Why is the military continuing to use the dangerous anti-malarial drug Lariam? That's the question former top military psychiatrist Elspeth Ritchie is asking in the wake of the Afghan massacre allegedly carried out by Staff Sgt. Robert Bales.
Ritchie, who now works as the chief clinical officer for the District of Columbia's mental-health department, has no proof that Bales was given Lariam (known generically as mefloquine). But, as she told Seattle Weekly in late March, she suspects that Bales had a psychotic episode, given how out-of-character the massacre seemed to be. And Lariam, she noted, has been associated with psychotic symptoms, including hallucinations, which might have led Bales to believe he was shooting enemy combatants rather than women and children.
Since then, Ritchie's suspicions have grown. As she outlined in a piece Monday for Time's "Battleland" blog, she's learned that the military still distributes Lariam to some extent in Afghanistan, where Bales was posted, despite the Army's repeated recommendations to prescribe the drug with caution. Bales, moreover, was operating in a rural area that was likely to have irrigation canals that would have made malaria a threat. What's more, the staff sergeant from Joint Base Lewis-McChord was working with Special Forces on a "village stabilization" mission, and Special Forces medics are not subject to broader Army policies.
Ritchie says that Bales would have been especially vulnerable to the side effects of Lariam because he had a traumatic brain injury. The Army has issued several memos advising that soldiers be screened for TBI before being given the drug.
"The DOD [Department of Defense] has not yet said yes or no" as to whether Bales was in fact given Lariam, Ritchie notes. "But I would think if the answer was no, they would have told us by now." Army Medical Department spokesperson Maria Tolleson says that the information is confidential due to medical-privacy laws.
Regardless, Ritchie is making the wider point that the military should no longer be using the drug, given all the negative medical information unearthed about it over the past decade. In addition to hallucinations, Lariam is thought to cause bad dreams, confusion, suicidal urges, and a dysfunction of the brain mechanism that regulates rage.
There are, Ritchie adds, alternative anti-malarial drugs. They're somewhat more inconvenient, given that they are taken daily—instead of weekly like Lariam—and can be more expensive. But in the face of another potential massacre, she suggests, they're worth it.