Former members of the Canadian Armed Forces want the federal government to reassess the effects of mefloquine on troops who took part in the ill-fated Somalia mission in the 1990s now that Health Canada has agreed that the drug, which was forced upon those soldiers, can cause serious psychological impairment and permanent brain damage.
An inquiry, they say, is needed to determine what role the drug might have played in the behaviour of Canadian soldiers who murdered a Somali teenager, an act that effectively ended the mission.
Health Canada's warning comes after years of denial by Ottawa that mefloquine poses any long-term detrimental effect – a denial that is still being echoed at Veterans Affairs and by the Defence Department even as some of the veterans who took the drug say their lives have been ruined by it.
Mefloquine continues to be offered as a preventive medication to Canadian troops who are sent to countries where malaria is prevalent, despite the fact that Health Canada quietly acknowledged in August that the drug can cause irreparable harm.
A new, detailed description of the drug's possible effects issued by AA Pharma, mefloquine's sponsor, and accepted by Health Canada on Aug. 4, says: "In a small number of patients it has been reported that dizziness or vertigo and loss of balance may continue for months or years after discontinuation of mefloquine and, in some cases, vestibular damage may be permanent."
The description says mefloquine use can lead to anxiety, paranoia and depression as well as hallucinations and psychotic behaviour – the same psychiatric symptoms reported by some of the soldiers who participated in the Somalia mission in the early 1990s, about 900 of whom were required to take the drug as part of a poorly monitored clinical trial.
The update came three years after the United States Food and Drug Administration issued similar warnings.
John Dowe, a Somalia vet and a member of the International Mefloquine Veterans Alliance, a network of veterans, families and friends affected by mefloquine, said the Health Canada revision was announced with little fanfare. "It kind of went under the radar," he told The Globe and Mail.
In addition to an inquiry, Mr. Dowe said, "We also want outreach, a call-out, a registry, for all those who took mefloquine by Health Canada, DND and Veterans Affairs so that people can be brought back in to determine their present condition; do they have mefloquine intoxication? And we want research, research, research so we can develop diagnoses and proper treatment."
During the Somalia mission, Master Corporal Clayton Matchee and Private Kyle Brown were charged in the beating death of Shidane Arone, a 16-year-old Somali. A previous inquiry into what became known as the Somalia Affair was cut short in 1997 before it had time to fully examine whether mefloquine was responsible for the distorted state of mind of the soldiers involved in that crime.
The troops who were deployed to Somalia were required to take mefloquine even though it had yet to be licensed for use in Canada. The government was upbraided in a 1999 Auditor-General's report for not obtaining the consent of the soldiers and for not monitoring the drug's efficacy and the side-effects. The Defence Department responded to that audit by saying "the health and safety of Canadian Forces personnel were not compromised."
But some of Somalia veterans, and others who took the drug in postings such as Rwanda and Afghanistan, say they have not been the same since.
Several of them recently appeared before the Commons Veterans Affairs committee to say they have suffered for years from depression, irritability, hyper-vigilance, sleep disorders and aggression. Dave Bona, a former member of the now disbanded Canadian Airborne Regiment involved in the Somalia mission, told the committee he tracked down 10 of the 28 men in his platoon and found that two have died by suicide, six have attempted it, and two others have suffered psychological issues.
But, three weeks after Health Canada posted the update indicating that the drug could cause permanent injuries, Veterans Affairs Minister Kent Hehr wrote to Mr. Bona saying: "A review of the scientific literature has shown that there are no long-term effects from taking mefloquine."
It is unknown whether anyone at the Veterans Affairs department was told by Health Canada about the revision to the mefloquine labelling. A spokesman for the minister said Friday that "the minister's office would not have been made aware of the update at Health Canada as Veterans Affairs wouldn't have been initially advised since the department doesn't prescribe drugs."
The Department of National Defence is also apparently unaware of the new warnings. Brigadier-General Hugh MacKay, the commander of the Canadian Forces Health Services Group, told the same Commons committee two weeks ago that mefloquine currently comprises about five per cent of all anti-malarial medications prescribed to Canadians military personnel.
Although the military is aware of the "potential short-term side effects of mefloquine," and of "the assertions of some regarding their theories that mefloquine might cause long-standing neurological damage and mental-health issues," said Brig-Gen. MacKay, "our assessment of their assertions at this time is that they are not sufficiently supported through direct scientific evidence for us to remove mefloquine as an option."
Brandon Kett was given mefloquine when he was sent to Afghanistan in 2007. Mr. Kett had asked to take another anti-malarial drug but, he told The Globe, mefloquine was what was issued at the remote base where he was stationed. Today, he said, he suffers from dizziness, tinnitus, depression, anxiety and paranoia.
Mr. Kett was diagnosed as having post-traumatic stress disorder, many of the symptoms of which mimic those associated with mefloquine toxicity. But when he suggested to DND medical staff that he might have mefloquine poisoning, he said, "they basically ignored me and just continued on with their PTSD treatment because they aren't allowed to validate the injury to us. So they have no treatment options."
Doctors say the counselling treatments that work for people with PTSD can actually exacerbate the problems of someone who has brain damage as a result of taking mefloquine because, when the treatment proves ineffective, it just increases the stress and despair.
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, told The Globe and Mail that "it's quite remarkable" that Health Canada authorized the new product description without any significant public notification.
Dr. Nevin notes that the new description says use of the drug should be discontinued at the onset of any neuropsychiatric symptoms. Many soldiers who took part in the Somalia mission reported such symptoms, including abnormal and alarming dreams, but no one told them to stop taking the pills.
While the Somalia inquiry "focused mainly on the perceived failings of junior soldiers and mid to senior leaders," said Dr. Nevin, "really the worst offence was this inexcusable decision by the highest levels of military leadership to condone a frankly illegal use of an experimental medication without any oversight and really in blatant violation of medical and ethical norms."