothing anti-inflammatory effect bute brought to racehorses in those simpler days when its use first became widespread. The alleviation of certain lamenesses was dramatic. 'Really sweet stuff,' I remember Wright Haggerty’s Kentucky groom telling me on the Shelby, Montana, backside in 1965 as he pestelled up tiny white 100-milligram dog pills he had received from my father, the attending and regulatory veterinarian (thus my job as urine catcher)." 
Phenylbutazone is used to treat a wide range of musculoskeletal disorders such as sprains and strains, muscular overuse (including both muscular damage and strain/damage of the tendons attaching muscles to bone), tendonitis, acute joint injury/strain/sprain, and arthritic conditions. It is also often used to control the fever associated with viral or bacterial infections but its use under these circumstances may mask the severity of the problem.  No doubt that short-term relief is of merit but continued administration can lead to severe and problematic consequences for the horse.
The question then arises as to the performance-enhancing ability of this so-called innocuous "aspirin-like" medication. There is no doubt to this end effect. Although Bute may not make a horse run faster, nonetheless it enables mobility via its anti-inflammatory effect. A horse that feels no pain will run as it would without the underlying physiological problems associated with their legs, feet or joints. Weakened musculoskeletal structures however are prone to further injury when worked to the same extent as their healthy counterparts.
The other problem that’s lies within is the mindset that if the horse doesn’t respond as expected simply increase the dosage. It has been proven time and again that the proper management of lameness in the horse is rest. Unfortunately for the horse, the owners and trainers are not willing to wait these long periods of time as with every passing day they lose more money.
"With racehorses the clock is ticking, fast. If drugs can save time with racehorses, they are used for just that. And that is the case these days. The industry has transcended bute. The monthly veterinary bills at Belmont and Aqueduct often exceed the monthly training fee. Ask any owner." 
Unmistakably the use of Phenylbutazone and other common NSAID's such as flunixin or ketoprofen allows the horse to continue training or return to training in a shorter period of time. However, with these drugs masking the degree of lameness that continues to exist, there is the consideration of the contribution to both catastrophic and non-catastrophic breakdowns. This is especially true in the case of "stacking" NSAID's — a common practice which is routinely used and appears frequently in the record of violations. Combining different NSAID's is an illegal practice due to this masking effect on lameness which can, in effect, eliminate pain. It is callous and irresponsible to believe these medications do not contribute to further detriment to the horse.
As with the corticosteroids, Bute can also increase the propensity toward gastro-intestinal ulceration when administered on a continuing basis. Gastric ulcers are common in horses, with prevalence estimated from 53 to 93%, depending on populations surveyed and type of athletic activity. The gastric ulcers in horses are caused by many factors including, anatomy of the stomach, diet, restricted feed intake, exercise, stress (stall or transport), and the use of non-steroidal anti-inflammatory agents.  In racehorses the incidence tends to the upper limit as a result of the implacable combination of strenuous exercise, stress and NSAID's.
This tendency of increased gastric ulceration however is neatly managed by yet more drugs. Enter the proton pump inhibitors (e.g. Ranitidine (Zantac), Omeprazole) which suppress the production of gastric acids – "Nexium" for horses. It seems then that the Class 5 medications such as these serve as a category of drugs that manage the effects of the other more potent ones — plainly a domino effect and a never-ending cycle of drug abuse that ultimately shortens not only the racing careers of these guileless creatures but also their life expectancy.
In 2008, the U.S. House Subcommittee on Commerce, Trade, and Consumer Protection examined the state of horse racing. During a hearing, Susan M. Stover, DVM, PhD, Diplomate of the American College of Veterinary Surgeons, Professor, JD Wheat Veterinary Orthopedic Research Laboratory, School of Veterinary Medicine, University of California, Davis, testified:
"Musculoskeletal injuries are the greatest cause of racehorse death and attrition" . . . . "From 1990 to 2006, an increasing trend was observed for injury rates. The proportion of Thoroughbred horses with a fatal musculoskeletal injury during racing and training has risen from approximately 3 horses to 5 horses per 1000 Thoroughbred race starts. The proportion of Thoroughbred racehorses with a fatal musculoskeletal injury has risen from 17 horses to 24 horses per 1000 Thoroughbred horses that started a race. Musculoskeletal injuries resulted in 19-33% of racehorses leaving training within a 3 month or less period in the United States." 
Dr. Stover explained "many catastrophic, fatal musculoskeletal injuries" result from pre-existing, less severe injuries that occur from "repetitive, overuse". In other words, horses continue to train and race despite injuries or damage which may be untreated or do not heal sufficiently. The result is further injury and damage, many times catastrophic or fatal. 
These comments together with the fact that the average number of starts per year for a racehorse has gone from over 11 to about 6 in 40 years beg the question as to how much of a role medication has played on the shortened careers and lives of the Thoroughbred. On the contrary Seabiscuit raced almost 40 times as a 2-year-old yet some still remain in denial.
"Trainer Ken McPeek suggested the Thoroughbred breeding industry is in part responsible for the decrease in the number of starts per horse. He said the economics of the business have made horses more valuable; therefore, they don't race as much, and are often are retired early, mostly for breeding purposes.
"Horses are every bit as sound today," McPeek said. "You can't blame medication for the problem. I think there is a correlation between (number of starts) and (the breeding industry), but how significant it is, I'm not sure." 
Repeated and long-term use of medications leads to tolerance; over time larger and larger doses are required to produce the same effect. Alternatively the effectiveness of the drug begins to ebb if the dosage remains the same. Building a tolerance for a drug exacerbates both drug abuse and dependency. Increased breakdowns, fewer starts and prolific drug use — there must be a connection. No time like the present has it been more important to put an end to this abuse and debauchery.
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