The Canadian military is issuing a malaria drug that can produce anxiety, paranoia and psychotic behaviour

by Brent Bambury (@notrexmurphy)

Canadian soldiers will soon be deployed on a peacekeeping mission in Africa and among the anti-malaria medications being made available is a drug called mefloquine. Of the three malaria prevention treatments in use, it's the most controversial. Short term use of the drug appears to cause startling side effects including night terrors, agitation, mood swings, panic attacks and hallucinations. Suicidal thoughts have also been reported.

There's evidence of long term consequences as well. Some research suggests permanent brain damage may have occurred in soldiers taking mefloquine.

In 2013, after the US Food and Drug Administration strengthened its warning on mefloquine's label and acknowledged the possibility of long term damage, US Special Forces discontinued use of the drug. It hasn't been banned outright by the US Military, though some, like Elspeth Cameron Ritchie, think it should be.

Dr. Ritchie is a retired US military colonel and a psychiatrist conducting research on the symptoms of mefloquine in veterans. On CBC Day 6 she told me she wouldn't want to serve next to a soldier taking mefloquine.

"We're talking about soldiers with weapons and it's just too dangerous to put somebody on a hallucinogen and have a gun in their hands."

The military connection

Mefloquine was developed by the US Military in the 1970s and approved for use in 1989. Almost immediately stories of side effects surfaced. Because the drug has been widely used by military personnel, many of the most infamous incidents happened to individuals who were enlisted and under command.

• In 2002, three US soldiers killed their wives after a tour in Afghanistan during which they were given mefloquine.
• In 2012, US Staff Sergeant Robert Bales had been taking the drug when he killed 16 Afghan civilians with no provocation.
• During the Canadian Airborne Regiment's ill-fated 1992 mission to Somalia, Master Corporal Clayton Matchee, who was charged in the murder of Somali teenager Shidane Arone, tried to commit suicide. 900 members of the Airborne were on a clinical trial of mefloquine at the time.

John Dowe was a member of the Canadian Airborne Regiment in Somalia in 1992. He says the adverse effects he experienced were immediate and troubling and that he still feels them to this day. He is convinced the drug played a role in the killing of Shidane Arone.

He recalled details of the incident on CBC Day6.

"So Master Corporal Matchee calls me over," he says.

"There's a prisoner inside the bunker. So I come over, I see the face of Shidane Arone. And he's battered, and he's a bit bruised up but this might have happened at the point of capture."

"So I didn't think too much more of it. But then, when Master Corporal Matchee all of a sudden freaks out and starts striking the prisoner on the leg, and then the walls and the floor of the bunker, he says 'Camel spiders!'

"There were no camel spiders in the bunker. Master Corporal Matchee was beating at camel spiders that were not there."

The risk of an adverse reaction

Lieutenant Colonel Andrew Currie is a physician with the Canadian Forces and the section head of the communicable disease control program with the Department of National Defence. He says one of the reasons he, as a physician, is comfortable with CF personnel taking mefloquine is the relatively low risk of adverse reaction indicated in the scientific data.

"Some of the numbers that are put out in terms of severe risk — like one in 10,000, one in 14,000 — that's actually, in the scientific literature, considered very low."

But Dr. Ritchie doesn't believe those figures are accurate.

"That figure of one in 10,000 to one in 14,000 is a figure that we were using 20 some years ago when we were looking at the issue."

She believes 25 to 50 per cent of those who take the drug will experience at least some adverse side effects.

Lieutenant Colonel Andrew Currie says he isn't seeing that in the literature.

"A recent study that has been put out looking at over 400,000 military users that have used mefloquine compared with the other anti-malarials [shows] the rate of adverse effects and adverse events with mefloquine are equal or in some cases actually better."

"So a lot of the controversy, that's mired in speculation. We're just not seeing that reported in the journals and the scientific research."

Potential litigation

In Australia, where there are calls for a judicial inquiry on the Australian Defence Force's use of mefloquine, authorities have been threatened with a class action suit from veterans. In the US, a former peacekeeper filed a suit against the government when she experienced adverse reactions.

Canadian Airborne Regiment veteran John Dowe says he thinks the Canadian Forces continues to issue mefloquine to avoid litigation.

"It is the belief of the International Mefloquine Veterans Alliance, all of us on the team, that the reticence to remove mefloquine from the formulary is because of pending litigation … because they fear that they're going to open a Pandora's box on a great amount of negligence — medical malpractice really — for the last 25 years."

Lieutenant Colonel Andrew Currie wouldn't comment on the threat of litigation.

He says the Canadian Forces remain committed to using mefloquine as one of the first line drugs in the upcoming Africa peacekeeping mission.

"Right now our first line agents are mefloquine along with Malarone and doxycycline. So we'll be offering the choice of those three anti-malarials to individuals who are going over."

"Recent literature continues to say that you get less breakthrough malarial cases with mefloquine. So it's a medication, the right medication that works."