Politicians of all stripes are asking the federal Health Minister to take another look at the potentially harmful effects of an anti-malarial drug that some veterans say permanently damaged their brains and contributed to the violence that erupted during the Somalia mission of the early 1990s.
At the same time, a proposed class-action lawsuit launched against the manufacturer of mefloquine and the Defence Department on behalf of veterans who say they still suffer repercussions from the pills they were forced to take on overseas deployments has been given new life as more former soldiers step forward to say they too were harmed.
The controversy around mefloquine, a drug marketed as Lariam that is still being offered to Canadian troops when they are sent to countries where malaria is prevalent, has been brewing since 1992 when a Somali teenager was beaten to death by Canadian soldiers. Veterans of the mission blame the drug for psychological damage that may have caused the aggressive behaviour.
The Commons Veterans Affairs committee, which is studying mental health and suicide prevention among former military personnel, wrote to Health Minister Jane Philpott last week to request that "the effects of the anti-Malaria drug mefloquine be examined in greater detail."
The committee heard this fall from several veterans who told heart-wrenching stories about what they describe as the after-effects of the medicine including tinnitus, psychosis, paranoia and an inability to control their tempers. The testimony shocked some MPs and moved at least one to tears.
"I write to you in my capacity as chair in order to bring forward the concerns raised with regard to the historic and continuing use of mefloquine as an anti-malarial prophylaxis," Liberal MP Neil Ellis wrote in the letter to Dr. Philpott.
Chief among the concerns raised at the committee hearings, wrote Mr. Ellis, were "neuropsychiatric reactions, questions over labelling and prescribing practices, paucity of empirical and peer-reviewed scientific evidence concerning neurotoxicity, and difficulties in finding potential treatment plans for those that may have persistent and lasting adverse symptomatology that could potentially be linked to the use of mefloquine."
When asked for her response to the letter, Dr. Philpott's staff turned the matter over to communications staff within the health department who said: "Health Canada continues to monitor the safety of mefloquine and will take action as necessary to make sure the benefits continue to outweigh its risks."
It wasn't until August of this year – three years after similar warnings were issued in the United States – that Health Canada posted a notice saying the drug can cause adverse neuropsychiatric reactions "that have been reported to continue many years after mefloquine has been stopped" and that "permanent vestibular damage has been seen in some cases."
A group of veterans is now calling for an inquiry into what role the medication might have played in Somalia, and for the government to contact troops or veterans who were required to take mefloquine to determine if they suffered long-term consequences. They also want more research to develop better diagnosis and treatment of the effects.
Meanwhile, as in Britain, Australia and the United States, some Canadian veterans are turning to the courts.
A class-action lawsuit is being prepared on behalf of a veteran of the mission to Somalia where soldiers were ordered to take the drug as part of a clinical trial even though the Defence Department did not, as required, obtain their prior consent or monitor the outcomes and effects. The suit was actually launched some time ago but sat dormant until this summer when some of the veterans felt ready to tell their stories, said Wayne Stickland, a lawyer with Larmer Stickland in North Bay, Ont.
Mr. Stickland said the suit names the Department of National Defence and Hoffman-LaRoche, the drug's manufacturer. The hope, he said, is to have the class-action certified in 2017. "It encompasses the deployment to Somalia and subsequent" missions, said Mr. Stickland. "So anybody who took mefloquine, either willingly or unwillingly – we say unwillingly – would be a potential class member."
The Commons Veterans Affairs committee also heard from Brigadier-General Hugh MacKay, the military Surgeon-General, who said the long-term negative effects of mefloquine have not been proven by science – a position he reiterated last week in an interview with The Globe and Mail.
Different studies have arrived at different results.
A research paper released this month by the Armed Forces Surveillance Branch of the Defence Health agency in the United States that looked at the effects of the drug on thousands of U.S. soldiers who took it between 2008 and 2013 found that mefloquine was no more likely than the two main competing anti-malarials to cause neuropsychiatric issues.
But the incidence of both post-traumatic stress disorder and psychosis were significantly higher among non-deployed troops that took mefloquine than those who took atovaquone/proguanil (Malarone), a drug which is now more commonly used by Canadian troops.
Remington Nevin, a doctor and researcher at the Johns Hopkins University Bloomberg School of Public Health in Maryland who has studied the effects of mefloquine for nearly a decade, said there was a lot of "crude" data in the study that could be used to support both sides of the argument.
But, said Dr. Nevin, the fact that non-deployed soldiers taking the drug were significantly more likely to get PTSD suggests there is something about mefloquine that can cause that to happen. "How," he asked, "do you get diagnosed with post-traumatic stress disorder if you are not exposed to a trauma?"