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Anti-malarial drug linked to Afghan massacre

Soldier was taking mefloquine when he killed 16 civilians, report indicates

Jul. 13, 2013 - 06:00AM   |  
Robert Bales
In less than a month, Army Staff Sgt. Robert Bales will be sentenced for the massacre of 16 Afghan civilians in March 2012. But new evidence suggests he was prescribed an anti-malaria drug known to cause hallucinations, aggression and psychotic behavior in some patients. (Spc. Ryan Hallock/AP)
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In less than a month, Army Staff Sgt. Robert Bales will be sentenced for the massacre of 16 Afghan civilians in March 2012.

His attorney, John Henry Browne, has not publicly disclosed whether he will use a mental health defense to fight for a parole-eligible sentence.

But an argument could be made that Bales, 40, was out of his mind:

■ He was treated for a traumatic brain injury resulting from a rollover accident in 2010 and possibly had post-traumatic stress disorder.

■ He admitted to using steroids, which can cause aggression and violence.

■ And new evidence suggests he was prescribed an anti-malaria drug known to cause hallucinations, aggression and psychotic behavior in some patients.

The Food and Drug Administration received notification in April 2012 from the maker of the anti-malarial drug Lariam, also manufactured under the generic name mefloquine, that a patient taking the medication “developed homicidal behavior and led to homicide killing 17 [sic] Afghans.”

The report, obtained July 5 by Military Times through a Freedom of Information Act request, states:

“It was reported that this patient was administered mefloquine in direct contradiction to U.S. military rules that mefloquine should not be given to soldiers who had suffered traumatic brain injury due to its propensity to cross blood-brain barriers inciting psychotic, homicidal or suicidal behavior.”

A spokesman for the manufacturer, Roche, said the company received an initial report March 29 from a pharmacist in the U.S. and was obligated to notify drug monitoring agencies worldwide by law.

An FDA adverse event report does not mean the medication caused any health problems; it indicates only that patients developed symptoms while using the product.

But the medically confirmed report does imply either that the source was someone involved with the patient’s medical care or that Roche received documentation verifying the information, said Dr. Remington Nevin, a leading researcher on mefloquine toxicity, who also filed a FOIA request for the information.

In 2009, the assistant secretary of defense for health affairs issued a policy listing mefloquine as a third-choice malaria preventative, behind doxycycline and chloroquine.

The memo stated that in cases where a service member had a history of neurological or mental health disorder, mefloquine should be used with caution only in areas where the malaria strain is resistant to other medications.

In January 2012, just months before the Kandahar massacre, Dr. Jonathan Woodson, assistant secretary of defense for health affairs, directed the Army, Navy and Air Force and the commander of the Joint Task Force National Capital Region Medical Command to provide his office with all data and policies related to mefloquine.

From 2010 to 2011, the military health system wrote 14,420 prescriptions for mefloquine, down from 55,766 from 2007 to 2009.

The drug remains popular for distribution among special operations forces because it is taken weekly rather than daily.

The FDA launched a review earlier this year to determine whether the drug needs a stronger warning label or more prescribing restrictions. That investigation is ongoing.

From 1996 to 2012, the FDA received 438 reports of adverse symptoms from 37 patients who took mefloquine or Lariam, according to a review of records conducted by Military Times.

Symptoms ranged from homicidal and suicidal ideation and psychosis to vomiting, nausea and dizziness.

Other factors that may play into Bales’ defense include discussion that he may have suffered from post-traumatic stress disorder. But while research shows that PTSD often causes anxiety, irritability and impulsive aggression, it is not associated with premeditated aggression and violence.

A medication Bales has admitted to taking is stanazolol or Winstrol, an anabolic steroid used for building muscles. Steroids can cause violence and aggression in “a certain percentage of people,” according to Dr. Harrison Pope, director of the biological psychiatry laboratory at McLean Hospital, Belmont, Mass.

All steroids “are capable of producing these reactions in a small minority of people,” Pope said. But steroids are not associated with memory loss during a violent incident, Pope added.

Bales told the judge in his case, Col. Jeffery Nance, that he does not remember setting fire to several bodies during his rampage.

Bales’ sentencing hearing is set for Aug. 19. Browne, his attorney, was to notify the court by July 1 if he planned to call on mental health experts as part of Bales’ defense. Neither Browne nor the Army returned requests regarding whether that motion has been filed.

If Bales receives a sentence that includes the possibility of parole, he would be eligible after 10 years.

Editorial systems manager Zac Jennings contributed to this report.

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