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'I told the doctor: I'm so ready to shoot myself' - some Irish soldiers say lives were ruined by antimalarial drug

With 47 cases ongoing and dozens more in the pipeline, the State is facing into a legal tsunami that could cost it tens of millions over its use of antimalarial drug Lariam. We talk to some of the Irish soldiers who say their lives were ruined after they were prescribed the drug for overseas missions

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Suicide attempts: Caitriona McCaughley was given Lariam on missions to Africa in 2006 and 2009. Photo: Dominick Walsh

Suicide attempts: Caitriona McCaughley was given Lariam on missions to Africa in 2006 and 2009. Photo: Dominick Walsh

Suicide attempts: Caitriona McCaughley was given Lariam on missions to Africa in 2006 and 2009. Photo: Dominick Walsh

They say war is hell, but for many Irish soldiers, the real ordeal only began when they came home.

Former Defence Forces private Caitriona McCaughley felt so low after a tour of duty in Chad she wanted to shoot herself.

For another ex-soldier, former private Paul O'Reilly, his return from Liberia brought with it nightmares, anxiety and unexplained bouts of anger and aggression.

They are not alone. While the symptoms and their severity can vary, similar stories have become increasingly common in recent years among army personnel who served on peacekeeping missions in sub-Saharan Africa.

While being a soldier can be a dangerous job, the symptoms McCaughley and O'Reilly describe are not being attributed to any traumatic or stressful event they encountered while on overseas duties.

Instead, the finger of blame is being pointed at mefloquine, an antimalarial drug better known by its brand name Lariam, which has been administered to Irish soldiers on missions in malarial regions since 2001.

Late last year, in what was widely regarded as a test case, a civil action by 33-year Defence Forces veteran Anthony Cole was settled by the State on confidential terms without any admission of liability.

Cole claimed he had not felt normal since a five-month tour of duty in Chad in 2009 and that he continued to suffer from headaches, nightmares and mood swings.

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Nightmares: Former soldier Paul O’Reilly during a mission to Liberia in 2004

Nightmares: Former soldier Paul O’Reilly during a mission to Liberia in 2004

Nightmares: Former soldier Paul O’Reilly during a mission to Liberia in 2004

A raft of other lawsuits has followed since then, including personal injuries actions filed by McCaughley and O'Reilly last May.

Their cases are among 47 currently being handled by the State Claims Agency. Dozens more are in the pipeline.

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Dublin-based solicitor and former soldier Norman Spicer, of Coleman Legal Partners, says his firm alone has instructions to issue 85 sets of proceedings and has 350 clients affected by Lariam.

It is all shaping up to be something of a legal tsunami which could cost the State tens of millions of euro in legal costs and damages.

Major questions are now being asked about why the Defence Forces has persisted with the drug for so long and why it continues to do so today.

The problems with Lariam are no secret. The drug is either not used or is treated as a medication of last resort by the military in France, Germany, the US, Canada and Australia.

In advice to doctors in 2013, manufacturers Roche said the most common neuropsychiatric reactions to it included abnormal dreams, insomnia, anxiety and depression. The manufacturer said hallucinations, psychosis, suicide, suicidal thoughts and self-endangering behaviour had also been reported.

A report commissioned by the Department of Defence on the drug and delivered the same year remains under wraps. The department has refused to publish it, saying it is "legally privileged".

Despite the mounting number of lawsuits and harrowing stories of ruined lives, Lariam remains one of three drugs currently prescribed to personnel on duty in malarial regions. The others are Malarone and Doxycycline.

In reality though, for many missions, Lariam appears to have been the only sanctioned option.

Internal Defence Forces documents seen by Review reveal instructions were given by the Defence Forces Medical Corps during the 2000s that personnel not suited to Lariam would not be considered fit for deployment in Eritrea, Liberia and Chad.

According to Spicer, this "no Lariam, no trip" policy discouraged the reporting of adverse symptoms as personnel feared they would be deemed "unfit" for overseas missions and that this could impact on their promotion prospects.

As recently as last May, the junior minister responsible for defence, Paul Kehoe, told the Dáil he had been advised by a medical officer in the Defence Forces that Lariam was the most suitable drug available.

"For as long as they are happy to prescribe it on medical advice, I will accept it," he said. Of the three drugs available, Lariam is the least expensive option, but is considered to have the harshest side effects.

Dr Remington Nevin, a former US Army major and expert on the effects of antimalarial drugs, told Review that what was "apparently intended as a cost-saving measure" was "almost certain to instead prove penny wise and pound foolish".

According to Dr Nevin, certain side effects, such as nightmares, insomnia, anxiety and changes in mood, affect over one in 10 who take the drug.

Nevertheless, mefloquine continues to be considered an effective antimalarial by international health agencies, including the World Health Organisation.

Many of the lawsuits focus on the manner in which the drug was prescribed.

According to the department, it is Defence Forces policy that personnel are individually screened for fitness for service overseas and medical suitability.

However, several lawsuits contain allegations that Lariam was administered in a "conveyor belt" manner, without the sort of in-depth individual consultation needed to establish if it was suitable for the person receiving it.

For example, the drug is contraindicated for people who have previously suffered from depression. Yet, soldiers like McCaughley, who had depression in her medical history, were given it.

The 33-year-old Tralee woman joined the Defence Forces in 2002 as a 17-year-old, just weeks after doing her Leaving Certificate.

Not long after enlisting, her grandmother, who she was close to, died.

"I was a bit low and I had my weapon taken off me. I was placed on unarmed duties," she says.

However, in 2006, while stationed at Collins Barracks in Cork, she was passed fit to serve with the UN mission in Liberia, where she was given Lariam.

"Nobody ever talked to me about my mental health before I went over," she says.

McCaughley also alleges she was not given specific advice or guidance about potential side effects.

On her return, she experienced sudden and unexpected periods of crying and tearfulness. Within months, the relationship she was in broke down.

Her weapon was removed from her for a second time and she received psychiatric treatment, but had no idea her symptoms may have been related to Lariam.

A further tour of duty followed in Chad in 2009. Again, she says she did not receive any particular individual assessment of her suitability for the drug.

She also says there was no discussion about putting her on an alternative antimalarial drug due to her history of depression.

"I went to Chad and had a grand trip. When I got home, everything turned to shit," she says.

"I remember returning to duty and walking into the doctor, saying: 'I actually can't do this. I am so ready to shoot myself'."

She was admitted to hospital but says her life became increasingly chaotic and a number of suicide attempts followed.

McCaughley says that at no stage during her treatment was she told what she was experiencing may have been related to Lariam. Instead, she says she was left to feel as though whatever was happening to her was somehow her own fault. When she decided to leave the Defence Forces in 2011, she didn't even say goodbye to those she had served alongside.

"I was too ashamed," she says. "I felt that I was so wrong, that I was so sick, that I was such a bad person, that I didn't deserve anybody's friendship, anybody's acknowledgement or care."

To this day she is battling health difficulties, but hopes her civil action will lead to an apology and an acknowledgement mistakes were made.

"I want them to say they are sorry for twice giving me this drug knowing that I had depression. That is all I want," she says.

"There are a lot of guys who have committed suicide in the army. Some of them I know. I really hope that anybody that I served with overseas [and who became ill] doesn't feel like it is their own fault. When they are crying at night on their own, I really hope they know they are not sick because of anything they have done."

For O'Reilly, a 49-year-old former soldier from Crumlin in Dublin, the Lariam ordeal began during a mission in Liberia in 2004.

"I remember a few weeks into the trip everybody started to get nightmares. There were six of us sharing a tent. Everybody suffered the same. If you weren't having a nightmare, you were listening to someone else having one," he says.

Bouts of anger and anxiety followed. "You would fly off the handle for absolutely no reason," he adds.

O'Reilly says he was not given any advice or literature about the potential side effects of Lariam before the Liberia trip.

After returning home, things "went downhill rapidly". His aggressive behaviour continued and he withdrew from social and family life. The nightmares continued, too.

O'Reilly says he came close to suicide twice, but swept how he was feeling "under the carpet" for several years.

It wasn't until 2009 he sought medical help from the Defence Forces.

"I was basically told I needed a kick up the arse and to get on with my life. That was the diagnosis," he says.

He eventually left the Defence Forces in 2011 after 21 years of service,

It was only years later, after connecting with former colleagues on social media, that he drew the link to Lariam. Now, he says he wants someone "to be held responsible".

"I am looking for justice for the people who have taken their lives, the people whose marriages have split up," he says.

"I can't believe they are still prescribing Lariam. It is flabbergasting. I can't believe they are still giving this to young men and women."

Review put a series of detailed questions to the Department of Defence, but it declined to respond to any of the allegations made by former soldiers.

"It would be inappropriate for the department to comment on individual cases or on matters that may arise in the course of this litigation," it said in a statement.

The department would not say if any changes or improvements had been made in recent years to the manner in which members of the Defence Forces are assessed for suitability to receive Lariam.

The statement said the choice of medication for overseas deployment, including the use of Lariam, was a medical decision made by medical officers in the Defence Forces, having regard to the specific circumstances of the mission and the individual personnel.

 

‘Deployment on mefloquine increases suicide risk several fold’

Mefloquine, the controversial anti-malarial drug better known by its brand name Lariam, was withdrawn from the Irish market in July 2016.

However, it remains available to the Defence Forces from international wholesalers.

Manufacturers Roche said the withdrawal was “a commercial decision” and denied it was linked to any legal or safety issue.

The continued use of the drug by the Defence Forces goes against the prevailing trend internationally.

Lariam is no longer used by the French or German militaries, while the US, Canada and Australia consider it a drug of last resort.

In the UK, a 2016 House of Commons defence select committee report recommended Lariam should no longer be issued, except as a drug of last resort.

Of considerable concern internationally is the apparent link between the drug and the suicides of soldiers.

One former Defence Forces member, Anthony Moore, told Review he knew of at least 12 former comrades who had been on Lariam and later took their own lives.

The Department of Defence declined to say if it had conducted or commissioned any research to ascertain if there was a link between Lariam and the suicides of personnel.

It also declined to say whether, given the mounting number of personal injuries actions being filed, it is considering a redress scheme.

Dr Remington Nevin, a former US Army major and expert on antimalarial drugs, says that from the data he had been able to obtain, it appeared that “within the Irish military deployment on a mefloquine mission increases several fold the subsequent risk of suicide, in comparison to deployment on a non-mefloquine mission”.

He tells Review: “Several countries, including the US and Australia, have quietly acknowledged the role of mefloquine poisoning in causing chronic disability among veterans, and have implemented processes to award disability benefits to those affected.

“In contrast, the policy of the Irish Government appears to be to place its soldiers at continued risk while refusing to acknowledge any basis for veterans’ claims.”


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