I have learned that current Canadian Forces policy requires a physician or other licensed professional to customize a choice of anti-malarial treatments in consultation with their soldier-patient; as opposed to what might have been prior practices in place, such as during the Somalia mission, of mass-prescribing mefloquine without consideration of other, potentially safer alternatives.
Unfortunately, even with this improved prescribing in place within the Canadian forces, there are still inherent risks with the continued use of mefloquine in combat soldiers, whether they have “known” mental health problems or not, because there is an invisible lethal predisposition. Often it’s impossible to predict whose brain can filter out and process the drug through the body, and whose brain falls into the unlucky percentage in which the drug collects at the nerve synapses to become a neurotoxin that kills brain cells and damages the brain long term.
With this precarious guillotine hanging over each soldier’s genetic makeup, it’s critical soldiers taking mefloquine are warned to be attentive to the development of subtle, mental health symptoms, such as a change in mood, or anxiety, which may be the first indications of a pending “more serious” event, including, potentially, suicide. But this is also an unrealistic expectation because the problem with this approach is that any soldier in a war zone may not be able to discern combat stress from what might be the first signs of an important drug side effect. A Catch 22 dilemma.
Thus, with growing appreciation of the inherent and unnecessary risks associated with mefloquine, the best solution is to discontinue use of mefloquine altogether by policy, as the U.S. military is doing, especially since medical science has definitely concluded mefloquine is no more effective than the safer daily drugs doxycycline or Malarone.
There is no question in my mind that Canadian forces would be safer and healthier, and at less risk of developing mental health side effects, if the use of mefloquine is simply banned from the Canadian military’s pharmaceutical arsenal.