Anti-malaria drug Lariam and the Scots who paid the price for taking it

Coolamon is not altogether similar to her former home in the Borders village of West Linton. The weather in the “hay and chaff” capital, she says, can almost be biblical in nature. Her decision to move to the other side of the world followed the tragedy that struck Quinn and her family 11 years ago this month.

It was on March 11, 2006, when Quinn entered the spare room at her West Linton home to discover that her 35-year-old husband – and father to her two young daughters – had hanged himself. Cameron, a retired British Army major, had been suffering from violent nightmares, severe paranoia and mood swings since he had returned from a military exercise in Kenya in 2001. Yet, with no prior warning of any suicidal intentions, and leaving behind no note, Cameron’s shocking death by his own hands hit the Quinn household with a terrible and incalculable force.

“The only thing I can think of that meant he may have considered suicide previously was that he knew exactly where he was going to find the rope that he used,” says Quinn, 47. “By the time I found him, he was dead.”

For Quinn, Cameron’s struggles began almost immediately after he was prescribed the weekly anti-malarial drug mefloquine – also known as Lariam. When Cameron, then a captain in the Highlanders, told Quinn that he had been given the drug to combat the mosquito-borne disease for his stint in the east African state, she was uneasy.

“I told him there had been a few issues around the drug,” she recalls. “I worked at Edinburgh University at that point as a neuroscientist and we had seen a lot of the work that had come through looking at the side effects of Lariam because they were mainly neurological in origin.”

Despite her worries, Quinn’s Lanark-born husband – who, she says, did not appear to be fully briefed about the possible adverse impacts of taking Lariam, ranging from headaches and tinnitus to depression and anxiety – was unconcerned.

“But it was about a week after he had come back, that I came in from work and found him uncharacteristically at home,” she says. “He was just sitting with his head in his hands on the sofa and I asked whether he was sick, and he said that he couldn’t go on, and that he felt like he wanted to give up.”

Disquiet surrounding the use of Lariam is not a new phenomenon. In the UK, and around the world, the anti-malarial has been the subject of widespread concerns, especially in the military. Last year, Lariam hit the headlines after the House of Commons Defence Select Committee criticised the Ministry of Defence (MoD) over its distribution of the drug, stating that it should only be used as a “drug of last resort”.

In Britain, the MoD prescribed Lariam to more than 17,000 troops between April 2007 and March 2015 – though with no data available before 2007, the overall figure is likely to be higher. Following the committee’s report, the MoD revised its malaria prevention policy. It directed that service personnel would only be prescribed Lariam – which the MoD had previously stated was not a so-called “first-line drug” – after a robust medical assessment, and announced the creation of a telephone and email helpline for current and former members of the military concerned about Lariam. However, SNP MP and Defence Select Committee member Douglas Chapman said he “felt that, in terms of its duty of care, the MoD should have said that they were prepared to take Lariam out of its list of prescribable drugs completely”.

The prophylactic was developed by the United States Army in the 1970s to protect against malaria – which kills hundreds of thousands of people, mainly in sub-Saharan Africa, each year – and was given to troops from the United Kingdom, the United States, Australia, Canada and Ireland. And just like the case of Cameron Quinn, it has been linked to mental disorders and suicides in the armed forces, as well as murders. Leading Lariam expert, Dr Remington Nevin, said the “public health tragedy” of Lariam “reflects to some extent a victory of the military’s goals over the public’s broader interests”.

The former US Army major added: “What needs to be understood is that Mefloquine is just the latest in a series of synthetic quinine-like anti-malarial drugs developed by the US military, initially out of military necessity, dating back to the World War II era, that have shared these toxic properties, and which have been successively withdrawn from use for reasons of safety when their dangers have become more widely known.”

The former head of the British Army, Lord Richard Dannatt, last year admitted that he himself had refused to take the drug after witnessing its harmful mental health effects on his own son. Anti-Lariam campaigners from around the world reacted with dismay at Lord Dannatt’s explosive admission, lamenting the time it had taken for the one-time military chief to come forward.

Lord Dannatt’s remarks also left James Donohoe cold. Donohoe, who today lives in Airdrie, North Lanarkshire, blames many of his medical conditions on Lariam, which he was given while serving with the US Army in Iraq during the 2003 Gulf War.

Donohoe, who describes himself as “a Scot who had the misfortune of being born in America”, says that, after leaving the army in 2005 and moving permanently to Scotland, he began to exhibit what many would consider the classic signs of Lariam toxicity.

“I began to notice that things were not quite right,” said Donohoe, who was born in New Jersey to Scottish parents. “Like my hearing – the tinnitus would start to go in both ears and was getting progressively worse – and I wasn’t sleeping very well: I get about four to five hours of sleep each night. And in those four to five hours I’m constantly up and tossing and turning.”

The 48-year-old also says he began suffering severe anxiety. Even now, he can find it difficult to feel at ease in social situations.

“If I’m in crowds or I can be sitting in a pub – I’m always on high alert – I can’t make conversation with folk,” says the former sergeant, his west-of-Scotland accent belying any trace of a young life spent in the United States. “I have a hard time on the phone – I can get very anxious and I always feel like someone is scrutinising me and judging me. It’s really starting to affect my life.”

Quinn’s claim that her late husband was not fully informed of the possible side effects of taking Lariam is echoed by Donohoe’s experience. He says he was neither warned about its potential darker side nor given the drug by a medical practitioner. It was, says the NHS warehouse worker, handed out by a superior. And taking it was an order.

Indeed, up until he read a posting on the internet concerning Lariam and confided in an army friend about his symptoms, he believed his array of complaints were from years of military wear and tear. But tinnitus, sleeplessness, anxiety and suicidal thoughts – which he maintains that he has no impulse to act on – all indicated a neurological disorder shared by other current and former military personnel who were exposed to the drug.

“It makes you angry,” he says, “because you give service to these governments and these countries and you do as you’re told, and then they keep this information from you and you’re discarded.”

Lariam was issued a “black box” safety warning by the US Food and Drug Administration in 2013 and banned from being dispensed to US Special Forces in the same year. It is used only as a drug of last resort in the US military.

But it isn’t just military personnel who have reported adverse effects from taking the anti-malarial. From 1984 onwards, the drug was licensed and prescribed to travellers and tourists, many of whom have also reported disturbing short to long-term health conditions associated with its use.

For Inverness-born Cailean Watt, it all began in 2005 when he took the drug while participating in a charity project in South Africa during a summer break from Glasgow University. Allocated the drug by the university travel clinic, he took up to eight tablets during eight weeks in South Africa before heading across the border to Mozambique.

“One day in Mozambique, I was sitting in a cafe with my friends and I had an absolute meltdown,” says Watt, who lives in Glasgow. “It started as a panic attack and I looked around me and didn’t know where I was or who I was.”

Watt, who works in television, says he spent days hallucinating and in a state of distress, but after testing negative for malaria, he returned home early to Scotland, “thinking I had some kind of crazy demon inside me”.

The following six to eight months were difficult for Watt. He temporarily dropped out of university and effectively barricaded himself in his flat. But he slowly began to find himself again – though he readily admits that the after-effects of the episode linger.

“If you’re run down or tired or stressed out it somehow manages to creep back into your head,” says Watt, 32. “Anything from quite extreme anxiety to paranoia – I’ve managed to find ways to deal with it – but it’s definitely had a huge impact on my life.”

When Watt made the link between his experience and Lariam – and discovered many others around the world had also reacted in similar ways after taking the anti-malarial – he set to work making a film about the drug. A Series of Adverse Events, his recently completed documentary looking at Lariam’s use in the military and in civilian life, was, naturally, a very personal project for Watt. He is hoping to place it into some film festivals this year then make it available online.

“My issue was that I was never totally convinced that it was Lariam that did this to me,” he says. “I just thought, ‘How could one little pill do this?’ but it’s highly likely that that’s why I lost my marbles for a while.”

Doxycycline and Malarone are widely seen as safer alternatives to Lariam by campaigners, but UK advocates of the latter’s continued use point to the likes of Public Health England, which, the MoD has said, recommends it “as a safe and effective form of malaria prevention”. Roche, the manufacturer of Lariam, referred The Herald Magazine to an August 2016 statement on the drug where it stated: “The benefits of Lariam outweigh the potential risks of the treatment."

Quinn, who said she wrote to Lord Dannatt outlining her opposition to Lariam’s use in the UK military after her husband’s death only to be rebuffed, has made campaigning against the use of it a major focus of her life in Australia where the Australian Defence Force classifies Lariam as a so-called “third-line agent”. But, as Quinn continues her efforts to gain recognition for Australian military veterans impacted by Lariam, she also has her eye on the drug’s wider impact, which, she contends, has only been given a toehold by its controversial use in the military.

“In order to get recognition of this problem, it’s almost as though a special group has had to step forward,” says Quinn. “It has given this cause traction in a way it hasn’t had in the civilian population. And yet [the scale of the problem] is going to be absolutely equivalent in all of those travellers who have taken this drug.”