Are PCVs and RPCVS at Risk for Taking Mefloquine?

The Huffington Post has a piece on line today that Bonnie Lee Black (Gabon 1996-98) emailed  me about on how the military scrambled to limit the use of the notorious anti-malaria drug called mefloquine (you might have known it as  Lariam) after that soldier’s attack on innocent children. Are you at risk,  we might ask? Remember how we took that drug in Africa and elsewhere?

Here’ is the Huff Post article written by Mark Benjamin, an investigative reporter in D. C.,  that points the finger at mefloquine as a possible cause of Bales’ tragic behavior.

WASHINGTON — Nine days after a U.S. soldier allegedly massacred 17 civilians in Afghanistan, a top-level Pentagon health official ordered a widespread, emergency review of the military’s use of a notorious anti-malaria drug called mefloquine.

Mefloquine, also called Lariam, has severe psychiatric side effects. Problems include psychotic behavior, paranoia and hallucinations. The drug has been implicated in numerous suicides and homicides, including deaths in the U.S. military. For years the military has used the weekly pill to help prevent malaria among deployed troops.

The U.S. Army nearly dropped use of mefloquine entirely in 2009 because of the dangers, now only using it in limited circumstances, including sometimes in Afghanistan. The 2009 order from the Army said soldiers who have suffered a traumatic brain injury should not be given the drug.

The soldier accused of grisly Afghanistan murders on March 17 of men, women and children, Staff Sgt. Robert Bales, suffered a traumatic brain injury in Iraq in 2010 during his third combat tour. According to New York Times reporting, repeated combat tours also increase the risk of post-traumatic stress disorder.

Bales’ wife, Karilyn Bales, broke her silence in an interview Sunday with NBC’s Matt Lauer, airing on Monday’s Today show. “It is unbelievable to me. I have no idea what happened, but he would not — he loves children. He would not do that,” she said in excerpts released Sunday. 

On March 20, Assistant Secretary of Defense for Health Affairs Jonathan Woodson ordered a new, urgent review to make sure that troops were not getting the drug inappropriately. The task order from Woodson, obtained by The Huffington Post,  orders an immediate “review of mefloquine prescribing practices” to be completed by the following Monday, six days after the order was issued.

“Some deployed service members may be prescribed mefloquine for malaria prophylaxis without appropriate documentation in their medical records and without proper screening for contraindications,” the order says. It notes that this review must include troops at “deployed locations.”

Army and Pentagon officials would not say whether Bales took the drug, citing privacy rules. When asked if Woodson’s mefloquine review was a response to the massacre, the military in Afghanistan referred the question to the Army. Army officials said they were “unaware” of the review. After being shown the task order via email, they stopped responding. The Secretary of Defense Office referred questions to the Army — and then back to medical officials in the secretary’s office. Those officials have not responded.

But the sudden violence and apparent cognitive problems related to the crime Bales is accused of mirrors other gruesome cases.

A former Army psychiatrist who was the top advocate for mental health at the Office of the Army Surgeon General recently voiced concern about Bales’ possible mefloquine exposure. “One obvious question to consider is whether he was on mefloquine (Lariam), an anti-malarial medication,” Elspeth Cameron Ritchie wrote this week in TIME’s “Battleland” blog,  noting that the drug is still used in Afghanistan.

“This medication has been increasingly associated with neuropsychiatric side effects, including depression, psychosis, and suicidal ideation.”

In 2004 in the United Press International, this reporter and reporter Dan Olmsted chronicled use of the drug by six elite Army Special Forces soldiers who took mefloquine then committed suicide. (Suicide is relatively infrequent among Special Forces soldiers).

“You’re ready to take that plunge into hurting someone or hurting and killing yourself, and it comes on unbelievably quickly,” said one Special Forces soldier diagnosed with permanent brain damage from Lariam. “It’s just a sudden thought, it’s the right thing to do. You’ll get a mental picture, and it’s in full color.”

Also that year, the UPI report showed how mefloquine use was a factor in half of the suicides among troops in Iraq in 2003 — and how suicides dropped by 50 percent after the Army stopped handing out the drug.

In a case that echoes the Bales’ case, that year the Army dropped charges against Staff Sgt. Georg-Andreas Pogany. Pogany had been the first soldier since Vietnam charged with cowardice. Like Bales, Pogany faced a possible death sentence. The Army dropped the charges after doctors determined that Pogany suffered from Lariam toxicity, which affected his behavior in Iraq.

In 2002, three elite soldiers, who took mefloquine in Afghanistan, returned to murder their wives and then commit suicide. Friends and neighbors described the soldiers’ behavior after taking the drug as incoherent, strange and angry.

Maj. Gary Kolb, spokesman for the Army’s Special Operations Command, was skeptical when asked at the time if mefloquine could have played a role in the tragedies at Fort Bragg. “I think you are heading down the wrong road. That is just my personal opinion.”

Bales’ attorney, John Henry Browne, has said his client has apparent mental health issues and is suffering with memory loss, among other things. A call to his office was not immediately returned.

UPDATE: 3 p.m. — Pentagon Assistant Press Secretary Carl Woog said in an email to HuffPost that Woodson’s review of mefloquine showed “no connection” between it and the Afghanistan murders. “Assistant Secretary of Health Affairs Jonathan Woodson requested this review in January to ensure each service conducts proper screening, patient education, and medical documentation,” Woog wrote. The March 20 order, however, coming nine days after the shooting, shows that one part of the Army issued a new, urgent call to complete the Jan. 17 request from Woodson within six days. The Pentagon still will not say if Bales was wrongly given mefloquine.