Charleston mass shooting suspect Dylann Roof was questioned by police in February, 2015, for “asking out of the ordinary questions” of employees at two stores in the Columbiana Mall in Columbia, South Carolina. A search found a “small unlabeled white bottle containing multiple orange in color square strips” in Roof’s right jacket pocket. Roof admitted that the strips were Suboxone and that he had gotten them from a friend, and not a prescription. Roof was then arrested for possession of a schedule III controlled narcotic.
What is Suboxone?
Suboxone is a medication approved by the FDA for the treatment of opiate dependence such as heroin addiction. Experts say it works well because it’s a very “sticky” drug, meaning it binds well with the same receptors as opiates.
“So if you were a heroin addict on Suboxone and you took heroin, it would have nowhere to bind because Supoxone sort of fills everything up,” explained CNN Chief Medical Correspondent Dr. Sanjay Gupta. “It essentially prevents those drugs from working.”
“It also stimulates the receptors, but not as strongly as heroin,” added Dr. Adam Bisaga, professor of psychiatry at CUMC and researcher at New York State Psychiatric Institute. Bisaga works closely with heroin addicts and has testified before Congress on combating the opioid-abuse epidemic.
“If addicts take it properly, they have no cravings, they have no withdrawal, and they feel ‘normal,'” said Bisaga. “And that’s why the medication is so effective.”
Suboxone has become widely used as a replacement for methadone because it can be prescribed by doctors in their offices, while methadone can only be provided at specialized addiction centers, of which there are a limited number In fact Suboxone was one of the first two narcotics to be made available under the Drug Abuse Treatment Act of 2000 to help solve the growing shortage of addiction treatment centers.
The generic name is buprenorphinie; it goes by “bupe” for short. According to the FDA, Suboxone is “less tightly controlled than methadone” because it has a “lower potential for abuse” and is “less dangerous in an overdose.”
Off-label use
But as with many prescription medications, there is potential for abuse by those who are not addicts, and who are simply on the search for a new high.
“People not addicted to opiates or pain medications would get a sense of euphoria taking Suboxone,” said Gupta. “A little bit of a high, essentially. But it’s an unusual choice as a drug of abuse, because it’s less powerful than other drugs and yet it’s a very expensive, harder to get drug.”
“Suboxone is an opioid medication,” said Bisaga. “It can be misused. Some use it intravenously, they inject it, and they have lost control over the medication and are truly addicted. But that’s really a small portion of patients. All the evidence shows that this is small.”
Burning question: was Roof on Suboxone?
Was Roof using this drug before the shootings and could it have contributed to his violent acts? There is no new information now that Roof obtained or used the drug after his February arrest. As for contributing to violence, experts say that is unlikely.
“There is no specific research showing that this specific medication has been linked to aggression,” said Bisaga. “In fact, when used properly this medication would stabilize people who otherwise would irritable, such as heroin addicts undergoing withdrawal and feeling anxious and irritable.”
“It’s not associated with violence or aggression,” said Gupta. “The only thing is that if you’re withdrawing from some of these types of drugs, that can cause a state of agitation. I have not seen someone withdrawing from Suboxone, but I have seen people who are withdrawing from alcohol, and that’s far more severe.”
“It’s highly unlikely that someone withdrawing from Suboxone would have a premeditated, well-developed plan and be able to carry it out,” added Bisaga. “We’re talking about very short-fuse, temporary type of irritability that might cause someone to break things or scream or something like that.”
Manufacturer response
The manufacturer of the drug, Indivior, PLC, provided CNN with the following statement:
“The use of SUBOXONE Film has not been associated with aggression in clinical studies or post-marketing experience. There is no indication that there is a link between aggression and buprenorphine containing products such as SUBOXONE Film.”
