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.