Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)

[stealthylizard]

My only reaction to mefloquine was diarrhea, a couple days after taking it, each week.  Thankfully that ended by the time I deployed.  Unfortunately, no vivid dreams.

 

[TN2IC]

My only reaction to mefloquine was diarrhea, a couple days after taking it, each week.  Thankfully that ended by the time I deployed.  Unfortunately, no vivid dreams.

I was the same. Nothing really strange.

 

[The Bread Guy]

Bumped with the latest call for a ban, from an interesting quarter ...

Former soldiers from the disbanded Canadian Airborne Regiment are pushing for a ban on the controversial anti-malaria drug mefloquine that some say plagued the disastrous 1993 Somalia mission.

Two events — the 2013 U.S. military ban on mefloquine for Special Forces and new scientific studies showing toxicity from the drug can cause permanent brain damage — should force a review of Canadian policy, says John Dowe, a former airborne soldier.

Two former military doctors also agree, given the new studies show evidence of long term, adverse effects similar to symptoms linked to post-traumatic stress disorder.

Dowe was witness to the horrific events in March 1993 — the beating death by two airborne soldiers of Somali civilian Shidane Arone, who stole into the Canadian desert compound in Belet Huen.

And he thinks mefloquine, with its many adverse side-effects, played a role in the appalling conduct of the two soldiers. Those side-effects include nightmares, insomnia, depression, cognitive impairment, mood swings and aggression.

Last fall, Dowe began to work with the International Mefloquine Veterans Alliance that is calling for a ban of the drug “in military forces worldwide.”

There are advocacy groups in Australia, the U.K., and Canada, Dowe said ...

More from the same reporter, speaking to Kyle Brown.

 

[AirDet]

This definitely something for us to keep an eye on. Most of us here have been on it over the years.

I remember having some really cool "day-mares" on it in East Timor. We often asked what other effects it was having on us.

 

[mariomike]

May 25, 2016

Risky anti-malaria drug given to thousands of Canadian veterans
https://www.thestar.com/news/world/2016/05/25/risky-anti-malaria-drug-given-to-thousands-of-canadian-veterans.html
Dave Bona, a veteran of the Canadian Airborne Regiment, says the Canadian military should follow the recommendations of a new U.K. report on mefloquine.

For 12 years, Bona said he took every treatment possible for PTSD, but he got little relief until his long-time psychologist told him his symptoms matched mefloquine toxicity.

 

[sidemount]

I am very glad i opted not to take it when I went to the stan....I was given doxycyline(spelling?)  since I am a diver and would be diving on hlta. And even then, after a week of not seeing mosquitos i stopped taking that as well. After hearing the stories of wacky wednesdays and all the reports on the dangers of it...I cant believe it was given to us

 

[medicineman]

I am very glad i opted not to take it when I went to the stan....I was given doxycyline(spelling?)  since I am a diver and would be diving on hlta. And even then, after a week of not seeing mosquitos i stopped taking that as well. After hearing the stories of wacky wednesdays and all the reports on the dangers of it...I cant believe it was given to us

Anopheles mosquitoes are night biters...probably wouldn't have seen many.  Of course, certain altitudes and season also decrease odds of seeing them/getting bitten by them.

As I tell my patients "All substances are poisons...There are none that are not...The dose differentiates a poison from a cure."  Yes even, oxygen and water are poisonous if taken inappropriately.  I'm still amazed at how many folks I'd see daily blaming their anti-malarials on anything or everything, yet guzzle down unquantifiable amounts of dietary supplements, alcohol, anti-inflammatories, etc.  Having seen malaria first hand on a number of occasions and a grandfather that was still getting cycling fevers 50 years after contracting it during the Second World War in SE Asia, I get more than annoyed from seeing people basically suffering from a self inflicted injury because their cousin's boyfriend's sister's girlfriend's uncle's brother in law had some problems with a drug.  Things were getting so bad in the US military at one point that there were parades daily/weekly for whatever drug was required - I witnessed this in Haiti with some Marines stationed near us.  The Commandant of the USMC decreed that anyone that got malaria from not taking their meds would be charged and their immediate commanders would also be charged, as a lot of folks were getting knocked out of action in Afgh and Iraq.

Some people are in fact more prone to problems than others, as after market research showed.  This is actually quite similar to other drugs like Zyban, where I've had a lot of experience with smoking cessation of people becoming maniacal because their brain chemistry was already messed up with unreported/underdiagnosed mental health issues.  It is for this reason there is a special screening for anti-malarials alone on a deployment DAG, with the meds being tailored based on general health issues and the sensitivity of the malaria organisms where you're going.

Anecdotally, I used mefloquine for 3-4 months in Kabul and only once did I remotely have anything resembling hallucinations - I get more vivid dreams taking melatonin than ever with Lariam.  I know friends that had some funky dreams and very few folks I looked after that had any real issues with the stuff.  Not so anecdotally, people are very varied in how they handle a wide variety of medication, especially if they're taking stuff over the counter and don't happen to mention it during a screening or they add alcohol to the mix.  For what it's worth, I still recommend it to folks civvy side if that's what the stuff is sensitive to where they're travelling...difference is of course, I still screen the snot out of them and make sure they're well aware of the side effect profile.

One last thing - beware the single article about someone with an axe to grind and a potentially large monetary settlement involved...

$0.02 Cdn

MM

 

[sidemount]

To me it was a risks/benefits analysis. After reading about the possible side effects especially wrt diving i opted from the ease of once a week to a (imo) safer once a day pill. Even then after a short time i opted away from that. Would I do it again....depends on the situation....would I ever take mefloquine....no, too much of a risk again imo.

YMMV

 

[Humphrey Bogart]

To me it was a risks/benefits analysis. After reading about the possible side effects especially wrt diving i opted from the ease of once a week to a (imo) safer once a day pill. Even then after a short time i opted away from that. Would I do it again....depends on the situation....would I ever take mefloquine....no, too much of a risk again imo.

YMMV

What if you're ordered to take it?  Oh wait this is the CAF, where orders are just suggestions  ;D

 

[Journeyman]

.....yet guzzle down unquantifiable amounts of dietary supplements, alcohol, anti-inflammatories, etc.

  Hell ya!!  :cheers:


Oh, you meant that as a negative thing

 

[Humphrey Bogart]

  Hell ya!!  :cheers:


Oh, you meant that as a negative thing

Ibuprofen is like my go to hangover cure.  Lately I've been taking it a lot  :cheers:

 

[Journeyman]

Ibuprofen is like my go to hangover cure.  Lately I've been taking it a lot  :cheers:

Ah, well once you find stasis by eliminating that nasty "sobering up" phase.....    ;D

 

[medicineman]

What if you're ordered to take it?  Oh wait this is the CAF, where orders are just suggestions  ;D

To me it was a risks/benefits analysis. After reading about the possible side effects especially wrt diving i opted from the ease of once a week to a (imo) safer once a day pill. Even then after a short time i opted away from that. Would I do it again....depends on the situation....would I ever take mefloquine....no, too much of a risk again imo.

YMMV

Interesting question from HB - if it were the only drug the local organisms were sensitive to and you were ordered to take it but didn't AND then got sick and were off duty for a long time and or repatted as a result, if I were your boss I'd charge your ass.  If the malaria threat were high and you didn't want to take it and said so, I'd ensure you weren't deployed and make a NTF as to why...and ensure that any time there was a mission to a tropical area, you wouldn't go.  As a medical person, I could probably make a case for a geographic PCat for someone who won't take anti-malarials...kinda like we do with folks with bad frostbite.  It's like with immunizations - after a certain point you don't get a choice in the matter.  Ok, well you do sort of - take em or leave...the military.

Also as an observation, you should be probably choosing things you take/do around operational roles first, not HLTA, you know, since the op has primacy over your vacation IMHO.

To all you Ibuprofen or Naproxen abusers, if I had a dime for every case of GI bleeding, gastritis or high blood pressure I'd seen related to over use of anti-inflammatory drugs, my job would be a hobby and Mike B. here would be very rich since I'd have bought the site off of him.  Sadly, I still have to wait to win the Lotto Max for that to happen.

MM

 

[Fishbone Jones]

It's not a single article. The US and the British have recognised the problems and have stopped issuing it. I know people that have claimed no problem and others that were totally fucked for three days every week after taking it. ÝMMV. Just because you had no problem doesn't mean others didn't. I've never seen a medic, especially a senior one, diagnose a group of people, over the Internet, based on their own experience.

Let's also not forget how the CF lied to get the stuff into Canada by saying it was for medical trials through Health Canada and then issued it to guinea pig soldiers . There are no test results at either organisation . So much for studies and those injured by the callous disregard of the liberal government of the time and others after them.

 

[Fishbone Jones]

This thread is about mefloquine, it's effects and what results are affecting people. Not someone's adherence to the Code of Service Discipline.

---Staff---

 

[medicineman]

It's not a single article. The US and the British have recognised the problems and have stopped issuing it. I know people that have claimed no problem and others that were totally ****ed for three days every week after taking it. ÝMMV. Just because you had no problem doesn't mean others didn't. I've never seen a medic, especially a senior one, diagnose a group of people, over the Internet, based on their own experience.

Let's also not forget how the CF lied to get the stuff into Canada by saying it was for medical trials through Health Canada and then issued it to guinea pig soldiers . There are no test results at either organisation . So much for studies and those injured by the callous disregard of the liberal government of the time and others after them.

I never made a diagnosis - an observation...and oddly that observation is based on not only my own experience with the stuff, but my experience prescribing it and my experience dealing with patients that have been on it, often more than once.  I read all the testimony from the hearings in Parliament back in the 90's - it was pure BS ass covering from both sides of the coin.  I've also read a large number of articles, some I'd call quality ones and others I'd call sensationalist fire starter.  All, including the monographs from the 90's state that there are potential neuropsychiatric issues with using it...oddly enough, worsened by the effects of alcohol, something of an issue with both Canadian and British forces up until recently...and all US/UK/Cdn forces while on leave.  Not so funnily enough, those same side effects are prevalent in certain population groups with a couple of very commonly prescribed antibiotics in Canada and the world over...but I've yet to be called in front of a Ministerial Inquiry/Inquisition because I made some folks see purple elephants or ghosties that weren't there by following what is considered standard of care with those drugs.  I stopped the medications and switched to one of the alternatives...which if people on mefloquine had actually asked, would have happened and continues to today, since most of the drugs used for prevention cause a lot of gut rot and other issues, including neuropsychiatric ones.

As for the rather emotional statement of yours about guinea pigs - something not for a rational/logical debate on anything, least of all here - the actual human guinea pigs were not in fact Canadian or British or American soldiers - they actually were US federal penitentiary inmates in the 70's while the drug was undergoing its Phase III trial.  It was based on that human safety trial that it was released to the public...and to the US Army for use in Vietnam, where many soldiers were being incapacitated or worse by various strains of falciparum malaria.  Non soldiers were using it for quite sometime in a wide variety of countries long before it landed here for use.  In the same vein, you may or may not have noted that many of our drugs or devices used in the CAF over the years were allowed to bused under Health Canada's Special Access Program.  Things like Quik Clot, Combat Gauze and other hemostatic agents, CAT or SOF-T's, morphine and valium auto injectors, HI-6, and pyridostigmine to name a few, were not licensed in Canada for what they're intended for up until recently (IIRC, the CBRN stuff still isn't - someone can correct me if I'm out of date there), yet was fired out the door to make sure soldiers had stuff to protect themselves, treat themselves or prevent badness from happening to them if they were exposed to it.  Believe me, the only complaints I heard in the early 2000's were about why we didn't have some of this stuff.

To make a long story short, while I'm sure there are a good number of people out there who have had issues with this stuff, I think you'll find that there are an awful lot more that didn't.

Lastly, I hope you didn't bruise your teddy when you threw him in the corner with your last post - a very legitimate question was asked and answered - the optics are that you didn't hear what you wanted to hear and you pulled your Mod Card out.  I'm not usually one to complain about things here, but, IMHArmyO that was offside.

:2c:

MM

 

[Fishbone Jones]

The Staff warning was to keep the thread on track as some were starting it down the path of obeying orders, legal scenarios, etc. That's why it was a stand alone post. Accusing me for doing my job, well, that's what's offside.

BTW, I don't have a teddy bear. I killed him years ago. His head is on the wall of my mancave and the rest of him is vacuum packed in the deep freeze. (Technically, I still have a teddy bear but in name only)

I just found it odd the a senior medic would dismiss people out of hand before ever meeting them. No matter what they've seen or done. Perhaps I misread and apologize if I did.

The rest of the stuff (auto injectors and such) is really just a straw argument and really doesn't mean anything to the subject.

But if you say the shit is good to go, I wonder why all these countries are withdrawing millions of dollars worth of the stuff. If you have inside info as to why they are so mistaken, I'd like to hear it. Seriously. I watched lots of friends do the Dr Jekyll/ Mr Hyde scenario when they were taking it. Including myself, which may explain my passion for the subject.

 

[medicineman]

One of the reasons it's being withdrawn from first line use is newer agents are finally coming on the market that will hopefully fill that gap - the problem is that it is still considered one of the most effective first line agents for multidrug resistant falciparum malaria, which is the stuff that kills you and causes more problems more frequently than the other 4 species.  I did a travel medicine consult on someone not long ago, and the US CDC travellers website still had it as a drug of choice for sub-Saharan Africa, where these folks were going.

The other reason is the public outcry over the stuff being used by the armed forces of various nations and having (what appears to be) an oddly higher than normal side effect occurrence rate than in the general civilian populations being prescribed the medication.  Some of that I believe (my opinion only) is because of exposure issues to things that cause PTSD, and it magnifying it because of it's affect on the central nervous system.  Don't forget, a lot of these drugs have to cross the blood brain barrier because you can get cerebral malaria as well, which as you might imagine is quite serious.  Add some hallucinations, lack of sleep and increased anxiety because of those as well as where you are, you have a potentially nasty cocktail of problems that might be brewed in some folks.  The other issue with our military populations is a preponderance for alcohol consumption - this drug, especially in those that are having higher psychiatric side effects, doesn't mix well with booze AT ALL.  It's cleared by the liver first off, so it's competing with the alcohol and secondly, the alcohol has disinhibitory effects and messes with the sleep cycle, so people are more apt to freak out, since the stuff isn't clearing the body the way it's supposed to.

I'm probably one of the least dismissive medical people you'll meet...I can be quite blunt with people about what's wrong with them and what they should do about it, but that's after I've heard them  out and looked them over.  One of the problems with this particular issue is the emotion it brings out in people...the other side of it is the problem of "association doesn't always mean causation" when it comes to this problem, since there are many factors involved.  Your comment about the Special Access Program actually has much relevance to this topic, since pyridostigmine bromide, a drug licensed in Canada and many other places to treat myasthenia gravis, a neuro muscular disorder, is NOT LICENSED for use as a nerve agent protective agent, but was granted special access due to animal research and mechanism of action.  It was used during Desert Storm by all coalition forces and was something thought to have a role in so called Gulf War Syndrome...something we don't hear about as much.

Lastly and most importantly, THANK YOU FOR YOUR APOLOGY and thanks for hearing me out.

MM

 

[BigDaddyFatback]

http://www.theglobeandmail.com/news/politics/sajjan-puts-onus-on-troops-while-defending-use-of-harmful-malaria-drug/article32846896

I and many others have taken this drug. The sell at the time was take it or get malaria. Complications from malaria may not be pensionable if you turned down the mefloquine.

I don't remember really having a choice around taking it either.

What is everyone else's experience around this issue?

 

[RedcapCrusader]

Another item of interest:

Veterans urge second look at soldier’s role in torture death of Somali teen in light of malaria drug’s side effects

Sheila Pratt, Postmedia News
Monday, Nov. 14, 2016

SASKATOON — Former Canadian Airborne soldier Clayton Matchee lives in a North Battleford, Sask., home afflicted with brain damage from a suicide attempt — a desperate act after he was charged in the murder of a Somali teenager.

That was more than 20 years ago, during Canada’s ill-fated Somali mission. Since then, Matchee’s name has carried the shame of that episode of Canadian military history.

But there’s a move afoot to change that view. Some of his fellow soldiers and a prominent U.S. medical expert now believe Matchee was experiencing severe psychological side effects of the controversial antimalarial drug mefloquine when he was involved in the beating death of Somali Shidane Arone in 1993.

Those veterans urged federal MPs on the parliamentary committee on veterans affairs to consider re-examining the incident in light of new research on the drug’s harmful side effects.

Lalancette changed his mind after learning of new research into the side effects of mefloquine, which include heightened aggression, paranoia, anxiety and vivid dreams.

“I feel shame because I put blame on Clayton Matchee and (Edmonton soldier) Kyle Brown,” Lalancette told the veterans affairs committee. (Brown spent four years in jail for his role in the beating death.)

“We should reach out to the victims of this pill and the first two would be Kyle Brown and the Matchee family,” Lalancette said.

In 1992-93, the 900 Canadian Airborne soldiers were among the very first Canadians to take mefloquine as part of a clinical drug trial run by the Canadian army. The side effects were not well understood or explained to soldiers.

Some of his fellow soldiers and a prominent U.S. medical expert now believe Clayton Matchee, shown here at a 2004 hearing in Saskatoon, was experiencing severe psychological side effects of the controversial antimalarial drug mefloquine when he was involved in the beating death of Shidane Arone in 1993.
That’s why the Matchee case should be reopened, said Dr. Remington Nevin, the leading U.S. expert on mefloquine’s neuropsychiatric side effects.

“I feel confident I can render an opinion as to whether his behaviour during that time may have been in some way affected by the drug,” Nevin told the MPs on the committee.

Given the new research into the drug, “many of the points of confusion that dominated discussion then no longer apply,” he said.

“We could come to a more solid mutual conclusion about the events of that day and the role of the drug in his particular case,” Nevin told the committee.

Leon Matchee, father of Clayton Matchee, reacted cautiously to the suggestion that his son’s case should be reopened. After so many years, it is difficult to hear about those terrible events again, he said in a phone call from his home in Meadow Lake, Sask.

John Dowe was one of the few Canadian Airborne soldiers to witness the beating of the Somali teen, who had stolen supplies from the Canadian Forces’ compound. He’s also convinced Matchee was hallucinating at the time and that his heightened aggression was a result of the drug’s side effects.

He described Matchee striking the bunker walls and the prisoner Arone with a wooden baton, calling out that he was killing camel spiders when clearly there were no spiders in the bunker.

“Him beating spiders that were not there — he was hallucinogenic,” Dowe said.

The 1996 Somalia Inquiry into those fateful events was shut down just a few days before evidence on mefloquine was to be heard, former Canadian army psychiatrist Greg Passey told the committee.

The inquiry commission’s final report said it was “not able to explore fully the impact of mefloquine.” The committee said it could only report some “general conclusions.”

“If mefloquine did in fact cause or contribute to some of the misbehaviour that is the subject of this inquiry, CF personal who were influenced by the drug might be partly or totally excused for their behaviour. However we were not able to reach a final conclusion on the issue,” the report said.

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