WASHINGTON -- The Pentagon is in the midst of a widespread review of the military’s use of a notorious anti-malaria drug after finding out that the pills have been wrongly given to soldiers with preexisting problems, including brain injuries such as the one sustained by the U.S. soldier who allegedly massacred 17 civilians in Afghanistan.
Mefloquine, also called Lariam, has severe psychiatric side effects. Problems include psychotic behavior, paranoia and hallucinations. The drug has been implicated in numerous suicides and homicides, including deaths in the U.S. military. For years the military has used the weekly pill to help prevent malaria among deployed troops.
The U.S. Army nearly the dropped use of mefloquine entirely in 2009 because of the dangers, now only using it in limited circumstances, including sometimes in Afghanistan. The 2009 order from the Army said soldiers who have suffered a traumatic brain injury should not be given the drug.
Staff Sgt. Robert Bales, the soldier accused of grisly Afghanistan murders of men, women and children on March 17, suffered a traumatic brain injury in Iraq in 2010 during his third combat tour. According to New York Times reporting, repeated combat tours also increase the risk of post-traumatic stress disorder.
Bales' wife, Karilyn Bales, broke her silence in an interview Sunday with NBC's Matt Lauer, airing on Monday's Today show. "It is unbelievable to me. I have no idea what happened, but he would not -- he loves children. He would not do that," she said in excerpts released Sunday.
On Jan. 17, Assistant Secretary of Defense for Health Affairs Jonathan Woodson ordered a review to make sure that troops were not getting the drug inappropriately. The task order from Woodson begins: "Some deploying Service members have been provided mefloquine for malaria prophylaxis without appropriate documentation in their medical records and without proper screening for contraindications."
On March 20, after the massacre, a follow-up order was sent to the southwest region that says troops in "deployed locations" may be improperly taking the drug.
“Some deployed service members may be prescribed mefloquine for malaria prophylaxis without appropriate documentation in their medical records and without proper screening for contraindications,” the order says.
Army and Pentagon officials would not say whether Bales took the drug, citing privacy rules. When asked if Woodson’s mefloquine review was a response to the massacre, the military in Afghanistan referred the question to the Army. Army officials said they were “unaware” of the review. After being shown the task order via email, they stopped responding. The Secretary of Defense Office referred questions to the Army -- and then back to medical officials in the secretary’s office. Those officials have not responded.
But the sudden violence and apparent cognitive problems related to the crime Bales is accused of mirrors other gruesome cases.
A former Army psychiatrist who was the top advocate for mental health at the Office of the Army Surgeon General recently voiced concern about Bales’ possible mefloquine exposure. “One obvious question to consider is whether he was on mefloquine (Lariam), an anti-malarial medication,” Elspeth Cameron Ritchie wrote this week in TIME’s “Battleland” blog, noting that the drug is still used in Afghanistan.
“This medication has been increasingly associated with neuropsychiatric side effects, including depression, psychosis, and suicidal ideation.”
In 2004 in the United Press International, this reporter and reporter Dan Olmsted chronicled use of the drug by six elite Army Special Forces soldiers who took mefloquine then committed suicide. (Suicide is relatively infrequent among Special Forces soldiers).
"You're ready to take that plunge into hurting someone or hurting and killing yourself, and it comes on unbelievably quickly,” said one Special Forces soldier diagnosed with permanent brain damage from Lariam. “It's just a sudden thought, it's the right thing to do. You'll get a mental picture, and it's in full color."
Also that year, the UPI report showed how mefloquine use was a factor in half of the suicides among troops in Iraq in 2003 -– and how suicides dropped by 50 percent after the Army stopped handing out the drug.
In 2004, the Army dropped charges against Staff Sgt. Georg-Andreas Pogany, who was the first soldier since Vietnam charged with cowardice. Like Bales, Pogany faced a possible death sentence. But the Army dropped the charges after doctors determined that Pogany suffered from Lariam toxicity, which affected his behavior in Iraq.
In 2002, three elite soldiers, who took mefloquine in Afghanistan, returned to murder their wives and then commit suicide. Friends and neighbors described the soldiers’ behavior after taking the drug as incoherent, strange and angry.
Maj. Gary Kolb, spokesman for the Army's Special Operations Command, was skeptical when asked at the time if mefloquine could have played a role in the tragedies at Fort Bragg. "I think you are heading down the wrong road. That is just my personal opinion."
Bales’ attorney, John Henry Browne, has said his client has apparent mental health issues and is suffering with memory loss, among other things. A call to his office was not immediately returned.
UPDATE: 4:23 p.m., April 5 -- On April 2, TIME's Battleland Blog reported that Bales' attorney, John Henry Browne, "would not be surprised" if Bales took Lariam. "So far, DoD has apparently neither confirmed or denied that Bales took mefloquine, citing medical privacy concerns. But they already leaked that he had a TBI, and reported him as using alcohol the night before. This is more than medical privacy at this point, this is national security," wrote Elspeth Cameron Ritchie.
Later that day, PBS reported that Browne will request Bales' medical records from the military.
"We have to order his medical records, and they haven't given them to us yet," he said on Thursday. "He was taking medications, but we don't know whether it was aspirin, heart medicines. We don't know what it was."
Browne said that in some previous legal cases, he has cited the side effects of a prescribed drug in a client's defense.
"There are a lot of medicines that can backfire," Browne said. He pointed, in particular, to recent reports about Lariam, an anti-malarial medication.
CORRECTION -- A previous version of this story reported that Woodson's Lariam review was ordered nine days after the massacre. In fact, the initial review was ordered in January. After the massacre, on March 20, one part of the Army issued an urgent call to complete the Jan. 17 request from Woodson within six days. The Pentagon still will not say if Bales was wrongly given mefloquine.
Mark Benjamin is an investigative reporter based in Washington. He can be reached at firstname.lastname@example.org.