Gov’t.’s refusal to recognize mefloquine drug affecting veterans and active troops amounts to criminal negligence


Shame on Canada! Shame on Health Canada! Shame on the Canadian Armed Forces! Shame on our government’s refusal to recognize the mounting evidence of the “military’s suicide pill” — the anti-malaria drug mefloquine or Lariam, as it is also called.

I am reposting recent reports that confirm how dangerous this drug is. Since we now have boots on the ground in Iraq, their lives and sanity are at risk as this drug is still issued as Canada’s preferred anti-malaria preventive treatment. There are other much safer and effective drugs, but they do cost more, particularly malarone used in both the treatment and prevention of malaria.

The callousness of our government in the treatment of our finest and best trained soldiers staggers the mind and heart of every caring Canadian. It’s time to make this government accountable for its deliberate and criminal neglect in safeguarding those who volunteer to sacrifice their lives for our country. Our military’s willingness to be sacrificed is not an invitation for the Canadian government to exploit them or to treat them as expendable fodder.

Why is mefloquine so dangerous?

1. “Mefloquine is neurotoxic and can cause lasting injury to the brainstem and emotional centers in the recipient’s limbic system.”

2. “Mefloquine can even occasionally cause a true dissociative psychosis. In a grip of such a terrifying psychosis, victims have jumped from buildings, or shot or stabbed themselves in grisly ways reminiscent of scenes from M. Night Shyamalan’s film, The Happening.”

3. “Mefloquine, a neurotoxic drug that can cause permanent brain injury, is contributing to our unprecedented epidemic of mental illness and suicide” among our military and veterans.

It’s all here in this latest collection of three reports. BONNIE


Overview

Mefloquine (brand names: Lariam, Mephaquin or Mefliam) is an orally administered medication used in the prevention and treatment of malaria. Rare but serious neuropsychiatric problems have been associated with its use. Mefloquine was developed in the 1970s at the United States Department of Defense’s Walter Reed Army Institute of Research as a synthetic analogue of quinine. The brand name drug, Lariam, is manufactured by the Swiss company Hoffmann–La Roche. In August 2009, Roche stopped marketing Lariam in the United States. Generic mefloquine from other manufacturers is still widely available. It is on the World Health Organization’s List of Essential Medicines, a list of the most important medication needed in a basic health system. There is widespread belief that mefloquine can have negative psychological effects on the user and that troops returning from deployments where mefloquine was used may be misdiagnosed as having PTSD rather than suffering from the effects of mefloquine. The three following articles from the US, Canada and the UK explore and document various aspects of the use of mefloquine.


Mefloquine: The Military’s Suicide Pill
US Army Major (Ret’d) Remington Nevin, MD

Featured image

Dr. Remington Nevin and the CBC’s Nancy Wood when she interviewed the former U.S. Army medical officer two years ago.

In late July, 2013, the FDA issued a powerful black box safety warning for a drug that has been taken by hundreds of thousands of troops to prevent malaria. The drug is called mefloquine, and it was previously sold in the U.S. by F. Hoffman-La Roche under the trade name Lariam. Since being developed by the U.S. military over four decades ago, mefloquine has been widely used by troops on deployments in Africa, Iraq and Afghanistan. We now recognize, decades too late, that mefloquine is neurotoxic and can
cause lasting injury to the brainstem and emotional centers in the limbic system. As a result of its toxic effects, the drug is quickly becoming the “Agent Orange” of this generation, linked to a growing list of lasting neurological and psychiatric problems including suicide.

The public had its first glimpse of the mefloquine suicide problem over a decade ago in 2002, when a cluster of murder-suicides occurred among Ft. Bragg soldiers returning home from deployment. All three soldiers had been taking mefloquine, yet an official Army investigation later concluded mefloquine was “unlikely to be the cause of this clustering.” The Army Surgeon General even testified to Congress there was “absolutely no statistical correlation between Lariam use and those murder suicides.”

The next year, in 2003, a spike in suicides in the early months of the Iraq war was linked in media reports to widespread use of mefloquine; in response, the U.S. Army promised a study “to dispel Lariam suicide myths.”

Yet, when mefloquine use was halted in Iraq in 2004, the active duty Army suicide rate fell precipitously. Earlier this year, I analyzed data from an investigation of suicides in the Irish military conducted by the Irish network RTÉ. In my analysis, troops prescribed mefloquine had a 3- to 5-fold increase in their risk of suicide in the years following deployment, as compared to similar troops deployed but not prescribed mefloquine. The conclusions from this analysis seemed clear: mefloquine was a strong risk factor for suicide. Drug regulators seemed to agree: soon after broadcast, Roche updated the Irish Lariam product information, warning the drug could cause suicide, suicidal thoughts and self-endangering behavior. Most importantly, Roche eliminated previous language that claimed that “no
relationship to drug administration has been confirmed.”

Yet, these observations only confirm what should have been apparent all along. Mental illness, including depression, anxiety, and psychosis, are known to be strong risk factors for suicide. And since 1989, when mefloquine was first marketed in the U.S., the product label has clearly warned that the drug could cause symptoms of mental illness, including anxiety and depression, and hallucinations and other psychotic manifestations. Since mefloquine increases the risk of mental illness, and mental illness increases the risk of suicide, it follows logically that mefloquine increases the risk of suicide.

We now recognize that mefloquine can even occasionally cause a true dissociative psychosis. In a grip of such a terrifying psychosis, victims have jumped from buildings, or shot or stabbed themselves in grisly ways reminiscent of scenes from M. Night Shyamalan’s film, The Happening. Those who have survived mefloquine’s psychotic effects describe experiencing morbid fascination with death, eerie dreamlike out-of-body states, and often uncontrollable compulsions and impulsivity towards acts of violence and self-harm.

As frightening as its intoxicating effects can be, mefloquine’s dangers may not go away even when the drug is discontinued. Today’s mefloquine product information warns of “serious, long-lasting mental illness” and psychiatric symptoms that can “continue for months or years after mefloquine has been stopped.”

Unfortunately, until recently, prominent authorities denied this was even possible. Clear the drug from your system, they insisted, and behavior would return to normal. As a result, troops home from a mefloquine deployment, suffering from persistent
dizziness or memory problems, insomnia, vivid nightmares, irritability and other changes in mood and personality caused by the drug have struggled to make sense of their lasting symptoms. Some of these veterans have even been diagnosed with PTSD or TBI.

But, some veterans, including those without traumatic exposures or who had never suffered a concussion, in whom these lasting symptoms couldn’t be easily explained, were accused of malingering or of having a “personality disorder”. In some cases, these troops were discharged without medical benefits and left to fend for themselves. It should not be surprising to learn that some of these mefloquine veterans, mentally injured, confused, and cast out by the military that unwittingly poisoned them, would later take their own lives in desperation.

In 2004, the military was strongly encouraged to conduct careful studies to evaluate the role of mefloquine in suicide, but these studies were never done. In light of the FDA’s black box warning, fulfilling this long overdue recommendation should now be a priority.

Yet, conducting such studies shouldn’t be necessary for today’s military leadership to acknowledge what follows logically from today’s science: Mefloquine, a neurotoxic drug that can cause permanent brain injury, is contributing to our unprecedented epidemic of mental illness and suicide. We must do more to reach out to veterans suffering in silence from the drug’s toxic effects, and ensure that those at risk of suicide understand how the drug has affected their mental health. As importantly, mefloquine veterans need to have affirmed by the military what they have suspected all along: that they are not crazy, and that it really is the drug that is the cause of their symptoms.

We owe it this generation of veterans to recognize the neurological and psychiatric effects of mefloquine neurotoxicity alongside PTSD and TBI for what they are: the third signature injury of modern war.


CBC News (Apr 11, 2012)
Malaria drug for Canadian troops called dangerous

Canada’s military apparently unconcerned over anti-malarial drug’s side effects

An anti-malarial drug that has been withdrawn from routine use by the U.S. military because of concerns about potentially dangerous side-effects continues to be prescribed to Canadian troops serving in malaria-prone regions. The drug, called mefloquine or Lariam, has been associated with psychiatric and physical side-effects that prompted the U.S. military to withdraw it from general use in 2009, but the Canadian Forces continue to prescribe it to soldiers.

Side-effects can range from anxiety, vivid nightmares and depression, to hallucinations and psychotic episodes, and the drug has also been blamed for suicides and long-term health problems.

Donald Hookey wonders if the mefloquine he was ordered to take in Afghanistan is linked to the rage and nightmares he still experiences. (CBC) Retired corporal Donald Hookey of Conception Bay South, N.L., has been home for six years from Afghanistan, but he remains haunted by his experience there. “I don’t think that I can honestly say that I’ve felt normal since I’ve been back.”

Until recently, Hookey blamed his rage and nightmares on post-traumatic stress disorder, but now he wonders if the anti-malarial drug mefloquine given to him by the army continues to exert long-lasting effects. “It really freaks me out … what I’ve been reading on the side-effects for the drugs.”

Mefloquine was developed by U.S. army researchers during the Vietnam War, but concerns about its side-effects eventually prompted a warning in a 2009 memo from the assistant secretary of defence: “Mefloquine may cause psychiatric symptoms … ranging from anxiety, paranoia and depression to hallucinations and psychotic behaviour … long after mefloquine has been stopped.”

Hoffman-Laroche manufactured mefloquine under the trade name Lariam, while a generic version called Apo-Mefloquine is produced in Canada by Apotex.

Risk of permanent effects cited U.S. army doctor Maj. Remington Nevin, who first gained experience with mefloquine during his deployment in Afghanistan in 2007, says that “there are a certain group of users in whom … these symptoms, the anxiety, the difficulty sleeping, the mood changes, these could be an indication, an early warning sign of a developing, more serious brain condition… a toxicity caused by rising levels of the drug.

“The worst-case scenario is that a soldier that suffers toxicity from mefloquine is left with permanent brain-stem injury.”

Personality changes in returning soldiers have been noted by their close family members. “It’s been very easy to attribute this personality change to some experience during deployment, perhaps some combat experience,” says Nevin, “but when
we see this in individuals that deployed but never had any traumatic exposures and who had an otherwise unremarkable time overseas, I think it becomes increasingly clear that it was the drug that’s responsible for these effects.”

The U.S. Centres for Disease Control recommended this year in its Yellow Book travel advisory that mefloquine not be considered the drug of choice for military deployments, given that “neuropsychiatric side-effects may confound the diagnosis and management of post-traumatic stress disorder and traumatic brain injury.”

Alternative treatments include doxycycline and atovaquone-proguanil (Malarone), which Nevin says are effective and more predictable.

The possibility that mefloquine may have been prescribed to U.S. Staff Sgt. Robert Bales, who has been charged with 17 counts of murder in the death of Afghan civilians, has been raised by retired army psychiatrist Elspeth Cameron Ritchie. The U.S. Defence Department has refused to confirm or deny that Bales took mefloquine, citing medical privacy.

Kevin Berry of Vancouver served in Afghanistan in 2003 as a 19-year-old infantryman. Mefloquine was administered once a week and “they made it abundantly clear we would be charged if we weren’t taking it.”

The side-effects were well-known, he says. “My section commander had been in Somalia and Rwanda. He said, ‘Get ready to go loopy, boys!’ You wake up shaking, sweating, terrified, you know: what’s going on? Am I going crazy? But you look around and — oh, everyone’s doing it.”

Berry says he quit taking the pills, without telling his superiors, and the side effects stopped.

Hookey says he wishes he had done the same. “I know guys who didn’t take the drugs because they said, ‘Screw that, man. I don’t know what’s in it.’ Maybe I should have been one of those guys, huh?”

The Canadian Forces base their use of mefloquine on recommendations of the Public Health Agency of Canada, which says the drug is “generally well tolerated” and that severe reactions such as seizures are rare (reported from one in 6,000 to one in 13,000 users). Long-term neuropsychological effects and reports of suicide ideation or suicide have not be confirmed, the agency says.

But, the military’s continuing use of mefloquine “is definitely deviating from the evolving standard of care, or the evolving standard of practices of Western militaries,” Nevin says.
“This will be a cost borne not by the militaries but by the various Veterans Affairs Departments,” he says.

The Canadian military declined to comment to CBC News about its use of mefloquine.
With files from the CBC’s Nancy Wood


Exclusive: The Lariam scandal – MoD ‘ignored decades
of warnings about dangers of suicide drug’
Drug that most GPs are reluctant to prescribe for their patients
and that is banned by U.S. military is putting thousands of British soldiers’ lives at risk
Jonathan Owen
Friday 27 September 2013

Thousands of British soldiers are being put at increased risk of psychosis and suicide because the Ministry of Defence refuses to stop using a controversial anti-malarial drug that has just been banned by the U.S. military, The Independent can reveal.

Mefloquine – better known as Lariam – has long been the subject of warnings over its effects on mental health and is now only used by a minority of people travelling abroad. Amid mounting concerns about the dangers of the drug – which has been linked
with a string of suicides and murders – the U.S. military acted this month to ban its use among special forces. The decision came after it was linked to the massacre of 16 Afghan civilians by a U.S. soldier.

Yet, British soldiers are still being given Lariam – a drug described as a modern-day “Agent Orange” by doctors because of its toxicity.

Speaking to The Independent, a former senior medical officer accused the MoD of ignoring repeated warnings over the dangers of the drug. Lt. Col. Ashley Croft, who served for more than 25 years in the Royal Army Medical Corps and is an expert on malaria, said: “For the past 12 years I was saying this is potentially a dangerous drug – most people can take it without problems but a few people will experience difficulties and of those a small number will become psychotic and because there are other alternatives that are safer and just as effective we should move to them but my words fell on deaf ears.”

Lt. Col. Ashcroft, who retired in April, accused the MoD of being in “denial mode.” He added: “The problem is that it can make people have psychotic thoughts and therefore act in an irrational manner and potentially a manner that is dangerous to themselves or their colleagues, or civilians.”

Doxycycline and malarone are safer drugs, which are as effective in preventing malaria, according to the retired officer. “Really the only people that get it [Lariam] now are the poor old soldiers and they have no choice.”

Mefloquine is typically given to soldiers serving in sub-Saharan Africa, parts of Latin America and South-east Asia. Lt. Co. Croft estimates around 2,500 soldiers a year are given the drug. Lariam was developed by the U.S. Army in the 1970s, and approved by the U.S. Food and Drug Administration (FDA) in 1989. It became a popular drug for preventing and treating malaria, but recent years have seen it become superceded by newer antimalarial drugs, such as malarone.

While most NHS doctors now recommend that civilians travelling overseas take alternatives to Lariam with fewer side-effects, British service personnel are given little choice about whether to take the drug. This is despite the U.S. military banning Lariam on safety grounds.

An order issued earlier this month by the U.S. Special Forces Command states: “Medical personnel will immediately cease the prescribing and use of mefloquine for malaria prophylaxis.” It adds: “Hallucinations and psychotic behaviour can occur
and continue for months or years after mefloquine use; cases of suicidal ideation and suicide have been reported.”

The decision comes after an order in July from the FDA to force manufacturers to give the drug a black box label, its strongest warning. The FDA warned that some neurological and psychiatric side effects can last for months or years after people stop taking the drug.

Staff Sergeant Robert Bales, the U.S. soldier who killed 16 Afghan civilians in March 2012, had taken Lariam while serving in Iraq.

Dr. Remington Nevin, a former U.S. army doctor and expert on the psychiatric effects of Lariam, who is based at the Johns Hopkins Bloomberg School of Public Health, said: “As a result of its toxic effects, the drug is quickly becoming the “Agent Orange” of this generation, linked to a growing list of lasting neurological and psychiatric problems including suicide.”

In addition to the mental health risks, physical side effects range from internal bleeding to liver and lung damage. But, there are no signs of the British Army stopping its use of Lariam. An MoD spokesperson said: “All our medical advice is based on the current guidelines set out by Public Health England. Based on its expert advice, the MoD continues to prescribe mefloquine as part of the range of malaria prevention treatments recommended. It is just one of the prevention treatments available and is only prescribed under certain circumstances to ensure the treatment provided is the most effective.”

While ordinary soldiers are routinely given the drug, the MoD ordered that it should not be given to air crew or divers, given the particular risks of such posts. In its latest guidance for commanders, dated 2013, it cites “significant risk of side effects, which could degrade concentration and co-ordination,” and that any such specialist personnel who take it will be unfit for duty for three months.

A spokesman for the Public Health England Advisory Committee on Malaria Prevention (ACMP), said: “Mefloquine is an extremely effective antimalarial and we are not aware of any new data that alter our view of the safety of mefloquine.”

He added: “Whenever new evidence about antimalarials appears the ACMP considers this as part of its continuous process of developing advice.”

Lt. Col. Croft condemned the ACMP for “promoting this drug as ‘safe’” and added: “They shelter behind collegiality, and won’t budge from this position since itwould imply that their earlier judgement on mefloquine was wrong, and if they were to now change their advice then they as individuals could potentially be cited, in personal injury actions brought by mefloquine-damaged travellers.”

Dr. Nevin further  commented: “Public Health England has a responsibility to protect the travelling public from the threat posed by dangerous medicines, and should carefully reconsider its recommendations in light of mefloquine’s neurotoxicity and its association with risk of permanent neurological injury and death.”

He added: “Mefloquine toxicity is also a potentially life-threatening condition that is fully preventable by use of safer daily antimalarials.”

Roche, the company that makes Lariam, warned of the risk of suicide more than a decade ago. And this July, in a letter to doctors in Ireland, Dr Maria Luz Amador, the company’s medical director, warned that the drug “may induce potentially serious neuropsychiatric disorders” and that “hallucinations, psychosis, suicide, suicidal thoughts and self-endangering behaviour have beenreported.”

A statement from Roche said: “All medicines have side effects and we are sorry to hear about those that experience adverse reactions to our medicines.” It continued, the benefits “outweigh the potential risk of the treatment and Roche maintains the position that there is no causal relationship between suicidal tendency, suicide or self-harm and Lariam.”

But it cautioned: “Lariam should not be prescribed for prophylaxis in persons with active depression or with a history of major psychiatric disorders or convulsions.”

Doctors “tend to steer clear of it,” said Dr. Claire Gerarda, the chair of the Royal College of General Practitioners. “I wouldn’t encourage it, because I think it’s got nasty side effects. I can’t remember the last time I prescribed Lariam.”

Lariam: The suicides, murders and incidents of self-harm
The controversial anti-malarial drug Lariam has been linked to a series of military suicides, murders and incidents of self-harm during the past 20 years.

* Staff Sergeant Robert Bales, the U.S. soldier who killed 16 Afghan civilians in 2012, had taken Lariam while serving in Iraq. Although he is not mentioned by name, an “adverse event” report was made to Roche, manufacturers of the drug, on 29th March 2012 from a pharmacist regarding an unnamed Army soldier. “The patient who was a soldier in the U.S. Army developed homicidal behavior and led to Homicide killing 17 Afghanis,” it said. The report, which was passed on to the U..S Food and Drug Administration, claimed the drug had been given “in direct
contradiction to U.S. military rules that Mefloquine should not be given to soldiers who had suffered TBI (Traumatic brain injury) due to its propensity to cross blood brain barriers inciting psychotic, homicidal or suicidal behaviour.”

* Canadian peacekeepers beat, tortured and shot two local teenagers in Somalia in 1993. Major Barry Armstrong, the military commander of the Somalia surgical unit, in a report dated October that year, stated: “I believe there may be an additional, simple explanation for our difficulties in Somalia: Canadian and American troops may have been impaired by the use of mefloquine.”

* In 2000, Lance Corporal Kristian Shelmerdine, the Parachute Regiment, shot himself in the arm while serving in Sierra Leone. He blamed the accident on the drug, claiming to have had bad dreams and woken up to find himself shot, but was found guilty of ‘negligent discharge.’ Two years later, four U.S. soldiers based at Fort Bragg, North Carolina (three of whom had recently returned from Afghanistan, where troops were prescribed Lariam) killed their wives. Two of the soldiers killed themselves.

* In 2004, a U.S. Army reservist shot himself in Iraq – just weeks before he was due to return home. In a U.S. army report which subsequently emerged, an army psychiatrist stated: “If toxicology reveals the presence of mefloquine, SPC Torres’ case should be viewed in light of other suicides suspected to be associated with the drug.”

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About Bonnie Toews and John Christiansen

Bonnie's Blog Posts invite our readers and free spirits everywhere to share life's adventures with us. I talk about writing my novels, reading books, chatting with other writers and John's and my journeys around the world. We welcome your anecdotes to our experiences and discussions.
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