Mefloquine, a nightmare drug given to military personnel and civilians

The malaria drug Lariam (mefloquine) is linked to grisly crimes like Army Staff Sgt. Robert Bales’ 2012 murder of 16 Afghan civilians, the murders of four wives of Fort Bragg soldiers in 2002 and other extreme violence.

While the FDA beefed up warnings for mefloquine last summer, especially about the drug’s neurotoxic effects, and users are now given a medication guide and wallet card, Lariam and its generic versions are still the third most prescribed malaria medication in the US. Last year there were 119,000 prescriptions between January and June. Though Lariam/mefloquine is banned in Air Force pilots, until 2011, it was on the increase in the Navy and Marine Corps.

The negative neurotoxic side effects of mefloquine can last for “weeks, months, and even years,” after someone stops using it, warns the VA. Medical and military authorities say the drug “should not be given to anyone with symptoms of a brain injury, depression or anxiety disorder,” reported Army Times—which is, of course, the demographic that encompasses “many troops who have deployed to Iraq or Afghanistan.”

In addition to mefloquine’s wide use in the military, the civilian population taking malaria drugs includes Peace Corps and aid workers, business travelers, news media, students, NGO workers, industrial contractors, missionaries and families visiting relatives, often bringing children.

What makes mefloquine so deadly? It has the same features that made the street drug PCP/angel dust such an urban legend in the 1970s and 1980s. It can produce extreme panic, paranoia and rage in the user along with out-of-body “dissociative” and dream-like sensations so that someone performing a criminal act often thinks someone else is doing it. (“Dust” users were also reportedly impervious to pain and, anecdotally, could pop their own handcuffs.)

An example of such “dissociative” effects is seen in Staff Sgt. Robert Bales’ rampage; according to prosecutors at his trial, Bales slipped away from his remote Afghanistan post, Camp Belambay, in a T-shirt, cape and night vision goggles and no body armor to attack his first victims. He then returned to the base and “woke a fellow soldier, reported what he’d done, and said he was headed out to kill more.” What?

In addition to Army Staff Sgt. Robert Bales’ 2012 attacks and the 2002 Fort Bragg attacks, Lariam/mefloquine was linked, in news reports, to extreme side effects in an army staff sergeant in Iraq in 2005 and to the suicide of an Army reservist in 2008.

Former Army psychiatrist Elspeth Cameron Ritchie, former U.S. Army Major and Preventive Medicine Officer Remington Nevin and Jerald Block with the Portland Veterans Affairs Medical Center agree in a recent paper that mefloquine may be behind “seemingly spectacular and impulsive suicides.” It can produce “derealization and depersonalization, compulsions toward dangerous objects, and morbid curiosity about death,” they write, describing frequent hallucinations “involving religious or morbid themes” and “a sense of the presence of a nearby nondescript figure.” The researchers refer to two reports of people on mefloquine jumping out of windows under the false belief that their rooms were on fire.

In 2009, the Army surgeon general and deputy assistant secretary of defense sent directives making Lariam a last choice drug for troops and last fall the Army banned it for the approximately 25,000 Green Berets, Rangers, Civil Affairs and Psychological Operations soldiers. But since the neurological effects of Lariam can continue indefinitely, troops and veterans may still be under its effects even if the drug has stopped being prescribed.

Lariam/mefloquine is one of five malaria drugs listed by the CDC for people who will be exposed to malaria. Other drugs include Malarone, a combination of the drugs atovaquone and Proguanil, Aralen (chloroquine,) primaquine and the antibiotic doxycycline marketed as Vibramycin. None of the drugs are ideal—Malarone can, for example, have renal effects, and Aralen can have liver, blood and skin effects. Some do not work right away or are ineffective against resistant malaria strains. But the main reason for mefloquine’s historic popularity is that it is taken weekly unlike all the other drugs (except chloroquine) which are taken daily. Some travelers also report that mefloquine is cheaper than other malaria drugs and say they only experience symptoms like memory loss and vivid nightmares. Still, since awareness of mefloquine’s dangers, many users are now required to read and sign an informed consent form.

An early example of public funding of pharma profits

Lariam/mefloquine was an early example of “technology-transfer” between publicly-funded and academic research and Big Pharma, driven by the Bayh-Dole Act of 1980. The Bayh-Dole Act dangled the riches of “industry” before medical institutions just as the former were floundering and the latter was booming, observes Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine. Turning universities into think tanks for Big Pharma has been so profitable, Northwestern University made $700 million when it sold Lyrica, discovered by one of its chemists, to Pfizer enabling it to build a new research building.

Lariam/mefloquine was developed by the Walter Reed Army Institute of Research (WRAIR) in the 1960s and 1970s after a drug resistant strain of malaria did not respond to medications and sickened troops during the Vietnam War. Though Lariam/mefloquine was developed with our tax dollars, all phase I and phase II clinical trial data were given to Hoffman LaRoche and Smith Kline free of charge in what was the first private public partnership between the U.S. Department of Defense and Big Pharma. You’re welcome! It was approved by the FDA in 1989.

Roche, which retained the patent, did well with the government largesse. In 2009, it spent $46.8 billion to buy Genentech (for comparison the entire yearly budget of the National Institutes of Health is $60 billion a year) and its cancer drug, Avastin, makes up to $100,000 per patient per year, despite reports of its limited effectiveness for some cancers for which it is used.

Nor was the testing of Lariam/mefloquine kosher. It was first tested on prisoners and soldiers who are not necessarily able or willing to refuse participation in clinical trials and it was also widely given to Guantanamo detainees. Phase III trials, that are supposed to be conducted on larger patient groups of up to 3,000 people, were not conducted at all, wrote the Journal of the Royal Society of Medicine in 2007 and “there was no serious attempt prior to licensing to explore the potential drug-drug interactions.” In fact, all users “have been involved in a natural experiment to determine the true safety margin,” says the journal, because “Consumers have been unwitting recruits to this longitudinal study, rather than informed partners.” No wonder mefloquine causes adverse effects in as many as 67 percent of users.

As seen with other drugs that have neuropsychiatric effects, like the antidepressant Cymbalta and seizure drug Neurontin, the military, government and Big Pharma blamed the effects on the patients not the drugs. When wives of four Fort Bragg soldiers were murdered during the summer of 2002—one was stabbed 50 times and set on fire—military investigators blamed “existing marital problems and the stress of separation while soldiers are away on duty,” not mefloquine. Right. Three of the four soldiers also took their own lives.

The military, government and Big Pharma similarly blame the current suicide epidemic among military personnel on factors others than the ubiquitous psychiatric drugs in use—even though 30 percent of the victims never deployed and 60 percent never saw combat. A recent five-year study by Pharma-funded academic, government and military researchers about military suicides, for example, does not even consider the drugs given to an estimated sixth of all soldiers almost all of which carry warnings about suicide. Hello?

It is also worth noting that the alarming side effects linked to mefloquine that patients, doctors and public health officials reported for at least a decade, were not acknowledged until profits ran out and Lariam became a generic, as has happened with other risky drugs. When sentiment turned against Lariam in 2008, its manufacturer, Hoffmann–La Roche ceased marketing it in the US and now the words “Lariam” and “malaria” draw no search results on its U.S. website! Who, us?

One group that has tried to raise awareness of the dangers of Lariam is Mefloquine (Lariam) Action, created in 1996 when founder, Susan Rose, noted Peace Corps workers given Lariam were falling ill, medevaced to the states, hospitalized and terminated from service. Rose soon enlarged the scope of Mefloquine (Lariam) Action to include travelers and military personnel.

“This black box [the strongest FDA warning on drug packaging] officially establishes that mefloquine can cause permanent, brain damage and more. It validates what we have been saying since the beginning,” Jeanne Lese, Director of Mefloquine (Lariam) Action told me. The problem is far from solved by the black box, says Lese. “The drug continues to be given out at travel clinics all over the U.S. and elsewhere every single day. What’s more, it is often prescribed with no hint to the patient about the black box, and no screening for contraindications such as history of previous depression or other neuropsych problems.”

Mefloquine’s checkered past

The four Fort Bragg soldiers charged with killing their wives during the summer of 2002 is not the only time Lariam/mefloquine has been in the news. There was also the case of Staff Sergeant Andrew Pogany who volunteered to serve in Iraq in 2003 and experienced such panic and PTSD symptoms in the war theater, he was sent back to Fort Carson and charged with “cowardly conduct as a result of fear.” Pogany and his attorney were able to prove that his reaction probably stemmed from Lariam and he received an honorable discharge. But Pogany, understandably, became a vehement advocate for the rights of soldiers with PTSD, especially those who have been given psychoactive drugs which often make symptoms worse not better.

The wife of a 17-year marine veteran I interviewed in 2011 reported a similar story. After being deployed twice to Iraq and once to Afghanistan, her husband developed extreme PTSD. “He went from being loving on the phone, to saying he never wanted to see me and our daughter again,” the wife said. “He said not to even bother coming to the airport to meet him, because he would walk right past us.” When the couple did reunite, the husband was frail and thin, and “the whites of his eyes were brown,” says his wife. The formerly competent drill instructor became increasingly and inexplicably unpredictable, suicidal, and violent and was incarcerated in the brig at Camp Lejeune for assault in 2011. I asked his wife to ask him during her visits if he had been given Lariam/mefloquine and she said he said yes.

In the nonfiction book, Murder in Baker Company: How Four American Soldiers Killed One of Their Own, Lariam is also raised as a possible factor in the brutal death of Army Specialist Richard Davis. When asked about Lariam in the crime in an interview, the author Cilla McCain said, “Although it was never mentioned in court, I think if this same case were to happen today, it would definitely be considered as a defense. These soldiers were overdosing on Lariam in massive amounts because there wasn’t proper oversight. In reality, proper oversight is impossible in a war zone but steps could have been taken to make sure that overdosing didn’t occur. Even without over dosage the Lariam issue is a volatile one at best and I’m positive we will be hearing more about the damage it has caused for years to come. Some scientists are linking Lariam directly to the historical rise of suicides in the United States.”

As a cloud grows over mefloquine, there is both good and bad news. The good news is in 2013 the Surgeon General’s Office of the Army Special Operations Command told commanders and medical workers that soldiers who have been thought to be suffering from PTSD or other psychological problems or even faking mental impairment may actually be mefloquine victims. The bad news is a new malaria drug developed at Reed during the same time period as mefloquine called tafenoquine is now fast tracking toward FDA approval. Jeanne Lese and Dr. Remington Nevin worry that the new drug has not been adequately tested for the same types of neurotoxic effects seen with mefloquine and that it will become mefloquine 2.0.

Martha Rosenberg is an investigative health reporter. She is the author of Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).