There are no adequate words to describe the recent racially-motivated mass murder of nine church members by a 21 year old, yes disturbed, male. Grievous…insane…terroristic…nothing truly captures the gravity of the situation.
As the details of the shooter’s life begin to surface, there have been several reports that the young man was taking Suboxone, a prescribed medication in the opiate family to help avoid the massive withdrawal symptoms from things like heroin or abused narcotic painkillers. As a result, there are a number of articles touting a connection between Suboxone use and aggression.
But do psychotropic drugs cause violence?
At best, we only have correlations between aggression and drug use. Thus, we need to be very careful when we blame violence on the ingestion of substance, whether prescription or otherwise. Correlations do not tell us causation. Even when we have a direct positive relationship (e.g., increased use of substance A followed by increased behavior B), we still do not have enough to say that there is a direct cause.
Correlations between prescriptions usage and violence do exist
There are a few studies that indicate a correlation between prescription drug use and violence. However, the relationship is connected mostly by those who stop taking their medication. It may be that the cause of violence is the noxious side-effects leading to a dis-use of the med resulting in an increase in psychiatric symptoms. So, do psychiatric symptoms correlate with increased violence? One study completed on a large psychiatric inpatient population determined that the rate of violent behavior one year post psychiatric hospitalization stood at about 27%. The numbers go higher if the person also has a co-morbid substance abuse problem (interestingly, men and women have about the same rate of violence but male violence tends to have more victims).
Certain medications seem to encourage more anger, aggression, and violence. Opiates tend to have a mollifying effect. People who use them may feel euphoria or calmness at first. As the narcotic wears off, there may be in increase in anxiety, pain, or agitation. There are, however, some who report increase angry and violent thoughts. One particular study suggests that prior personality factors may influence aggressive responses in an individual.
Suboxone is one of those drugs used to combat opiate abuse. Itself an opiate, if taken for a long period of time it becomes the addiction without the euphoria. The goal of the medication is to get off the opiate onto Suboxone and then slowly taper on Suboxone to the point that opiates are not longer needed.
There is little evidence that SSRIs and other psychotropics cause or even encourage violence. What is true is that violence, like everything else, is a multifactored event. Those prone to addiction, isolation, delusion, paranoia, impulse control problems may have increased risk to resort to violence. Those with particular personality features may be prone to violent responses. Certainly, environmental factors are also in play: culture, education, economic resources, history of victimhood all have potential impact on the choice to use violence to solve problems. And finally, faith and character (which itself is developed due to nature/nurture) plays a significant role in how we see others and whether we afford them with kindness and compassion.
If nothing is to blame, is there anything we can do?
It is good to resist the impulse to blame any one thing for the cause of violence. However, it is legitimate to take each of the factors commonly present in violence and to examine them one-by-one to see how we may intervene. Talk about gun availability and gun cultures. Talk about mental illness. Talk about medication (mis-use, over-use, adherence). Talk about racism and prejudices? Talk about poverty. Talk about substance abuse. Look for small ways that we can intervene and begin to change the way we talk about violence in our society. Look for the micro-aggressions and decide to stand against them early and often.
Will we always have individuals bent on destroying others? Yes. But, let us be known for being peace-makers.
Musings on Faith and Psychology 
Another factor that should be talked about is family breakdown. The family situation in the Charleston shooting seems likely to be a contributing factor. In the wider culture, discussing the fallout of divorce seems to be a taboo: It is easier to talk about systemic racism than the consequences of family breakdown.
The vast majority of people on meds for a mental illness diagnosis are not violent. However, from what I’ve read, there is evidence of a connection between violence and psychotropic medications in some people. The problematic times are during changes up or down with the medications, which would include individuals who go off of their meds cold turkey.
Psychiatrist Peter Breggin wrote a book, “Medication Madness,” that documents several case studies that show the relationship between medications and violence. Dr. Breggin described there how a Wyoming judge found there was sufficient scientific evidence to implicate Paxil in a case of murder suicide, where the jury awarded a $6.4 million verdict against GlaxoSmithKline.
You can also read about a Canadian court decision that concluded that Prozac was a contributing factor in a teen stabbing his friend to death here: http://breggin.com/index.php?option=com_content&task=view&id=295. There are other articles noting the association of violence and medications on Dr. Breggin’s website.
Also look at Psychrights.org, which has articles available on the topic, many from academic journals. Also look at the website Mad in America (madinamerica.com). Search under “violence” on all three sites sites.
There is also an activation effect from buprenorphine, effecting levels of dynorphin, a neurotransmitter. The opioid in Suboxone, buprenorphine, is the primary ingredient in a fast acting antidepressant (ALKS-5461) that will likely be approved by the FDA by 2017. It is an antagonist of the kappa opioid receptor (KOR). KOR antagonists are thought to have a therapeutic value in treating anxiety and depression. You can read more about this drug in “The Coming Depression Apocalypse” on my website: faith-seeking-understanding.org.
If the Charleston shooter was mixing Suboxone with other meds or drugs, that could be a contributing factor to his actions.
I especially liked the point of “resisting the impulse to blame.” Often we have to choose: are we helping or are we judging?
And, of course, strictly speaking, drugs cause violence even less than horses cause rodeos!
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