Magic Johnson

Mefloquine, a pill taken weekly, was developed in the 1960s and 1970s by the Walter Reed Army Institute of Research after a drug-resistant strain of malaria sickened troops in Vietnam. It was widely prescribed to U.S. service members from 1989, when it was approved by the Food and Drug Administration, until 2009, when the Department of Defense issued directives effectively making it a last-choice drug for troops.

“It was recognized around the time of its U.S. licensing that there were very significant problems with this drug,” said Dr. Remington Nevin, a board-certified physician epidemiologist and former Army preventive medicine officer who has authored more than 30 scientific publications on malaria and antimalarial medication. “It was clearly known that some people became psychotic and some people became very violent, but at the time, it wasn’t appreciated just how serious these neuropsychiatric effects could be in terms of causing lasting disabilities.”

Nevin noted that the known dangers of mefloquine (previously marketed in the U.S. as Lariam) were such that its manufacturer, Swiss multinational pharmaceutical company Roche Holding AG (Roche), and the FDA agreed to language in the initial product insert that warned certain symptoms—anxiety, depression, restlessness or confusion—should be considered as early signs of a “more serious event” and the drug must be immediately discontinued by its user.

However, according to Nevin, most troops didn’t receive those warnings or have logistical access to alternative medications while deployed. There was also no way for DOD medical personnel to identify ahead of time who was susceptible to the drug’s neurotoxicity, estimated to be anywhere from one-quarter to two-thirds of its users.

“Instead, the military said, ‘Here’s your mefloquine, you’re getting on the plane, you may have some crazy dreams, but suck it up and drive on,’” said Nevin, who now serves as executive director of The Quinism Foundation, a group dedicated to supporting research on quinoline drugs. “So, we systematically ignored and undermined the critical safety warnings in the product insert.”

After various international studies confirmed mefloquine’s potential for causing psychological illness, and a growing list of its neuropsychiatric adverse effects—including vertigo, tinnitus, insomnia, vivid nightmares, visual and auditory hallucinations, paranoia, seizures, mood swings and suicidal ideations—became more well known, Roche pulled the drug off U.S. shelves. Eventually, in 2013, the FDA issued its strongest “black box” warning, that mefloquine can cause long-lasting and even permanent damage, bringing an end to the DOD’s nearly quarter-century use of the drug.

Exposure to antimalarial drugs has been introduced as a possible factor in several cases of violent murder over the past two decades. Cases include Army Staff Sgt. Robert Bales, who pleaded guilty to avoid the death penalty for slaying 16 Afghan civilians in Kandahar Province, Afghanistan, in March 2012, as well as four soldiers who killed their spouses over a six-week stretch in 2002 at Fort Bragg, N.C. This factor was also discussed when a group of soldiers from Fort Carson, Colo., were charged with manslaughter after throwing an Iraqi man in the Tigris River in 2004.

In a 2013 publication, Nevin and other military medical professionals argued that mefloquine can produce “derealization and depersonalization, compulsions toward dangerous objects, and morbid curiosity about death.” It can also produce dissociative effects that make someone performing violent acts think someone else is committing the crime.

Unfortunately for veterans affected by mefloquine, the Department of Veterans Affairs does not recognize an association between the drug and negative mental health outcomes