Mefloquine / Topics & Posted Articles

Canadian Forces curb use of mefloquine, but study findings anger veterans

GLORIA GALLOWAY
The Globe and Mail
Published Thursday, Jun. 01, 2017 8:25PM EDT
Last updated Thursday, Jun. 01, 2017 9:52PM EDT

Canadian soldiers who are deployed to regions where malaria is prevalent will no longer be offered mefloquine as a first option for preventing the disease, the military has decided after a completing a study prompted by veterans who say the drug caused permanent brain damage.

The Canadian Forces on Thursday released a report from a task force on mefloquine that was ordered last fall by General Jonathan Vance, the Chief of Defence Staff. Health Canada simultaneously made public its own findings about the safety of the drug. Both studies conclude there is no evidence that the drug causes long-lasting and permanent neurological and psychiatric problems.

That angers some veterans, who say they experience debilitating mood issues, sleep disorders, aggression, depression and memory loss as a result of mefloquine toxicity.


“There is no doubt in my mind that this drug caused, and causes, serious, serious issues for a lot of us,” former soldier Dave Bona said.

The military’s report recommends that the two most commonly prescribed alternatives – Malarone and doxycycline – be considered preferred options for soldiers deploying to countries where malaria is a risk, and that mefloquine be used only when the other drugs are not tolerated or when a soldier has taken it previously, had no problems with it, and chooses to take it again.

The change closely aligns the policy of the Canadian Forces with that of the Australian, U.S. and British military, which have declared mefloquine a drug of last resort. Germany has banned it for its soldiers.

The Canadian military study did not involve original scientific research, but analyzed available studies on the medication and reviewed the Canadian Forces’ experience with it.

“It just infuriates me. It’s like they have cherry-picked the reports they want to use to support their own agenda,” said Mr. Bona, who took mefloquine during the Somalia mission of the early 1990s as part of an unorthodox and possibly illegal clinical trial run by the Department of National Defence and Health Canada. Some blame the drug for the violence in which Canadian troops beat a 16-year-old Somali to death.

Mr. Bona’s partner, Teresa Untereiner, said it is is both dangerous and irresponsible to say mefloquine causes no permanent neurological harm. “When they deny that it has an effect, they’re able to deny the people who have been affected any services,” she said.

Health Canada updated the warning labels for mefloquine in August to emphasize that certain side effects can persist for months or years after the drug is discontinued and may be permanent in some patients. The department said the reported symptoms include anxiety, paranoia, depression, hallucinations, psychotic behaviour and, in rare cases, thoughts of suicide.

How such side effects might affect soldiers when they are deployed to dangerous parts of the world was part of the study released by the military on Thursday, said Lieutenant-Colonel Andrew Currie, the head of the communicable disease prevention program for the Canadian Forces. “At the end of the day,” Lt.-Col. Currie said, “that was certainly part of the decision-making that the surgeon-general had when he proposed the new policy on mefloquine.”

It is important to point out that the number of soldiers who have been using mefloquine has diminished significantly, he said.

In fact, task force could find just 111 military patients who had been prescribed mefloquine between December, 2013, and December, 2016, a time when there was no large deployment to a country where malaria is prevalent. Of those cases, however, it was discovered that 12 per cent were given the drug even though they had a history with anxiety, depression or PTSD that meant it was was not recommended. The report advises the military to develop better screening procedures.

The Commons Veterans Affairs Committee, which has been studying mental health and suicide among veterans, had heard much testimony from veterans such as Mr. Bona who believe they were injured by mefloquine.

Cathay Wagantall, a Conservative MP who is a member of that committee, commended the military for making mefloquine a second-line drug. But by declaring there is no evidence of permanent neurological and psychiatric damage, she said, “I think they are trying to dismiss themselves now from having to deal with the fact that, for years, soldiers have suffered, and veterans have suffered, with the use of this drug.”

Remington Nevin, a doctor at the Johns Hopkins University Bloomberg School of Public Health in Maryland, who has studied the drug’s effects for nearly a decade, was harsh in his assessment of Health’s Canada’s conclusions. The federal department “shamefully appears to be taking a page from the playbook of tobacco company executives in attempting to manufacture doubt about the known chronic effects of mefloquine which are clearly acknowledged by international drug regulators,” Dr. Nevin said.

As for the report of the Canadian military, the recommendation to further restrict use of mefloquine is a tacit acknowledgment that the Forces have failed to use mefloquine safely, and that its continued use poses a risk to its members, Dr. Nevin said.

“While this report is a step in the right direction for serving members of the Canadian Armed Forces,” he said, “it does a disservice to Canadian veterans. Canadian mefloquine veterans deserve to have the government acknowledge that their health has been placed at risk by Canadian Armed Forces’ misuse of mefloquine.”

https://www.theglobeandmail.com/news/politics/mefloquine-will-no-longer-be-canadian-forces-first-malaria-prevention-option/article35184526/

Here is the message I got at work today that goes out to all members of the CAF who have DWAN(military email) about Mefloquine.

From: Defence Team Messages
Sent: June-01-17 12:04 PM
Subject: Surgeon General Statement on Mefloquine

This message is being sent to all recipients on the DWAN.

As members of the Canadian Armed Forces, we operate in some of the most difficult environments in the world, from the high Arctic to the heart of Africa. And the role of the Canadian Forces Health Services Group is to ensure we’re resilient to illness and injury no matter where we operate, and to get us back to fighting shape when needed.

I was ordered by the Chief of the Defence Staff to provide recommendations on how to best protect our people from malaria using third-party, peer-reviewed scientific analysis. As a result, I asked our subject matter experts to conduct a review partly out of concerns surrounding the use of the drug mefloquine because I needed to know if other treatments developed since the 1990s can deliver the same results with fewer side effects.

I have now received the results of that review, which you can read here (http://www.forces.gc.ca/en/about-reports-pubs-health/surg-gen-rpt-mefloquine.page). Here are the findings:

·      --  Malaria is a serious and often fatal disease. In their last reporting year, the World Health Organization tracked 212 million cases and 429,000 deaths worldwide.

·     --  Mefloquine is extremely effective at preventing malaria, and because it requires weekly doses instead of daily ones, is more effective in an operational theatre where there are fewer chances to miss a dose.

·     --  While the side effects of mefloquine can vary, even the most minor ones – nausea and dizziness – can limit operational performance. More serious side effects such as anxiety, nervousness, and depression are rare, but can pose risks to a member’s long-term health.

·     --  Alternative anti-malarial treatments, such as doxycycline and “AP,” provide comparable protection from most malaria strains, and pose less serious risks to the user.

·     --  As other anti-malarial treatments became available, CAF prescriptions for mefloquine have decreased from nearly 90% in 2003 to less than 2% in 2016.

As a result of this review, mefloquine will now be considered a second-line treatment for the prevention of malaria among CAF personnel. It will only be recommended for use in people who cannot use other treatments for any reason (such as drug allergies), or for people who have used it in the past and experienced no side effects.

In spite of the potential side effects of mefloquine, they are less serious than complications from preventable disease. CAF members will not be deployed into operational theatres where malaria is present, without sufficient protection to prevent malaria.

I want to thank our medical professionals for their work on this review, and I encourage all members with questions about mefloquine – or any other medication – to consult your physician and make an informed decision.

Colin MacKay
Brigadier-General
Surgeon General of the Canadian Armed Forces


I'm curious about this quote:  “Mefloquine will now only be recommended for use if a CAF member requests it, or if there are contraindications to the member being prescribed other anti-malarials,” the DND noted in a news release in the post above.

It is not what was released to the military members and when I looked in the hyperlink of the Surgeon General's report and searched for the  word "request", it wasn't there.  Hhhmmmm.  Who would request Mefloquine now after all the stories of problems our soldiers are going through?  Damned Spin Doctors, making it look like the soldier has a choice. That way, when we complain, it was our fault in the first place!

Sabrelove

Canadian Forces abandons mefloquine as main drug to combat malaria

DAVID PUGLIESE, OTTAWA CITIZEN

June 1, 2017

The Canadian military will no longer use mefloquine as its main drug to combat malaria.

The Department of National Defence and the Canadian Forces announced Thursday the release of the findings from the Surgeon General’s Review on the Operational Use of Mefloquine. The review looked at available literature on mefloquine use and how it is used in an operational setting.

“Mefloquine will now only be recommended for use if a CAF member requests it, or if there are contraindications to the member being prescribed other anti-malarials,” the DND noted in a news release.

“We are recommending mefloquine as a second line drug only, because of the unique operational environment that we work in,” Brigadier-General Colin MacKay, Surgeon General, noted in a statement. “This direction should not be applied to a non-military environment. We will continue to monitor and review all relevant scientific literature on mefloquine.”

More from the DND release:



- Compared to currently recommended alternatives, the body of evidence suggests mefloquine is not consistently associated with an excess overall risk of adverse effects, nor is it associated with an excess risk of not being able to perform occupational duties.


- No evidence was found (that met the inclusion criteria) that would suggest potential long-term adverse effects of mefloquine on human health.


- The report also recommended caution for the CAF, because the deployment of large numbers of personnel within a short period of time can pose challenges for adequately screening individuals for potential contraindications. Additionally, the dispersed deployment of personnel, limiting access to physicians on operations, may reduce opportunities to assess for adverse effects and if necessary to provide alternative medications to CAF personnel taking mefloquine. Also, the nature of the short term side effects associated with mefloquine could impact an individual’s performance and could be confused with usual responses to operational situations, which would in turn complicate the management of adverse effects.

http://ottawacitizen.com/news/national/defence-watch/canadian-forces-abandons-mefloquine-as-main-drug-to-combat-malaria

Globe & Mail Tues March 7th

The Canadian army officer who led the UN peacekeeping mission during the Rwandan genocide says the antimalarial drug mefloquine affected his thought processes during his deployment but the military refused to let him stop taking it.

Roméo Dallaire, the human rights activist, retired lieutenant-general and former senator who speaks openly about his struggles with post-traumatic stress syndrome, told the Commons veterans affairs committee this week that mefloquine interferes with the ability to make quick decisions in military theatres.

“I was a year on mefloquine. About five months into it, I wrote to National Defence headquarters and I said this thing is affecting my ability to think. This thing is blowing my stomach apart. This thing is affecting my memory, and I want to get rid of it,” Mr. Dallaire told the committee.

“I then got a message back – it was one of the fastest ones I have ever got back – which essentially ordered me to continue it,” he said. “If not, I would then be court-martialled for a self-inflicted wound.”

Soldiers who were given mefloquine in Somalia in the early 1990s as part of a poorly administered – and possibly illegal – clinical trial run by the Department of National Defence have told the veterans affairs committee that the medication caused lasting brain damage. Some blame the drug for the violence that erupted on the night Canadian troops beat a 16-year-old Somali to death.

At the request of the committee, Health Canada began in December to review available information about any causal link between the use of mefloquine and persistent neurological or psychiatric adverse events, their frequency and severity and whether any particular segment of the population is at increased risk.

In August, the health department updated warning labels for mefloquine to emphasize that certain side effects can persist for months or years after the drug is discontinued and may be permanent in some patients. Reported symptoms include anxiety, paranoia, depression, hallucinations, psychotic behaviour and, in rare cases, thoughts of suicide.

Germany recently banned the use of mefloquine within its forces. Other countries, including the United States, have declared it the drug of last resort for military personnel needing protection from malaria.

Different drugs with fewer side effects are now more commonly prescribed to Canadian soldiers when they deploy to a region where malaria is prevalent. But they are still given mefloquine far more frequently than are U.S. troops.

Canada’s Chief of the Defence Staff has ordered senior military health officers to review the scientific literature on the drug. Their findings are expected this month.

Mr. Dallaire said mefloquine should still be prescribed to deploying soldiers who cannot tolerate one of the alternatives. “I have seen what malaria does when you take no prophylactic.”

But he said the other anti-malarials are better options. “Mefloquine is old-think and it does affect our ability to operate,” Mr. Dallaire said. In his case, the side effects were so severe that he had to ask his assistant to monitor his actions.

Soldiers should not be impaired by medication, Mr. Dallaire said, when they are dealing with “the very complex scenarios in which we find ourselves – when you are facing children [that pose threats] and you’ve got seconds – nanoseconds – to decide whether you are going to kill a child or not to save other people.”

Retired brigadier-general Joe Sharpe, who served as a special adviser to the Defence Ombudsman on operational stress injuries, joined Mr. Dallaire at the committee. He also said he would not impose an outright ban on mefloquine in the military.

“If mefloquine is the only prophylactic you can find to protect the troops from malaria, and they have to go off and do their job, then you are going to have to use it and take the risk,” Mr. Sharpe said.

But if they return from the deployment with psychological issues, then Canada must take care of them, he continued, and the government must not demand stacks of proof or question if they are imagining their symptoms. “If they believe mefloquine is the problem,” Mr. Sharpe said, “mefloquine is the problem.”

Veterans, families want answers over Forces' use of Mefloquine

By CHRIS DOUCETTE, TORONTO SUN

FIRST POSTED: MONDAY, JANUARY 23, 2017 08:18 AM EST | UPDATED: MONDAY, JANUARY 23, 2017 09:34 AM EST


From the early 1990s to the present, Canadian soldiers have been given a powerful anti-malaria drug called Mefloquine to protect them when they are deployed. (Bob Tymczyszyn/Postmedia Network)

The call for accountability over the Canadian Forces’ use of a controversial anti-malaria drug is growing louder and veterans and family members hope Prime Minister Justin Trudeau will hear their cries for help.

A former medic who served in Somalia, the wife of a soldier disgraced in the Somalia Affair, the mother of a soldier who killed himself in Rwanda and a doctor with expertise in the neuropsychiatric effects of Mefloquine toxicity recently submitted written statements to the Standing Committee on Veterans Affairs outlining the drugs’ devastation.

Marj Matchee writes her husband, Clayton, suffered paranoia and hallucinations prior to his 1993 arrest for the deadly beating of a Somali teen.

“You see things when you sleep. You see it in the daytime too,” she recalls him saying.

Many veterans who were forced to take the drug before it was licensed still suffer from side effects that Health Canada and AA Pharma, the Canadian supplier of the drug, quietly added to Mefloquine’s warning label last year.

“We must do more to reach out to these veterans, to acknowledge the harms that Mefloquine has caused them, and commit to funding research to study and ultimately try to reverse these effects,” Matchee writes.

Dr. Remington Nevin, of Johns Hopkins University, says Mefloquine toxicity can cause brain damage that mimics PTSD, so sufferers may receive the wrong treatment and symptoms such as suicidal thoughts persist.

The National Defence Department recently revealed 441 male service members committed suicide from 1995 to 2014. Those numbers don’t include veterans.

So it’s unclear how many former soldiers like Lionel Desmond, who killed his wife, daughter, mom and himself on Jan. 3, have committed suicide.

Conservative MP Cathay Wagantall, a member of the Standing Committee on Veterans Affairs that has urged Health Canada to review Mefloquine, said it’s frustrating our military has yet to follow the lead of our many allies and either ban the anti-malarial or list it as a drug of last resort.

“With all the evidence now available, they’re choosing to pretend it’s not happening,” she said.

The Department of National Defence currently has no plan to contact current or former soldiers and ask if they are suffering any known side effects of Mefloquine.

“There is a Surgeon General’s review ongoing and the results are expected at the end of March,” the DND reported.

Veterans Affairs encourages any former soldiers who need help to call 1-866-522-2122 or our visit www.veterans.gc.ca.

“The health and well-being of veterans is a top priority for the government of Canada and we are committed to providing Veterans with the support that they need, when they need it,” Veterans Affairs said.

GENERAL REMEMBERS

Retired Canadian Forces general and Senator Romeo Dallaire served in Rwanda where he was affected by the drug Mefloquine. In his new book Waiting For First Light: My Ongoing Battle with PTSD, Dallaire discusses the drug’s effect on him:

“The drug, Mefloquine, affected my eyesight, sleep and frame of mind. It was the preferred anti-malaria medication because it was taken weekly, instead of daily. As early as January 1994, I had been in touch with Ottawa to say this drug was affecting my ability to function, and I want to stop taking it. Their response was that my doing so would be considered a self-inflicted wound: a chargeable offence.”

LINKS TO THE PAST

Some suicidal and homicidal incidents with suspected links to Mefloquine:

• March 16, 1993: Canadian Airborne Regiment Master Cpl. Clayton Matchee and Pte. Kyle Brown tortured and killed Somali prisoner, Shidane Arone, 16. Brown was imprisoned 40 months and now reportedly suffers from PTSD. Matchee suffered brain damage in a failed suicide effort and was deemed unfit to stand trial.

• Dec. 25, 1994: Canadian Airborne Regiment Cpl. Scott Smith told a reporter Mefloquine caused him to hallucinate while in Somalia, then two months later he killed himself on Christmas Day in Rwanda.

• 2000: Now retired lieutenant-general Romeo Dallaire, who has admitted Mefloquine affected his ability to function in Rwanda in 1994, attempted suicide with alcohol and pills.

• March 12, 2015: Decorated veteran Joseph Woods, 42, a special forces soldier who served in Croatia and Somalia where all troops were given Mefloquine, hanged himself while in Maplehurst prison and died two days later.

• Jan. 3, 2017: Decorated veteran Lionel Desmond, 33, of the Royal Canadian Regiment, was suffering from PTSD after serving in Afghanistan when he shot his wife, their 10-year-old daughter and his mom in Nova Scotia.

http://www.torontosun.com/2017/01/23/veterans-families-want-answers-over-forces-use-of-mefloquine

Murder-suicide raises questions about anti-malaria drug

By CHRIS DOUCETTE, TORONTO SUN
FIRST POSTED: SUNDAY, JANUARY 15, 2017 04:16 PM MST | UPDATED: SUNDAY, JANUARY 15, 2017 05:07 PM MST


Lionel Desmond and his wife, Shanna, hold their daughter Aaliyah in a photo from the Facebook page of Shanna Desmond.

When a former soldier killed himself and his family recently in Nova Scotia, some veterans and their relatives immediately wondered if Mefloquine was to blame.

And with concern mounting over our military’s continued use of the controversial anti-malaria drug — unlicensed in Canada when first issued to troops under the guise of a human drug trial during the 1993 Somalia mission — they want answers from the federal government.

“The blood of everyone who dies due to this drug is on the hands of those who pushed it,” Marj Matchee told the Toronto Sun recently.

Her husband, like many soldiers, suffered hallucinations, nightmares, bursts of anger and other side effects, after taking Mefloquine in Somalia.

Canadian Airborne Regiment Master Cpl. Clayton Matchee was involved in a disgraceful, deadly beating of a teenage Somali prisoner but unable to stand trial after suffering brain damage in a suicide attempt.

His wife has always blamed Mefloquine.

Retired lieutenant-general Romeo Dallaire wrote in his latest book about his PTSD that he told his superiors the anti-malaria drug was impairing his abilities in Rwanda in 1994.

More than two decades later, some soldiers still suffer neurological and psychological side effects of what is now known as Mefloquine toxicity.

The drug’s Canadian supplier, AA Pharma, recently updated its Mefloquine warning acknowledging that symptoms like hallucinations, paranoia, psychotic behaviour, vertigo and suicide may persist years after use.

However, the company and the Canadian military have maintained the risk of severe adverse reactions is quite low.

Several allied countries have either deemed Mefloquine a drug of last resort for soldiers or banned it.

But as of last month, the Canadian Forces maintained Mefloquine remains one of three anti-malaria drugs that will be used during an upcoming African mission.

But will that stance soften after the Jan. 3 tragedy that saw Lionel Desmond, 33, kill his wife, 10-year-old daughter and his mom in rural Nova Scotia?

Desmond served with the Royal Canadian Regiment in Afghanistan in 2007 and was battling PTSD even before his release from the military in 2015.

“This looks increasingly like our worst warnings,” veteran John Dowe said, adding 90% of Canadian troops in Afghanistan that year were given Mefloquine.

As head of the Canadian chapter of the International Mefloquine Veterans Alliance, he is pleading with the government to identify and reach out to soldiers given the drug.

Dr. Remington Nevin, who works at Johns Hopkins University and has studied anti-malarials extensively, also urged Canadian officials to reveal whether Desmond took the drug.

“Mefloquine can cause a range of severe neuropsychiatric adverse reactions that can mimic symptoms of PTSD and post-concussive injury,” he said.

http://www.calgarysun.com/2017/01/15/murder-suicide-raises-questions-about-anti-malaria-drug

I took that shit in 2003/2004 in Kabul.
Perfect subjects for big pharma experimenting on us. Not much choice. Incredibly vivid dreams, etc, etc., etc.  They also tested our livers before giving it to us ... how many with liver cancers?
Prostate and bladder cancers? Lung and blood cancers?  Nobody looking into that? It will be like agent orange.

Cheers

Canadians concerned about anti-malarial drug mefloquine’s effects on armed forces: poll

GLORIA GALLOWAY
OTTAWA — The Globe and Mail
Published Wednesday, Dec. 28, 2016 9:19PM EST
Last updated Wednesday, Dec. 28, 2016 9:19PM EST

Large numbers of Canadians are so concerned about the effects of mefloquine on this country’s armed forces that they want the government to contact those who might have been harmed and to pay for research into the long-term psychological problems the anti-malarial drug may cause.

Those are the findings of a new poll conducted late last month by Nanos Research for The Globe and Mail at a time when veterans, especially those who were on the troubled Somalia mission of the early 1990s, were coming forward to say they believe the medication left them with irreparable brain damage.

More than half of the poll respondents – 53 per cent – said they believe the government, and mefloquine’s manufacturer, Roche, should pay for research into the possible long-term side effects of the drug, which is still being offered to Canadian troops who go to countries where the risk of contracting malaria is high. Another 7 per cent said the government should be solely responsible for that research, and 38 per cent said the responsibility is the manufacturer’s alone.

Just 1 per cent of those surveyed said no one should be required to pay for more studies of mefloquine.

When asked if the government should contact all soldiers and veterans who have taken the drug to determine if it had harmed them, 45 per cent of respondents said “yes,” and said they would be willing to see tax dollars spent to that end. An equal number said it should be up to the veterans to contact the government if they believe they have suffered lasting damage.

“I think it’s fair to say that the 45 per cent who want the government to spend money to contact veterans who have been given the drug to determine if they have suffered harm is a good indication that they’re concerned enough about the issue for the government to spend money,” said Richard Jenkins, Nanos’s vice-president. “And virtually everybody believes someone should be out there doing research.”

The survey of 1,000 Canadians randomly recruited by telephone is expected to reflect the views of the country at large within 3.1 percentage points, 19 times out of 20.

The Liberal government has so far rebuffed requests from veterans and opposition MPs to examine the possible long-term effects of mefloquine in greater detail.

Health Canada updated the warning labels for mefloquine in August to emphasize that certain side effects can persist for months or years after the drug is discontinued and may be permanent in some patients. Symptoms reported include anxiety, paranoia, depression, hallucinations, psychotic behaviour and, in rare cases, thoughts of suicide.

Germany recently banned the use of mefloquine within its forces. Other countries, including the United States, have declared it the drug of last resort for military personnel needing protection from malaria.

Canada’s Chief of Defence Staff has ordered senior health officers to review the scientific literature on the drug. But senior military personnel remain skeptical of claims that mefloquine causes long-term damage, except in the rarest of cases. And the military’s surgeon-general has said there is not enough evidence that the drug is a problem to justify spending money on research.

Many of the soldiers who were given mefloquine in Somalia as part of a clinical trial that was poorly administered and possibly illegal reported the types of symptoms mentioned in the Health Canada warning. Some blame the drug for the violence that erupted on a night that saw Canadian troops beat a 16-year-old Somali to death.

A long-running inquiry into what is known as the Somalia Affair was cut short in 1997, in the week before the investigation was to explore the impact of mefloquine.

“I am going to push specifically, again, for reopening the Somalia inquiry on the basis of what is now known,” said Cathay Wagantall, a Conservative MP and a member of the Commons Veterans affairs committee, which has heard testimony from veterans who say mefloquine has ruined their lives.

The survey’s findings are being released as the parents of a soldier who took his own life in 1994 are demanding that federal cabinet ministers apologize for the loss of their son, who was prescribed mefloquine in Somalia and then again in Rwanda, where he died.

Val Reyes-Santiesteban and Wayne Smith, the parents of Corporal Scott Smith, asked last week for Defence Minister Harjit Sajjan and Health Minister Jane Philpott to apologize on behalf of their departments, which a 1998 Auditor-General’s report said conducted the clinical trial without obtaining the required consent of the soldiers or monitoring for adverse effects.

Ms. Reyes-Santiesteban is also calling on the government to ban mefloquine for soldiers or to declare it the drug of last resort. The government, she said, must overcome the “unrepentant culture of denial regarding the drug’s inherent dangers.”

http://www.theglobeandmail.com/news/politics/canadians-concerned-about-anti-malarial-drug-mefloquines-effects-on-armed-forces-poll/article33446165/

'A horror movie in a pill:' make mefloquine last resort for Alberta travellers, critics say

'We haven’t seen the safety concerns in the individuals that we’ve prescribed it for'

By Andrea Huncar, CBC News Posted: Dec 22, 2016 5:00 AM MT Last Updated: Dec 22, 2016 5:00 AM MT


Dr. Remington Nevin is concerned Alberta prescribers are not fully taking into account the level of risk associated with melfloquine outlined in Health Canada's updated drug description.

An antimalarial drug commonly prescribed in Alberta is facing growing calls from critics who want it downgraded as a drug of "last resort" for travellers.

"I am concerned Alberta prescribers are not fully taking into consideration the very significant level of risk acknowledged by the latest product monograph," said Dr. Remington Nevin, a former U.S. Army major and leading expert on the neuropsychiatric side effects of mefloquine.

"The reason Canadian travellers have been placed at risk for the last few years is that … the Canadian government is still in denial about the drug's true dangers."

In August Health Canada revised the drug's prescribing information. The updated label warns that those experiencing side-effects such as anxiety, paranoia, hallucinations, thoughts of suicide and psychotic behaviour must stop using the drug. Side-effects can persist for years or become permanent in some people, it adds.

'The Canadian government is still in denial about the drug's true dangers'
- Dr. Remington Nevin

But Nevin said the updated information was not sufficiently publicized. Canada is "stuck in a culture of denial" because the government fears being held accountable for the events connected to Somalia and mefloquine two and a half decades ago, he said.

In the early 1990s, 900 members of the Canadian Airborne Regiment on a peacekeeping mission in Somalia were among the first Canadians to take mefloquine.

Camel spiders

Former soldier John Dowe said the drug left him with insomnia and nightmares, but for others in his contingent it was far worse.

Dowe recalled how Cpl. Clayton Matchee "wigged out," beating imaginary camel spiders in the bunker where he held a bruised Somali prisoner.


Canadian veteran John Dowe experienced nightmares, insomnia and other side-effects after taking mefloquine in Somalia in 1993.

When Dowe returned an hour later, Somali teen Shidane Arone's lifeless body was sprawled on the ground as soldiers tried to revive him. Matchee, who was charged in the murder of the teen, was found unfit to stand trial after an apparent suicide attempt, which the family questions, caused brain damage. The charges were withdrawn.

Twenty-five years later, the military still considers mefloquine a viable option for soldiers — something Dowe is lobbying to change. The Canadian Department of National Defence says soldiers are free to take another antimalarial medication, however.

"The weight of evidence supports the opinion that the use of Mefloquine by military personnel is not associated with an increased risk of adverse effects associated harm compared to alternatives," the department said in an email to CBC.

'Placing civilians at great risk'

Dowe, who has co-founded the International Mefloquine Veterans Alliance, said mefloquine should only be used by travellers as a last resort.

"It's placing civilians at great risk because the literature is not up to speed as it should be, and as it is internationally," said Dowe, who is also leading the push for an inquiry into the consequences mefloquine had on soldiers during the Somalia mission.


Canadian veteran John Dowe said mefloquine should be prescribed as a last resort for Alberta travelers.

"In doing the research I understood the great gap that Canada is in right now in relation to our allies in the other countries in their proactiveness of removing mefloquine."

In 2013, the US Food and Drug Administration strengthened its warning on mefloquine's label "due to risk of serious psychiatric and nerve side effects". Afterwards, the U.S. Special Forces stopped using the drug altogether.

"Alberta needs a much more prominent and clear statement and directive from Health Canada," said Dowe.

Mefloquine, also known by the brand name Lariam, is one of several antimalarial options that includes doxycycline and Malerone (a combination of atovaquone and proguanil).

Roche, the manufacturer of Lariam, declined comment about the risk allegations. But the drug is still being defended by Alberta health authorities.

'A reasonable choice'

"Mefloquine is actually a reasonable choice and our experience with using mefloquine has been good," said Judy MacDonald, medical officer of health with Alberta Health Services. "From our experience we haven't seen the safety concerns in the individuals that we've prescribed it for."

Prescribing practices did not change after August's update to the label, said MacDonald. She said it wasn't necessary because clients were already being warned about risks and precautions.

MacDonald said mefloquine is the only option for new babies, children or pregnant women, if other risk factors aren't present.


Dr. Judy MacDonald said mefloquine is the only option for some clients.

It is not a good option for anyone with anxiety, active depression or psychosis, which patients are asked about during a "careful risk assessment," she said.

Nurses go over the side effects of mefloquine and those who experience problems are instructed to call health officials. But MacDonald said those kind of calls are "very rare."

Nevin disagrees with MacDonald about the risks.

"It is literally a horror movie in a pill," said Nevin, estimating about a third of patients experience side effects which require them to stop taking the drug.

"And any physician who would recommend this drug to an infant or a preverbal child does not understand the product" label information, he argued.

'Irresponsible and cruel'

Nevin said the updated drug information clarifies that reactions can be permanent. And it advises prescribers to tell patients to stop taking the drug as soon as they experience symptoms such as vivid dreams, insomnia or mild mood changes -- which might be the only warning signs to avoid permanent brain injury.

"I think it is terribly irresponsible and cruel to prescribe this drug to an infant or a preverbal child who may experience horrific side effects and have no way to communicate that to their parents," said Nevin.

The common assumption the drug is safe for people without mental illness "is absolutely not the case," he added.

'The benefits of mefloquine outweigh its risks when it is used as directed'
- Health Canada

Bev Skwernuik said she was convinced she had special powers, bestowed on her by Jesus, after an Edmonton travel clinic prescribed mefloquine in 1998.

Nearly two decades later, Skwernuik, an optometrist who lives in Comox, B.C., is surprised the drug is still widely prescribed and also believes it should be a last resort.

"Mefloquine -- it's Russian roulette," she said. "You don't know if you're going to be the one who's going to have a side effect and sometimes it's hard to feel or see it until it's too late."


Bev Skwernuik said she experienced delusions, hallucinations and paranoia after taking mefloquine prescribed by an Edmonton travel clinic.

In a statement, Health Canada said prescribing information was updated to better emphasize mefloquine's known risks and that certain side-effects can persist for months or years afterwards "and may be permanent in some patients."

The update took into account prescribing information from the U.S. Food and Drug Administration, European regulators and risks of malaria, which killed an estimated half a million people in 2015, according to the statement.

"The benefits of mefloquine outweigh its risks when it is used as directed," the Health Canada statement added.

http://www.cbc.ca/news/canada/edmonton/a-horror-movie-in-a-pill-make-mefloquine-last-resort-for-alberta-travellers-critics-say-1.3908080

Former soldier suffers after taking anti-malaria drug

BY CHRIS DOUCETTE, TORONTO SUN
FIRST POSTED: SUNDAY, DECEMBER 18, 2016 06:21 PM EST | UPDATED: SUNDAY, DECEMBER 18, 2016 07:44 PM EST


Dave Bona, who served with the Canadian Airborne Regiment in Somalia and Rwanda, is convinced the drug, Mefloquine, cost him his military career.

Dave Bona suspected for decades it was the anti-malaria drug he was forced to take while serving in Africa that cost him his military career and left him struggling with neurological and psychological issues.

So when when he was finally diagnosed with Mefloquine neurotoxicity a few months ago, the 49-year-old was relieved.

At least now the former paratrooper, who served with the Canadian Airborne Regiment in Somalia and Rwanda, understood why treatments for post-traumatic stress disorder were not relieving many of his debilitating symptoms.

“There have been periods where I was OK and happy, but for the bulk of the time I was trapped in a depressive state,” Bona said, explaining his daily suicidal thoughts, vertigo, seizures and other issues began long before he was kicked out of the Canadian Forces in 1999.

“I honestly don’t know how I’ve survived,” he added.

Bona wants other veterans to know Mefloquine neurotoxicity can mimic and amplify PTSD.

He has seen “significant improvements” recently with Loreta, a neurofeedback therapy designed for brain injuries.

Military sticks with controversial drug

Despite reports of veterans’ lives being ruined — even lost — after taking Mefloquine, the Canadian Forces will continue to rely on the controversial drug for malaria prevention.

But when our military is deployed on its latest UN mission to Africa in 2017, soldiers will be able to choose to take Doxycyline or Malarone as an alternative.

“As it stands now, it continues to be one of three first line drugs we’ll be using,” Canadian Forces physician Lt.-Col. Andrew Currie said recently.

Earlier this fall, veterans shared tragic stories in front of the Standing Committee on Veterans Affairs in Ottawa, explaining they still suffer psychological and neurological side effects more than 20 years later.

That prompted Canada’s chief of defence staff to request a reassessment of the drug.

A month later, Currie said the review is done and Mefloquine remains the best choice for malaria prevention.

“We have to follow the science,” he said. “So we looked at group studies not individual cases.”

Currie claims recent studies suggest the risk of serious adverse reactions remains “quite low,” between 1 in 10,000 and 1 in 14,000.

“The intent has always been to protect the soldiers against a potentially deadly disease,” he said. “But as with any medication, you have to weigh risk versus benefit.”

About 18,000 soldiers have been prescribed Mefloquine since 1992.

Conservative MP Cathay Wagantall has been in touch with more than a dozen struggling veterans and was “not pleased” the review wrapped up “so quickly.”

“If you look at the world view right now, we are definitely not in line with our allies,” she said, noting a former head of the British army even apologized recently to troops who took Mefloquine under his command when he was unwilling to take the drug.

Canada out of step with allies

With several allied countries now either banning Mefloquine or only giving it to soldiers as a last resort, an expert on the anti-malaria drug is urging Canada to follow suit.

“For nearly 25 years, Canadian officials have hid their heads in the sand,” Dr. Remington Nevin, of Johns Hopkins University, said recently. “It’s a real scandal and it’s quite tragic.”

Nevin, a dual citizen born in Toronto, served as a doctor with the U.S. military in Afghanistan in 2007 where he witnessed the dangerous side effects of Mefloquine on American and Canadian soldiers.

As a leading authority on anti-malarials, he has a keen interest in the Somalia Affair.

In 1993, Canadian soldiers serving in the troubled country, beat a Somali prisoner to death. Nevin said the subsequent inquiry that was shut down prematurely in 1996 should be re-opened.

“You can’t understand the history of Mefloquine use in the Canadian Forces without looking at the critical problems in Somalia,” Nevin said. “Those soldiers were unwitting participants in a fraudulent study.

“It is incredible (no government or military officials) have been disciplined, fired or prosecuted for the events of that era,” he added.

Mefloquine, also known as Lariam, was first used as a malaria treatment by the U.S. military in the ’70s after being hastily approved by the FDA without human trials. In 1989, the U.S. began using the drug for prevention.

Nevin said some side effects of Mefloquine were well known in 1993 when the Canadian military accessed the unlicensed drug through an “experimental trial” for Somalia.

“The Canadian Forces agreed to carefully monitor soldiers but they did not,” he said, explaining Health Canada licensed the drug soon after.

He pointed out in August the Canadian supplier of the drug, AA Pharma, updated its warning for Mefloquine acknowledging hallucinations, paranoia, psychotic behaviour, vertigo, suicide and other adverse reactions may persist years after use.

Dave Bona, one of 900 or so Canadian Airborne Regiment members forced to take Mefloquine before it was licensed, is among the soldiers struggling with some of those side effects.

He recently reached out to former platoon members and of the 10 he contacted, two had killed themselves, six attempted suicide and only one was doing well.

Nevin said that suggests the rate of adverse reactions is much higher than the 1 in 11,000 number Canadian officials cling to.

Mefloquine is now also commonly used by travellers.

But Nevin believes Doxycycline and Malarone are safer options, even though both are more expensive and must be taken daily rather than weekly.

http://www.torontosun.com/2016/12/18/former-soldier-suffers-after-taking-anti-malaria-drug

Pinger,

Canada is still issuing Mefloquine.

I'm going to guess that eventually this will end up before the courts.

" Friday December 09, 2016
The Canadian military is issuing a malaria drug that can produce anxiety, paranoia and psychotic behaviour "

What, was this not discontinued...?

Anti-malaria drug did more damage than it prevented: Canadian vets

FIRST POSTED: SATURDAY, DECEMBER 17, 2016 05:26 PM EST


Some Canadian soldiers who received the anti-malaria drug Mefloquine have reported a number of side-effects including psychaitric disorders.

Dave Bona is still haunted by the horrors he witnessed as a soldier in Somalia more than two decades ago.

Kids being blown up and a fellow paratrooper being killed by an accidental discharge are among the images forever etched in the veteran’s memory.

He self-medicated with alcohol for years because getting “blind drunk” was the only way he could sleep. But the drinking led to “conduct issues,” which saw him stripped of his rank and honour, then ultimately booted from the military in 1999.

Later diagnosed with post traumatic stress disorder, Bona tried pharmaceuticals, counselling and even a service dog. But his anger, suicidal thoughts, seizures, vertigo and other symptoms persisted.

The once proud member of the Canadian Airborne Regiment is now among a growing number of vets who believe they were poisoned by the anti-malaria drug Mefloquine, which they were forced to take before it was licensed in Canada as part of a terribly executed human trial during their ill-fated 1993 United Nations mission.

“If not for that drug, I’d still be in the military,” said Bona, who now lives in Saskatchewan.

Mefloquine, aka Lariam, is now known to have a lengthy list of side effects such as paranoia, confusion, hallucinations and suicide, some of which can continue for years after taking it.

The Canadian government said it is study the drug but still plans to make it one of three to be used during the upcoming peacekeeping mission in Africa.

But Bona said his judgement was impaired by the drug and his difficulty distinguishing fantasy from reality became clear one chilling night in 1993 when he woke up walking barefoot across a darkened military compound in Somalia clutching his fully loaded assault rifle.

“I remember having an overpowering feeling I was going to shoot someone,” Bona said.

Vivid nightmares were so common, especially the night of their weekly dosage, soldiers dubbed them “meflomares.”

Hallucinations were also widespread.

“It was so bad that our platoon commander asked that we be confined to the compound the days we took our Mefloquine, but the request was denied,” Bona said.

The drug’s manufacturer, AA Pharma in Vaughan, updated its known adverse reactions to the drugs in August and include hallucinations, suicidal ideation, depression and panic attacks.

While deployed in Rwanda in 1994 he stopped taking Mefloquine preferring to take his chances with malaria — a fatal disease transmitted via a mosquito-borne parasite.

Donning a maroon beret, getting his jump wings and serving with Canada’s most elite soldiers was Bona’s boyhood dream.

But after his African tours and enduring the shame of the airborne being disbanded, his life was in a tail-spin. His first wife left him and he faced a court-martial.

“I still struggle with being dishonourably discharged,” Bona said.

**********

Death threats forced Marj Matchee to go into hiding with her daughter when her paratrooper husband was tied to the deadly 1993 beating of a Somali prisoner.

But after living with the shame for decades, she is now demanding the Canadian government shoulder some blame for the Somalia Affair.

“It’s been 23 years of denial,” the Saskatchewan woman said recently.

Clayton Matchee was a proud member of the Canadian Airborne Regiment, a loving husband and doting father, but he became angry and withdrew from his family after taking Mefloquine.

“He kept alluding to that drug,” Marj, 54, said, recalling one terrifying night when Clayton was home from Somalia on leave.

“I woke up to him choking me,” she said. “He realized what he was doing and said, ‘Oh my God, I’m in Canada, it’s this f------ drug.’”

When Master Cpl. Clayton Matchee and Pte. Kyle Brown were arrested for killing 16-year-old Shidane Arone, Marj immediately blamed Mefloquine, which was still experimental in Canada.

Her husband, who was “strongly against suicide,” attempted to hang himself in his cell and suffered permanent brain damage that left him unfit to stand trial.

Brown served 40 months in prison and now reportedly suffers symptoms similar to others poisoned by Mefloquine.

Three other soldiers were dismissed from the army for Arone’s death, including an officer who ordered troops to rough up prisoners.

John Dowe, head of the Canadian chapter of the International Mefloquine Veterans’ Alliance, served in Somalia and maintains soldiers of all ranks were affected by Mefloquine.

Dowe remembers Clayton seeing “camel spiders that weren’t there” while guarding Arone, so he has no doubt the drug played a role in the killing.

**********

When Val Reyes-Santiesteban last spoke to her only child, Cpl. Scott Smith, on Christmas Eve 1994 he was making plans for his life after returning home from Rwanda.

“He called to wish me a merry Christmas and he seemed happy,” the Stoney Creek woman recalls.

The 23-year-old paratrooper was found dead from a self-inflicted gunshot wound the next day.

For 20 years his mom has maintained he suffered an adverse reaction to the anti-malaria drug Mefloquine he was forced to take during his two tours in Africa.

“He came home on leave from Somalia and he just wasn’t himself,” Reyes-Santiesteban said.

Before leaving for Rwanda, Smith told his mom Mefloquine was “bad stuff.”

He also told a reporter he experienced hallucinations from Mefloquine in Somalia but was “prepared to endure these side effects” again in order to make a difference in Rwanda.

http://www.torontosun.com/2016/12/17/anti-malaria-drug-did-more-damage-than-it-prevented-canadian-vets

Friday December 09, 2016

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



By Brent Bambury

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."


Mefloquine is one of three anti-malaria drugs used by the Canadian Armed Forces.

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.


Canadian veteran John Dowe is the head of the Canadian chapter of the International Mefloquine Veterans' Alliance.

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 Natural 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."

http://www.cbc.ca/radio/day6/episode-315-military-vs-mefloquine-top-holiday-books-of-2016-harry-benson-standing-rock-tees-and-more-1.3885384/the-canadian-military-is-issuing-a-malaria-drug-that-can-produce-anxiety-paranoia-and-psychotic-behaviour-1.3885389

Accordingly, the goal of the study is not to assess whether to recommend legislative or regulatory amendments to a specific benefit or service, but rather to examine whether existing benefits and services, as designed, can achieve their objectives, as perceived by the intended beneficiaries: veterans and their families
Not with a carrot over my head (NVC). Which benefits can be cancelled upon ministerial review.
Stop wasting money and help out the ones that protect and defend our land (and revert back to the Pension Act policies, i.e. instated by the Queen)
Make the lives of all veterans better.


Is there something I am missing?