Lariam: The ‘health tragedy’ and the soldiers who pay

Antimalarial intended as “last resort” has been linked to cognitive breakdowns and suicides among military personnel.

Alasdair Soussi - Please do not use
Bill Manofsky is a retired US Navy commander who was given Lariam when he was sent to Kuwait [Alasdair Soussi/Al Jazeera]

Glasgow, Scotland – At 38 years old, the former British Royal Navy engineer has lived much of his adult life in mental torment. Dispatched to Sierra Leone in 2000 as part of Operation Palliser – Britain’s military intervention in the then war-torn African state – the young Englishman spent weeks off the West African coast, performing his naval duties and faithfully taking his weekly dose of mefloquine – the antimalarial drug also known as Lariam.

Some 16 years later, and the one-time sailor’s brush with Lariam continues to haunt him.

Speaking to Al Jazeera on condition of anonymity, the now self-employed aircraft engineer bristles at the mere mention of a drug he blames for his ongoing bouts of anxiety, depression, suicidal and homicidal thoughts, all of which began shortly after his return home from West Africa.

What started as panic attacks that left him unable to travel through tunnels or on trains soon developed into a daily psychological battle that left him barely able to function. He even attempted to take his own life on three separate occasions while still in the navy.

“I subsequently turned to drinking quite heavily,” recalls the engineer, who, previously of good health before taking Lariam, resigned his from the navy at the end of 2001. “I was that on edge – but I didn’t know why.

“[I] started putting two and two together and started digging into what Lariam was doing to people,” he says. That is when he discovered he was not alone.

A drug of last resort

In Britain, the Ministry of Defence (MoD) prescribed Lariam to more than 17,000 troops between April 2007 and March 2015 – though with no data available before 2007, the overall figure is likely to be higher. It remains in use in the British armed forces – to the consternation of many Lariam sufferers and their families – but is not, according to the MoD, the main antimalarial of choice.

The number of people who have suffered side-effects after taking the medication remains unclear, but according to retired Lieutenant Colonel Andrew Marriott, who gave evidence to the inquiry, between 25 and 35 percent of personnel who had been described Lariam were affected.

In May this year, the House of Commons Defence Select Committee criticised the ministry over its distribution of the drug, stating that it should only be used as a “drug of last resort” (PDF).

The drug was developed by the United States Army in the 1970s to protect against the often fatal mosquito-borne tropical disease, and was given to troops from Britain, the US, Australia, Canada and Ireland. Today, it has been linked to cases of mental disorders, suicides and even homicides in the armed forces. The drug has become for leading Lariam expert Dr Remington Nevin, something of an international “public health tragedy”.

Nevin, a postdoctoral fellow in environmental health at Johns Hopkins Bloomberg School of Public Health, told Al Jazeera: “What needs to be understood is that mefloquine is just the latest in a series of synthetic quinine-like antimalarial drugs developed by the US military, initially out of military necessity, dating back to the World War II era, that have shared these toxic properties, and which have been successively withdrawn from use for reasons of safety when their dangers have become more widely known.”

Lord Richard Dannatt, the former head of the British Army, last month admitted he himself refused to take the drug after witnessing its adverse mental health effects on his own son.

The MoD is expected to publish its response to the committee report on September 13.

A public health tragedy

Bill Manofsky is a retired US Navy commander who was given Lariam when he was sent to Kuwait before the 2003 Gulf War. What began as bouts of insomnia, panic attacks and other psychological disorders soon developed into a long-term condition that has left him with vertigo, short-term memory loss, and random tremors in his hands and legs.

“It is really sad that this happened, especially when two safer and more effective antimalarial drugs were available – doxycycline and malarone,” says the 57-year-old, who lives in California.

In the US, Lariam, which was issued a “black box” safety warning by the US Food and Drug Administration (FDA) in 2013, was banned from being dispensed to US Special Forces in the same year. It is used only as a drug of last resort in the US military.

“It has been quite a tragedy for the families, too,” Manofsky adds. “The spouses get back a person who is totally different.”

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In Australia, army Major Stuart McCarthy, 46, has been a high-profile anti-Lariam campaigner. After taking part in an “unethical drug trial” for the antimalarial drug tafenoquine towards the end of a 1999 deployment in Bougainville, Papua New Guinea, McCarthy was prescribed Lariam, which, according to Australian Defence Force is a so-called “third-line agent” – to be used when other drugs are not available  – while serving at the UN Mission in Ethiopia and Eritrea in 2001.

While serving in the UN Mission in Ethiopia and Eritrea in 2001, worrying psychological symptoms began to develop while out on the field, and despite ceasing to take the drug, its side-effects carried on after he returned to Australia.

McCarthy told Al Jazeera that the symptoms “continue to have a debilitating impact on my career, lifestyle and relationships,” adding that his “most debilitating problems are cognitive, including short-term memory and concentration difficulties”.

McCarthy, who says that he is being medically discharged from the army because he is “no longer fit to deploy overseas”, said that after a two-and-a-half-year fight with the Australian Defence Force medical system, he has been admitted into an “acquired brain injury” rehabilitation programme.

“I doubt there will ever be a ‘cure’ for my injury,” he says, “but I am confident this rehabilitation will help me to improve over time.”

A judicial inquiry

For McCarthy, who has since served in Iraq and Afghanistan, his ongoing commitment to highlighting the plight of those impacted by Lariam has included giving testimony to an Australian Senate inquiry, where he called for “a judicial inquiry into the use of these drugs in the Australian Defence Force” believing that “it is likely that criminal offences have been committed by numerous government officials”.

In Britain, challenges to the government’s Lariam policy are just as strong. When contacted by Al Jazeera, a British defence ministry spokesperson said: “The majority of personnel receive alternatives to Lariam, and it is only prescribed after an individual risk assessment. We have a duty to protect our personnel from malaria, and in some cases, Lariam, which continues to be recommended as safe by respected bodies, including Public Health England, is the most effective way of doing that.”

The ministry has also established a “Mefloquine Single Point of Contact”, which provides information for former and serving military personnel who have concerns about their experience with the drug.

Roche pharmaceuticals, Lariam’s manufacturer, forwarded a media statement to Al Jazeera issued last August that states the company “agrees with the findings of the defence committee’s report … that Lariam should only be prescribed following an individual risk assessment, to those unable to tolerate other treatments, and only after the patient is made aware of alternative treatments”. 

The company added that it has “produced a guide for healthcare professionals … intended to aid compliance with warnings about risks [of using the drug] and to ensure patients are more aware of the neuropsychiatric side effects and to react promptly when these occur.”

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Yet, for the one-time Royal Navy engineer, who says that he wasn’t prescribed Lariam by a doctor or warned of any potential side effects, such words ring hollow.

“I’d rather have contracted malaria and died than have to go through every day under a big dark cloud, having suicidal and homicidal thoughts,” he stated.

Manofsky contends that justice for him and fellow sufferers will only “be served when all the global defence and government establishments provide proper healthcare to all those who took mefloquine – no expense spared”.

“If they can spend trillions on these wars, they can spend a little more to help us out.”

Follow Alasdair Soussi on Twitter: @AlasdairSoussi

Source: Al Jazeera