THE Australia Defence Force has defended its use of a potentially harmful anti-malaria drug following a series of QT reports on the drug's devastating effect on a former soldier.

Ipswich couple Brian and Lee McCarthy told the QT that they had watched their son, Major Stuart McCarthy, 46, decline since he was given the drug Mefloquine during his service in Timor in the early 2000s.

The decorated Ipswich soldier was involved in clinical trials of the drug, alongside other service men and women from 1RAR, 2RAR and 4RAR.

Mefloquine is a neurotoxin which has been linked to countless deaths, psychotic breakdowns and suicides across the world.

Roche, the company that produces the drug, wanted to withdraw it from the market in the 1990s given the wide-spread harm it caused.

In a response that was emailed to the QT several days after the stories about Major McCarthy ran, the ADF said that Mefloquine was still a registered drug and remained in use across the world.

Major Stuart McCarthy. Afghanistan, 2011. Photo: Contributed
Major Stuart McCarthy. Afghanistan, 2011. Photo: Contributed Contributed

The ADF argued the risks of soldiers contracting Malaria outweighed risks associated with the drug.

"The ADF has confirmed that Mefloquine remains a registered drug for the prevention of malaria in the US and United Kingdom and that the US Department of Defence and the UK Ministry of Defence have similar policies to the ADF on the use of Mefloquine as a third line antimalarial medication," the ADF statement said.

"Malaria remains a disease of high military significance and the ADF continues to research and monitor research to ensure that its members have the best possible protection when operating in malaria endemic areas.

"All antimalarial medications have potential side-effects which in very rare cases can be severe or fatal."

The ADF said it would continue to prescribe the drug because the Therapeutic Goods Administration-approved information has shown it to be safe and tolerated "in most people".

"Antimalarial medication is critical to protecting members operating in malaria endemic areas. Mefloquine is a third line agent, only prescribed when the other medications are inappropriate for the individual concerned. It is only prescribed in accordance with TGA approved product information," the ADF statement said.

The ADF estimated that since July 1, 2000, 578 members had been prescribed Mefloquine and a further 1319 were prescribed the drug as part of formal Army Malaria Institute trials in Timor Leste.

While acknowledging potential side-effects, the ADF denies a link between the drug and soldier suicides, claiming that checks of ADF members known or suspected to have committed suicide revealed none of them had taken Mefloquine since 2000.

"It is important to note that serious on-going side effects due to Mefloquine are rare," the ADF said.

"The risks decrease quickly after the medication is ceased. There were no such cases identified in the Army Malaria Institute trials in 2000-2002.

"All ADF members are examined following deployment and periodically throughout their career. Any member suffering on-going symptoms is appropriately investigated and managed. The more complex cases will be managed within the ADF Rehabilitation Program."

SIDE EFFECTS: Parents of Major Stuart McCarthy, Lee and Brian, talk about their son’s health.
SIDE EFFECTS: Parents of Major Stuart McCarthy, Lee and Brian, talk about their son’s health. Rob Williams

 

Here are the QT's questions and the full ADF response:

1. Is the ADF aware of the medical proof which shows this medication can have severe, and fatal, side effects?

Response: Malaria is a potentially life threatening condition for ADF members operating in a malaria endemic area.  Mefloquine is one of only three medications approved by the Australian Therapeutic Good Administration (TGA) for malaria prevention and is currently used around the world.

The ADF has confirmed that mefloquine remains a registered drug for the prevention of malaria in the US and United Kingdom and that the US Department of Defense and the UK Ministry of Defence have similar policies to the ADF on the use of mefloquine as a third line antimalarial medication.

Malaria remains a disease of high military significance and the ADF continues to research and monitor research to ensure that its members have the best possible protection when operating in malaria endemic areas.
All antimalarial medications have potential side-effects which in very rare cases can be severe or fatal. 

 

2. Why does the ADF continue to administer this drug to its personnel?

Response: Mefloquine was first registered with the TGA in 1993 and since there have been over 35 million prescriptions of mefloquine world-wide.

When prescribed in accordance with TGA approved product information mefloquine has been shown to be safe and well tolerated in most people.

Antimalarial medication is critical to protecting members operating in malaria endemic areas.  Mefloquine is a third line agent, only prescribed when the other medications are inappropriate for the individual concerned.  It is only prescribed in accordance with TGA approved product information.

 

3. How many ADF personnel have been exposed to this neurotoxic drug?

Response: Mefloquine is only used in Defence as a third line agent when other medications are not appropriate.

Prior to 2000 there was no centralised prescribing database in Defence with prescription details being maintained on individual medical record.

However in the fifteen years between 1 July 2000 to 30 June 2015 there have been 578 members identified as having been prescribed mefloquine and a further 1319 members prescribed mefloquine as part of formal Army Malaria Institute trials in Timor Leste.

The combined total of 1987 is likely to be a slight over-estimate due to potential overlaps in the two datasets.  In the same period it is estimated that over 40,000 ADF members were prescribed other antimalarial medication.

 

4. What is the ADF doing to assist personnel who it administered the drug to, and who may have experienced serious on-going side effects, in their road to recovery?

Response: As mentioned above, the ADF only prescribes mefloquine in accordance with TGA approved product information.  ADF health policy also states "Mefloquine should not be given to individuals with active depression, a recent history of depression, generalised anxiety disorder, schizophrenia or other major psychiatric disorders, or with a history of convulsions".

ADF policy also requires members starting mefloquine to be warned about the possibility of severe central nervous system adverse effects and to advise them to immediately contact their medical officer if they experience anxiety, depression, restlessness or confusion. In these cases mefloquine would be ceased and an alternative antimalarial prescribed.

It is important to note that serious on-going side effects due to mefloquine are rare.  The risks decrease quickly after the medication is ceased. There were no such cases identified in the Army Malaria Institute trials in 2000-2002.  All ADF members are examined following deployment and periodically throughout their career.  Any member suffering on-going symptoms is appropriately investigated and managed.  The more complex cases will be managed within the ADF Rehabilitation Program. 

 

5. How many ADF personnel suicides have been linked to the administration of Mefloquine?

Response: The database of ADF members known or suspected to have committed suicide has been cross checked against ADF prescribing data on mefloquine since July 2000.  None of the individuals on the list were identified as taking mefloquine at the time.

 

6. Did Vice Admiral Ray Griggs mislead the recent Senate Inquiry into the Mental Health of ADF Serving Personnel in his attempt to dismiss the side effects of the drug?

Response: Vice Admiral Griggs did not provide evidence on Mefloquine to the recent Senate Inquiry into Mental Health of ADF Serving Personnel



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