As more and more people are growing alarmed, we’re also seeing increasing advocacy for those suffering long-term from the toxic effects of mefloquine or Lariam as the preferred anti-malaria drug used by our military for more than 25 years. What a relief! Many of us have felt like lone voices in a desert for more than 20 of those years. The following report comes from testimony submitted to the Joint Veterans’ Affairs Committee Hearing on Veteran Service Organizations’ Legislative Priorities for the House and Senate Committees on Veterans Affairs in the U.S. by The Association of the United States Navy. At some point, our Canadian Military and Health Canada have to cave under such growing data and acknowledge what our veterans have suffered and endured since first introduced to this anti-malaria preventative treatment in Somalia and every overseas assignment since in areas where malaria occurs.
If Canadian Veterans Affairs case workers still deny your suffering and need for treatment as well as disability compensation, hand them this excerpt from the AUSN testimony. BONNIE
“AUSN is concerned about the lasting effects on Veterans’ health from exposure to the controversial antimalarial drug mefloquine, which has been linked to a growing list of troubling psychiatric and neurological disorders. In Senate testimony in 2012, a former U.S. Army public health physician and epidemiologist [This was Dr. Remington Nevin.] cautioned that mefloquine could become the Agent Orange of this generation. In response to these concerns, AUSN and other organizations have been calling on the Department of Veterans Affairs (VA) to do more to educate Veterans to the dangers of mefloquine, to sponsor long-overdue research into the drug’s toxicity and to prepare its healthcare providers and disability evaluators to properly evaluate claims of long-term harm arising from Veterans’ exposure to the drug. Although there is a VA website, http://www.publichealth.va.gov/exposures/mefloquine-lariam.asp, this issue needs further study and analysis at the VA in order to evaluate such claims.
“Previously sold in the U.S. under the trade name Lariam®, mefloquine was first synthesized in 1969 by scientists affiliated with the Walter Reed Army Institute of Research (WRAIR). Following a 20 year development effort, which culminated in the drug’s licensing in 1989 by the Food and Drug Administration (FDA), mefloquine quickly became the military’s “drug of choice” for the prevention of malaria, in part because its weekly dosing schedule simplified command-directed administration. Over the next quarter century, many hundreds of thousands of servicemembers were directed to take the drug, from operations in Somalia in the 1990s, to operations in Africa and Afghanistan as late as this year.
“Since then, reports of mefloquine’s sometimes horrific side effects have become commonplace among Veterans, and reliable stories of Veterans suffering often debilitating injuries from the drug have been regularly featured in the media. Since 1989, even the drug manufacturer has warned that during use, if signs of unexplained anxiety, depression, restlessness or confusion are noticed, these could be considered an early warning sign of a more serious event from the drug. Yet, what this more serious event was has only became clear in July 2013, when the FDA added to the drug’s label a boxed warning, advising that mefloquine could cause serious psychiatric effects, including anxiety, paranoia, depression and hallucinations that could last years after use, and neurological effects including ringing of the ears, loss of balance and vertigo that could be permanent in some cases. This black box drug label also warns of a risk of suicidal thoughts and suicide.
“Following the FDA’s boxed warning in the summer of 2013, Dr. Jonathan Woodson, the Assistant Secretary of Defense for Health Affairs, emphasized that mefloquine should only be used as a drug 7 of last resort to prevent malaria and called attention to data showing military prescriptions had fallen over 90% in previous years as the drug’s dangers became better known. To prevent malaria, the military now recommends the safer daily drugs Malarone® or doxycycline, the latter of which, ironically, was the military’s drug of choice over a quarter century ago before mefloquine was first introduced. AUSN notes that now that these safer daily drugs are once again used in place of mefloquine, malaria cases in the Department of Defense (DOD) are at their lowest level in a decade. Given that the safety and effectiveness of these daily drugs appears to be far superior to mefloquine, AUSN questions why mefloquine was ever used at all given its dangerous side effect profile, particularly over the past decade, during which time two safer daily alternatives have been available. For this reason, AUSN also supports legislation to remove mefloquine from the approved DOD formulary for non-emergency use and to fund the purchase of safer, and consequently more expensive, alternative anti-malarial drugs throughout the military medical services. Although curtailing new prescriptions of mefloquine is a necessary first step, this alone will do nothing to address the long-term harm that has already been suffered by prior generations of Veterans exposed to the drug. Scientists now recognize that mefloquine is neurotoxic and can cause permanent brain injury, resulting in a range of lasting psychiatric and neurological symptoms. According to the Centers for Disease Control (CDC), these symptoms may even confound, or complicate, the diagnosis and management of Traumatic Brain Injury and Post-Traumatic Stress Disorder. The U.S. Army Special Operations Command (USASOC), which recently banned mefloquine altogether, has even emphasized that some of the symptoms of mefloquine toxicity could be mistaken for malingering, or conversion, somatoform or personality disorders.
“As stated before, for Veterans experiencing these symptoms, information available to those who were possibility exposed to mefloquine from the VA remains inadequate. VA websites still feature incorrect information on the drug’s side effects, fail to highlight the seriousness of FDA’s boxed warning and provide few resources directed specifically to help Veterans better understand their symptoms and seek appropriate care. VA must do more to reach out to affected Veterans with improved and more detailed and frank information. AUSN also calls upon the VA to sponsor long-overdue research to better understand the drug’s long-term effects and the burden of its toxicity among Veterans. VA should formalize the limited but ground-breaking clinical research into mefloquine toxicity, already being conducted by the War-Related Illness and Injury Study Center, and increase funding for extramural clinical and epidemiological research at civilian academic centers.
“More must also be done to educate VA clinicians and disability evaluators to the effects of the drug. As early as 2004, the Veterans Health Administration (VHA) had issued an information letter (IL10-2004-007) to its clinicians warning of the possibility of long-term effects from mefloquine, but this letter was allowed to lapse and is now unavailable. AUSN calls on the VA to update this letter to reflect the latest research on mefloquine’s harmful effects, to disseminate its contents to its providers and to supplement this effort with conferences, lectures and continuing medical education (CME) as appropriate. With the FDA’s acknowledgement of the possibility of lasting side effects from the drug, the VA must also update its disability evaluation processes to recognize that certain long-term psychiatric and neurological effects may be the result of mefloquine exposure. As a 2012 memorandum by Dr. Woodson acknowledged, many military servicemembers were dispensed mefloquine without proper medical, the VA must develop procedures to adjudicate such claims, even in the absence of proof of prescribing.
“AUSN is concerned at the possibility of a hidden epidemic from mefloquine toxicity. The steps outlined above will help in stemming this epidemic and aid in assisting affected Veterans, before mefloquine becomes our military’s next Agent Orange.”