Mefloquine (often sold under the brand name of Lariam) was first developed in the 1970s by the U.S. military as synthetic analogue to quinine. As the drug of choice in treating chloroquine-resistant malaria and as an oral preventive agent, mefloquine is still widely prescribed despite a growing controversy over health problems and bizarre acts of violence linked to the drug. After a 2013 ban by the U.S. military on mefloquine for Special Forces soldiers and warning from the U.S. Food and Drug Administration that mefloquine can have permanent neurological side effects - including hallucinations, depression, anxiety, and dizziness, former soldiers from the now-disbanded Canadian Airborne Regiment are calling for a total ban by the Canadian Forces.
The Airborne Regiment was disbanded following the disastrous Somalia Affair including with incidents of shocking violence such as the torture-murder of Somali teen Shidane Arone in 1993. Former members of the Regiment are now speaking out on the role mefloquine may have played in the violence and how easily its side effects can be misdiagnosed as similar conditions such as posttraumatic stress disorder (PTSD). John Dowe, who personally witnessed many of the incidents over which the Regiment was disbanded, has been working with the International Mefloquine Veterans Alliance on a call for a worldwide ban on mefloquine use in the military. Dowe is also calling for a formal review on mefloquine use in the Canadian military over suggestions that the drug was improperly prescribed to soldiers.
Medical researchers have found that mefloquine has neurotoxic properties, unlike other anti-malaria drugs. They suggest that this makes is almost impossible to safely dispense the drug when troops are deployed in military situations. Part of the problem in dealing with mefloquine side-effects in soldiers is that the often-macho military culture makes them less likely to admit to experiencing emotional problems or nightmares. Vivid dreams, which is one of the key indicators that someone is vulnerable to mefloquine's influence, are fairly common in combat situations and can often be misattributed to stress. Military doctors were also reluctant to take soldiers off mefloquine due to the lack of real alternatives in the field.
Last year, a parliamentary committee in the U.K. began an inquiry into how the British military ignored proper guidelines in dispensing mefloquine to all British soldiers being sent to malaria-prone regions. Despite being warned by the drug manufacturer Roche that all soldiers receiving mefloquine would need to be individually assessed for preexisting mental health problems such as depression and would also need to be monitored for potential side-effects, the drug was simply handed out to soldiers indiscriminately. British Defense Minister Mark Lancaster later issued an apology to affected British soldiers.
Much like with the British military, soldiers of Canada's Airborne Regiment being deployed to Somalia were also given mefloquine without any special assessment or monitoring of potential problems. According to one medic on the Somali mission, mefloquine was simply included as part of a weekly "sandwich bag" with no mention of possible side effects. Many of the soldiers experienced "meflomares" - nightmares linked to mefloquine exposure and some are still experiencing problems decades later.
John Dowe and fellow Airborne veterans also suggest that mefloquine may have played a direct role in Shidane Arone's beating death since the two soldiers involved had both been taking it at the time (Master Corporal Clayton Matchee and Private Kyle Brown were later charged with homicide). Other soldiers who had been implicated in the killing had also been taking the drug. Among the revelations that came out in the later investigation of the "Somalia affair" was that the soldiers on trial had been used as "guinea pigs" testing mefloquine's effectiveness in preventing malaria at the time the murder occurred.
Despite the warnings and ongoing investigations, mefloquine continues to be used by the Canadian military as a front-line anti-malarial agent along with other drugs that have fewer side-effects. Given the warnings issues by military forces in other countries however, fewer soldiers are taking it these days. A spokesperson for Canada's Defense Department says that only five percent of military personnel are using the drug when deployed in countries such as Afghanistan.
Whether or not mefloquine is dropped for use in future missions, the long-term consequences for veterans who had used the drug in the past are only just beginning to be understood. Considering the large number of veterans being treated for PTSD and other mental health problems linked to serving overseas, identifying the ones who are actually dealing with mefloquine exposure may well prove to be impossible.