The following article appears on the Lariam ACTION USA website. It provides an excellent overview of the story of mefloquine experiences, particularly by Canada‘s Airborne in Somalia. The journalist mentioned in the article who interviewed Cpl. Scott Smith was me. BONNIE
The Nightmare Drug
By Jason Sheftell
Lariam is a popular anti-malaria drug that has made its manufacturer millions. But it can also be a hallucinogen with horrifying side effects that may have led to murder and suicide.
Clayton Matchee, master corporal in the Second Canadian Airborne Regiment – the equivalent of the elite US Ranger Force – is home on leave in Saskatchewan visiting his family. His wife notices he’s agitated. Usually a playful father, Matchee is avoiding his baby daughter. He can’t sit still. One night he wakes up throttling his wife’s throat. “It’s that crazy drug they’re giving us,” he apologizes to her.
“That crazy drug” is Lariam, an anti-malaria drug that was not yet legal in Canada but was being tested on Airborne soldiers in Somalia. Others in Matchee’s unit have complained about the drug, reporting “dizziness, depressed mood, thought disturbance and nightmares.” The troops even have a name for the day of their weekly Lariam dose: Psycho Tuesday.
On Psycho Tuesday, March 16, 1993, two weeks after the incident with his wife, Matchee is back with his unit in Belet Huen, Somalia, a gun-running and drug-dealing stop between Ethiopia and the Somali capital of Mogadishu. It’s 105 degrees. Tension is high. Somali gang members have been pilfering supplies from the Canadians: underwear; coffeepots; T-shirts; but no guns, yet.
Late that night around 10 p.m., the Airborne nabs an intruder. Sixteen-year-old Somali Shidane Atone is caught in an abandoned compound. He says he’s searching for a lost child. According to international policy Arone’s to be guarded and protected overnight before he’s handed over to Somali cops in the morning.
But Matchee, a 26-year-old, 6-foot-4-inch, 230-pound Canadian Native-American, is antsy. He’s been downing Tusker Ale flown in from Kenya. And there’s that Lariam. Matchee’s eyes are wild, and people aren’t sure if he’s drunk or just plain crazy.
After allegedly being prodded by a superior, Matchee beats Arone silly for three hours. The boy’s genitals are burned. Someone allegedly sodomizes the prisoner with a lead pipe. Officers visit the bunker to get in their licks. Matchee even takes trophy pictures, talking gibberish and laughing all the while. When the boy dies, his body is rushed off the base. Two days later when the trophy pictures are handed over to military brass, Matchee is thrown into a bunker brig. Before being questioned, he tries to hang himself with bootlaces. He doesn’t succeed, but he loses oxygen to his brain and falls into a coma. Currently functioning with a mind of a three-year-old, Matchee is now in a Saskatchewan mental institution. No one will ever know exactly what went on- in his head.
“That wasn’t my husband,” says Matchee’s wife Marj.”He had an attitude, but he wasn’t a murderer. It was that crazy drug.” A government inquiry disagrees, but a member of Canada’s Parliament and the surgeon in Somalia who resuscitated Matchee both suspect Lariam was involved.
“The military was administering that drug illegally and hardly tracking its effects,” says John Cummins, the Parliament member.”They had no idea what Mefloquine could do to people.”
Mefloquine Hydrochloride is prescribed around the world as Lariam. With approximately a 90 percent efficacy rate, Lariam is one of the most effective anti-malaria preventative and treatment drugs ever manufactured. Since the drug was first prescribed in Switzerland in 1985, some 13 million prescriptions have been written worldwide. Until last year, Lariam was the sole anti-malaria “drug of choice” listed by the Centers for Disease Control and Prevention (CDC) in Atlanta.
Lariam is also the “nightmare” drug, as it’s known to travelers who come face to face with its potential side effects, which include dizziness, vertigo, loss of balance, headache, insomnia and abnormal dreams. There’s more. According to Lariam manufacturer Hoffmann- LaRoche (which also makes Valium), less frequently reported events include impact on the central and peripheral nervous systems. Possible adverse effects listed by Hoffmann-La Roche’s product literature include “convulsions, depression, hallucinations, psychotic or paranoid reactions, agitation, aggression, confusion or forgetfulness.” The literature notes that “suicidal ideation” has also been reported, but that “no relationship to drug administration has been established.”
Doctors do not refute the reports of extreme side effects. “Lariam is a very effective drug with some real problems,” says Dr. Jay Keystone, a professor of medicine at the University of Toronto and a world-renowned tropical disease expert. “I have no doubt that Lariam does cause these adverse side effects. But they are very rare. And the flip side of not taking Lariam could be much worse –malaria.”
Even today, malaria, which is spread by infected mosquitoes, remains a killer. Approximately 300 million people contract it each year. More then one million of those, mostly African children, die. Discovered by researchers at the Walter Reed Army Institute during the Vietnam War era, Mefloquine was found to be effective against, the most deadly strain of malaria, P. falciparam. Mefloquine has an extraordinarily long half-life for a drug – several weeks after the last dose. It stays in your system long enough to ensure the malaria parasite is dead and gone. The side effects also linger.
Since the FDA approved Lariam in the United States in 1989, the incidence of adverse side effects reported by medical studies has increased steadily. Hoffmann-La Roche, which has changed the product literature on the drug more than once – each time significantly increasing the type of side effects reported – sticks to the results of a 1993 study it sponsored; out of 145,000 travelers, one in 10,000 reported adverse side effects, sometimes resulting in hospitalization. But other studies cast doubt on those numbers. A 1996 British study reported one in 140 users could no longer carry out their daily duties. A 1999 study by Scripps Travel Clinic in California found one in five users stopped taking the drug after side effects.
European government health agencies are taking the problem seriously.In 1997, the Dutch Department of Health stopped recommending Lariam for short trips. In Austria, the recommendation is that women, who studies show are more susceptible to Lariam’s side effects, should take only half the dose that men do. In Britain, the Department of Health has stopped recommending Lariam for journeys of less than two weeks. “For such a short journey” says Dr. Ashley Croft, a British public health consultant and Mefloquine expert, “the risks of bad Lariam-related side effects were judged to be greater than the rather lower risk of getting malaria.”
Exactly how Lariam works is unknown. Even Hoffmann-La Roche’s product literature says the drug’s “exact mechanism is not known.”Also unknown is why side effects impact some but not others. “The brain is the last frontier,” says Dr. David Flockhart, chief of the Division of Clinical Pharmacology at Georgetown University, “and no one spends a lot money figuring out why side effects occur.”
But it’s these side effects that have led to controversy and sparked extensive media coverage and government conversation worldwide. The BBC show Watchdog, the British equivalent of 20/20, reported on Lariam in 1996. In Australia, the TV program Insight revealed that the Australian military is using Doxycycline, a Lariam alternative, to avoid future complaints of neuro-psychiatric effects from its forces. Many African doctors won’t prescribe Mefloquine.
In March 1997, on the floor of the British House of Commons, Parliament member Jean Corston mentioned a previously healthy friend who became mentally incapacitated after taking Lariam. “After seeing what happened to my friend,” she says now, “and hearing firsthand the extraordinary stories of sufferers, I decided to act. It was important to push the debate upon others.” Corston’s action was a crucial part of Britain’s decision to not prescribe Lariam for short trips.
For some reason, though, the firestorm has largely avoided America. “Lariam toxicity is just as prevalent in the United States as anywhere else,”‘ says Jeanne Lese, the Information Coordinator for Lariam Action USA, an information and support advocacy group. “The real problem in this country is that Lariam’s adverse reactions are unrecognized and misdiagnosed.”
The trippy details of more than a handful of Lariam stories resemble those of acid or crystal-meth users. They’re engaging, hard to forget and sometimes unbelievable. Mentally strong people suddenly flip out and don’t know why. Until someone tells them about Lariam’s potential side effects, they think they’re going crazy.
Marty, 27, an ex-Peace Corps employee with no history of mental illness, took Lariam for 15 months in West Africa, and returned home to a world he couldn’t control. “I wanted to escape from myself,” he says. After four months of constant anxiety, a short temper, paranoia and suicidal thoughts, he drove from Chicago to Oklahoma and back, all the while trying to escape imaginary pursuers. Once back home, he heard voices and took off again, convinced the CIA was after him. He flipped his car in Wisconsin and wandered around naked while mumbling to himself before being placed in the psychiatric unit of a Green Bay hospital. Believed to be the first American to receive workers’ compensation for Lariam’s side effects, Marty is feeling normal again, three years later.
Dr. Hans 0. Lobel, who was formerly head of the CDC’s Malaria Section and monitored Lariam’s effects on Peace Corps volunteers, discounts stories like Marty’s. Lobel blames the Lariam controversy partially on the sensational nature of the foreign press. “It’s the same thing as the breast-implant controversy here,” he says. “There wasn’t significant evidence of adverse reactions across a large group of women, but it caused heavy coverage.” Lobel, a staunch Lariam supporter, contends that most reports of side effects are due to travel-related stress.
But it’s hard to believe stress alone caused incidents as severe as these:
After taking just six Lariam doses, Kim, 47, an experienced yacht captain, spiraled into a year-long depression and lost her job as an operating-room technician. She awoke one morning hallucinating that there was a robotic video camera in her closet filming her every move. Eric, 36, suffered from self-mutilation dreams after taking Lariam. He often found himself pulling his car over and bawling hysterically.
For 50-year -old artist Allen, Lariam reminded him of his LSD days. After taking Lariam, he had an out-of-body experience that blended carnal rapture, astral traveling and fear of never being able to return to his body. He now talks coherently about theories linking Lariam, the CIA and aggression-drug testing during the Vietnam War. For Allen, though, Lariam wasn’t all negative: “It connected me to things I knew were there but couldn’t previously get in touch with.”
And then there’s Jason, 34, a writer who went on a six-week tour of India in 1995. After his second Lariam dose in a windowless New Delhi hotel room, he swears Lucifer tried to convince him to move on to his next life and stop being such a “pussy” about death. When he finally fell asleep, he dreamed of being chased by disfigured human-like animals speaking in tongues, prodding his every orifice. He left India after 22 hours, terrified.
Lariam is big business. Hoffmann-La Roche estimates 500,000 prescriptions are written annually. Since Lariam is taken weekly, one week before departure, each week spent in the risk area and at least four weeks after returning, the smallest prescription is usually seven pills. At approximately $8 to $10 a pill, at least $56 is spent per prescription, which means yearly sales are upwards of $25 million.
When asked about Lariam’s side effects, Hoffman-La Roche spokesperson Charles Alfaro says, “Side effects are very infrequent, and there is no documented correlation between the reported extreme events and Lariam at this point.”
According to Sue Rose, Lariam Action’s legal advisor, who has a Masters in Public Health, that’s not the case. “The science is turning against Lariam,” she says. “Plus, doctors are becoming more interested and not dismissing Lariam sufferers as quacks.”
No class-action suit in the United States has been filed, but there are currently individual lawsuits against Hoffmann-La Roche in several states. Because they are ongoing, no parties will comment on specific details of the current suits. Rose does say that plaintiffs contend that Hoffmann-La Roche failed to properly warn them of the frequency, severity and duration of the drug’s side effects. “How many bodies do we have to walk over before action is taken?” she asks.
As for Lariam alternatives, the CDC recently changed its recommendation on preventing and treating malaria to include Malarone™, GlaxoSmithKline’s new anti-malaria drug. Approved by the FDA last July, Malarone is the first anti-malaria drug to come to market in the United States since Lariam. Unlike Lariam, Malarone is taken daily. Early clinical trials show it to be just as effective. Still, the Peace Corps and the U.S. Armed Forces continue to recommend Lariam.
Inside Master Corporal Clayton Matchee’s Canadian Airborne unit, odd events continued to surface. As many as 10 soldiers complained of nightmares, one reported “feelings of unease and paranoia,” and yet another heard voices and talked to himself. One soldier was hospitalized for psychiatric reasons. Another shot himself in the arm while cleaning his weapon. Several soldiers were switched to Doxycycline with no future complaints.
Then, on Christmas Day 1994 in Rwanda, the Airbone’s Scott Smith, a dedicated soldier and part-time jokester, shot himself in the head. Months earlier, Smith told a journalist he was suffering from Mefloquine hallucinations. The day he died, he spoke to his mom, dad, stepmother and best friend. He laughed with his mother, asking if he could come live with her when he was out of the army in July.He made plans with his best friend to go to his grandfather’s place. No one Smith spoke to, not one of the people closest to him, thought anything was wrong. But after drinking a few beers and palling around with army buddies, Smith, just 23, shot himself with his own rifle. “He snapped, and Mefloquine is 100 percent responsible,” says Smith’s mother, Valeria Smith. “I know it, and the government knows it.”
While Lariam’s culpability was never proven, Canadian doctors who reviewed the case feel the same way. Three months later, on March 5, 1995 – two years after Matchee went haywire – the entire Airborne was disbanded after it became clear that the unit’s command could not discipline or control the soldiers.
Up to this point, there are no reports of recreational use of the drug. One thing, however, may someday be proven a medical certainty – you’ll never dream like you do on Lariam. Your mind swirls. You question who you are and where you come from. People and places from a past and future you don’t recognize appear in your sleep. You ask yourself questions you would never dream of asking – like, “Why am I here? Why are we here? Who says death isn’t better?” – and you have access to the answers. It’s as if your soul is a tour guide to all your beginnings and ends.
How do I know?
Jason, who met the devil in Delhi? He’s me.