Second soldier took malaria drug (Ft. Bragg wife murder)

UPI ^ | 8-9-02 | Mark Benjamin and Dan Olmsted

[Pharmboy]

FAYETTEVILLE, N.C., Aug. 9 (UPI) -- A Fort Bragg soldier charged with 1st degree murder in the death of his wife took an anti-malaria drug linked to aggression and suicidal thinking while serving in Afghanistan, and allegedly killed his wife just weeks after his return.

Thomas Maher, attorney for Master Sgt. William Wright, confirmed Friday his client took Lariam, also called mefloquine, meaning that at least two of the three soldiers who served there and allegedly killed their wives this summer also likely took the drug.

"He was taking it," Maher said. Maher said Wright didn't attribute any particular adverse effects to the drug, but "He felt like he was kind of floating when he got back" from Afghanistan.

Wright, a special operations soldier in the 96th Civil Affairs Battalion, strangled his wife, Jennifer, at their Fayetteville home on June 29, then buried her body in a shallow grave, according to authorities.

Army officials have said it is unlikely the anti-malaria drug Lariam played any role in the killings because some of the suspects in the recent rash of domestic violence near Fort Bragg did not serve in Afghanistan and one of the soldiers had been back in the United States for seven months, making a connection to the drug unlikely.

The Pentagon is set to send a team to Fort Bragg to review military policies and programs related to the killings, according to Maj. Gary Kolb, Spokesman for the Army's Special Operations Command. Kolb said that team will decide whether or not to look into the use of Lariam.

"If that includes a look at what they may have used in Afghanistan, they are in the position to look at that. All our records are completely open," said Kolb.

A second soldier suspected of killing his wife this summer, Sgt. 1st Class Rigoberto Nieves, had almost certainly been given Lariam in Afghanistan also, according to an Army medical source familiar with Nieves' duty there.

Nieves was with the 3rd Special Forces Group. He shot and killed himself after shooting his wife, Teresa, in a bathroom of their Fayetteville home on June 11, just two days after returning early from service in Afghanistan, according to police.

Sgt. 1st Class Brandon Floyd, 30, served in Afghanistan from November to January as a member of the secret counter-terrorism unit called Delta Force. It is unclear if Floyd took Lariam, but Army troops in Afghanistan and other malarial countries are routinely prescribed it.

Floyd shot his wife, Andrea, in their home in Stedman, near Fayetteville, on July 19, then shot and killed himself.

Lariam has been blamed for psychotic episodes and suicidal behavior for more than a decade. The official product information sheet for Lariam, written by drug manufacturer Hoffmann-La Roche and approved by the U.S. Food and Drug Administration, states that Lariam has been associated with aggression, paranoia and suicidal thoughts.

The deaths have been particularly mysterious because the cases involving the Special Forces soldiers do not appear to have been foreshadowed by a pattern of domestic violence leading up the killings.

"At this point there is no indication that there was a history of domestic violence," said Kolb.

In around 80 percent of cases, an increasing level of domestic violence predicates a killing, according to Debby Tucker, co-chair of the Defense Department's task force on domestic violence and co-founder of the National Training Center on Domestic and Sexual Violence in Austin, Texas.

A UPI story published July 30 reported that scores of Peace Corps volunteers are coming forward saying that over the past 12 years they suffered paranoia, anxiety, hallucinations, memory loss and suicidal behavior they blamed on Lariam. Some of the reports include problems that patients said have lasted for years or months after they stopped taking the drug.

In a May 21 article, United Press International found evidence that the drug can cause mental problems so severe that in a small percentage of cases it has triggered suicide. Thousands of pages of internal Roche safety documents obtained by UPI showed the company tracking suicides and suicidal behavior and acknowledging that depression -- which it said can lead to suicide -- is a known side effect of Lariam.

[Pharmboy]

I searched but couldn't find this posted. Sorry if this is a re-post.

Interesting development, eh?

[Fundamentally Fair]

Interesting development, eh?

I suppose, but how many other “coincidences” will be discovered? They all wore camouflage? All wore hats while deployed? Their dog-tag chains were all made of the same metal?

[Dales]

Lovely.

[mattdono]

Any see the movie "Jacob's Ladder"?

[Pharmboy]

True enough, but people react differently to drugs and not dogtags. Perhaps we can understand why these men (if indeed they did) reacted in this manner. Please note that this side effect has been reported with this drug before.

Not many drugs have "increased aggression" as a side effect.

[verity]

Endless speculation!

[Vidalia]

"Army officials have said it is unlikely the anti-malaria drug Lariam played any role in the killings because some of the suspects in the recent rash of domestic violence near Fort Bragg did not serve in Afghanistan and one of the soldiers had been back in the United States for seven months, making a connection to the drug unlikely. "

Why is the conclusion of this article in the middle of the piece?

[corkoman]

Take a look at the package insert for any new drug introduced in the past 4 years - he list of "side effects" will include EVERYTHING under the sun. Unless they list everything an adverse experience is considered "unexpected" and is treated like a hoy patatoe (that e is intentional).

Correlation is NOT causation. Military families are stressed like no other so, unfortunately, it is not unusual for these blow-ups to occur. Infrequent yes, but not unheard of.

[donozark]

Not familiar with Lariam. Post-Vietnam, we were required to continue taking C-P (Chloroquin-Primaquin) anti-malaria tablets for several months. We had to sign a document promising to take same. Years later, gov said C-P pills were cancer causing agent. Same with Dapsone-which we only took while "outside the wire."

If soldiers are required to continue taking Lariam, perhaps further research is called for.

[Pharmboy]

Here's an excerpt from a Canadian report on problems that might have been caused by the drug in the early '90s. And yes, the package inserts list many side effects but "violent behavior" is a very specifc and unusual one, unlike "headaches, nausea, diarrhea, etc."

I am in the industry and am quite familiar with package inserts--check out my Freeper handle <;-)

And no, correlation is definitely NOT causation, but some pretty important causations have begun by observing correlations.








THE MEFLOQUINE ISSUE
Mefloquine is a relatively new anti-malarial drug, first made generally available to the Canadian public in 1993.1 It is used both to prevent malaria (that is, as a prophylactic) and to treat malaria. Mefloquine is used in areas where the local strains of malaria have developed a resistance to other anti-malarial drugs. Somalia is one such area.


The suggestion was made to us that mefloquine caused severe side effects, including abnormal and violent behaviour, among some Canadian Forces (CF) personnel in Somalia. We were not able to explore fully the possible impact of mefloquine. This would have required additional hearings dedicated specifically to the issue, which time did not permit. However, we report here our general findings about mefloquine and its possible impact on operations in Somalia. Readers will see readily that further investigation is warranted before any firm conclusions about the role of mefloquine can be drawn.



THE NEED FOR ANTI-MALARIAL MEDICATION

Anti-malarial medication was clearly necessary for Canadian troops deployed to Somalia. There is a year-round risk of malaria in Somalia.


A recent U.S. medical journal article reported 48 cases of malaria among U.S. forces stationed in Somalia over the entire duration of the U.S. deployment. 2 In addition, the malaria produced by P. falciparum was considered more severe than some other forms of malaria and therefore warranted strong precautions.3


A September 1992 memorandum from DND's Director, Health Protection and Promotion, entitled "Preventive Medicine Recommendations for Somalia", also discussed the malaria risk. The memorandum recommended the weekly use of mefloquine:


All of Somalia is considered malarious with [P.] falciparum predominating and chloroquine resistance reported. Mogadishu is said to present a lower but still present risk.... Mefloquine weekly is recommended. DHPP 2 hereby provides blanket approval for mefloquine to be provided to personnel deploying on this mission.... Personnel for whom mefloquine is medically contraindicated as per Ref D, e.g., pilots, can be given doxycycline 100 milligrams per day.4

Most CF members stationed in Somalia in 1992 and 1993 were prescribed mefloquine. However, some CF pilots and divers received another anti-malarial drug, doxycycline, because mefloquine was thought to cause dizziness and loss of fine motor control in some users. The post-deployment report of the HMCS Preserver, for example, stated that all aircrew on active flying duties used doxycycline.5 The report also noted that several CF members who suffered adverse effects from taking mefloquine were switched to doxycycline.


CF members began taking mefloquine one week before deployment and continued to take it weekly during deployment and for four weeks after deployment.6 They received a preventive (prophylactic) dose of 250 milligrams once a week. A message of December 25, 1992, confirmed that 3,000 mefloquine tablets were issued on December 23, 1992, and that a further 24,000 tablets were on order.7


Mefloquine was taken once a week, on Wednesdays. A standing operating procedure dated November 11, 1992, stated:


Malaria prophylaxis will be provided by the use of once weekly dosing with Mefloquine. The UMS [Unit Medical Services] staff will supervise the distr of this med, and will likely occur at the same time and place each week; i.e. the Wed noon meal. A nom roll will be used to pos check distr. 8

However, a later standing operating procedure, dated January 2, 1993, stated that "All pers will take the anti-malaria pill mefloquine every Friday."9 Still, it appears from the limited information before us that mefloquine was normally taken on Wednesdays. Later in this chapter we discuss the significance of the day on which mefloquine was taken.





WHO RAISED THE CONCERN ABOUT THE POSSIBLE IMPACT OF MEFLOQUINE ON BEHAVIOUR?
The first public suggestion that mefloquine might have caused, or contributed to, abnormal behaviour in Somalia appears to have been made by Maj Barry Armstrong, the officer commanding the surgical section of the medical unit in Somalia. Speaking to the Canadian Forces Medical Services Group Conference, Operational Medicine, October 26,1993, Maj Armstrong argued as follows:


I believe that the UN's failures in Somalia are rather exceptional, considering previous peacekeeping successes. I believe that a simple reason may exist. Canadian and American troops may have been impaired by the use of mefloquine....

Mefloquine is well known to have neurologic side effects. The manufacturer's literature states that reactions are rare, but include convulsions, psychosis, nightmares, dizziness, headache, confusion, anxiety and depression. There are over 100 case reports of such serious reactions requiring hospitalization. From the medical literature, it seems that such reactions occur in 1 per 2,000 people when prophylactic doses are given, or up to 1 per 200 when stronger, treatment doses are given. [Treatment doses are given only to those who contract malaria; no suggestion has been made that any non-infected CF member in Somalia received the stronger treatment dose.]

Less severe reactions (not requiring hospitalization) are more common, but the incidence is not known. We had one psychiatric hospitalization in Belet [H]uen, which did not respond to the usual treatment of battle stress. The diagnosis made by psychiatrists at NDMC [National Defence Medical Centre], after he was evacuated, was an organic brain syndrome, probably due to mefloquine. The suicide attempt in theatre may also be mefloquine related.10

There are three of us presenting on Somalia today. Two of us had minor neuropsychiatric problems which occurred regularly in the 24 to 48 hours after our weekly mefloquine doses. If there are two of us, these reactions aren't so 'rare'. Burke in The Lancet, June 1993, writes, "As a demographer with a quarter of a century's experience, I know that if I encounter finite numbers of a supposedly rare occurrence, the true rate is higher." He goes on to recommend alternatives to mefloquine.

In 1992, mefloquine was the best choice as an anti-malarial. However, we realized some of the risks and did not prescribe this medication for pilots. The U.S. military has also rejected mefloquine use for their aircrew, because of the neuropsychiatric side effects.

The mechanism of mefloquine effects on the brain (like its effects on malaria) is unknown. However, it is structurally similar to quinine and quinidine. Mefloquine can cause additive effects with these drugs. Quinine and quinidine are known to be blockers of the fast sodium channel. This sodium channel is found on the cell membrane of nerve cells, and is activated early when nerve cells fire. Specifically, it is believed that agents similar to mefloquine block the sodium channel by locking closed the 'inactivation gate' in the channel. Some sodium channel blockers, such as Dilantin (diphenylhydantoin), have been clearly shown to have adverse effects on cognition. According to my literature review, these neuropsychiatric tests have not been done on any subjects taking mefloquine.

Further, it should be better known that the mefloquine malaria pills taken by the Canadian Forces are 10 per cent stronger than those given to the American Forces, despite both being labelled as 250 milligrams. (250 milligrams of mefloquine base in the Basel manufactured pills, versus 250 milligrams of mefloquine salt in the U.S. produced pills).

I believe that mefloquine causes sub-clinical adverse effects on cognition. The usual soldier taking the drug is not aware of any problems. Nevertheless, his thinking could be impaired. Like many people tipsy after 2 or 3 alcohol-based drinks, he would not recognize that his judgement was diminished. He would not recognize this because the adverse effect is on cognition, including impaired insight. Like the impaired driver who feels fine, our soldier would feel fine, despite his impairment....

Definitive proof regarding the effects of mefloquine on thinking would require a randomized, double-blind, placebo-controlled study. The measurements should be taken by neuropsychiatric testing (the same techniques used to prove the adverse neurologic effects of low-dose alcohol). Such a study would be much less expensive than the costs of flying MlAl tanks to Mogadishu. The real difficulty in Somalia might be drug side-effects. It would be wiser to conduct such a study of mefloquine, than to simply abandon the concept of international peace-making.

On October 6, 1994, John Cummins, a member of Parliament, issued a press release relating to the death of Shidane Arone.11 The press release, although referring (apparently mistakenly) to a drug to combat cholera, not malaria, raised the possibility that the drug (presumably mefloquine) may have contributed to the violent behaviour of MCpl Matchee:


Another element of this unfortunate affair which has not been addressed was that every Thursday troops in Somalia were given an experimental drug to combat cholera.12 The day the drug was administered in Somalia was known as "psycho Thursday". What effect this drug and the beer he consumed may have had on the behaviour of Corporal Matchee has never been discussed.


Mr. Cummins raised the same issue later that month in the House of Commons:


[T]he minister and the military establishment ignored the well known effect of Mefloquine, a malaria drug administered to Canadian troops in Somalia. Side effects include violent dreams, hallucinations, confusion, anxiety and mental depression. Mefloquine could have precipitated the murder of the prisoner and Master Corporal Matchee's attempted suicide.13

In a letter dated October 26, 1994, to the Minister of National Defence, Mr. Cummins restated his concern about mefloquine:


The Department should have known of the problems associated with the combination of mefloquine and alcohol prior to Somali[a], and certainly would have known afterwards but has so far failed to conduct either field or clinical research....

I would ask that you initiate the process for the release from military detention of Trooper Kyle Brown pending an investigation. 14

[Pharmboy]

See post #10